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Chapter 43 : Public Health Importance of Cryptococcal Disease: Epidemiology, Burden, and Control

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Abstract:

This chapter focuses primarily on HIV-associated cryptococcosis, due to its much greater public health burden, and discusses the challenges to public health agencies in addressing the threat of . The vast majority of disease caused by is found in persons who are infected with HIV, especially those who develop AIDS. The large global burden of cryptococcal disease presents a number of challenges to public health, particularly in the resource-poor regions of high HIV prevalence in sub-Saharan Africa and South/Southeast Asia. Public health surveillance is an essential element in public health practice and allows factual insight into the epidemiology of a disease in order to inform decisions and take action. Cryptococcal antigenemia has been shown to be prevalent in persons without symptomatic disease. The study from Cambodia treated 10 persons with asymptomatic antigenemia with fluconazole 200 mg/day for 12 weeks. By 12 weeks after initiation of therapy, none of these had developed cryptococcal meningitis. From a public health standpoint, one of the more challenging aspects of the epidemiology of is the emergence of the primary pathogen in North America. In order to fully understand the epidemiology of this emerging infection in the United States, both human and animal public health agencies at the federal, state, and local levels are working together to form a surveillance network.

Citation: Park B, Lockhart S, Brandt M, Chiller T. 2011. Public Health Importance of Cryptococcal Disease: Epidemiology, Burden, and Control, p 585-593. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch43

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FIGURE 1

Comparison of deaths in sub-Saharan Africa due to HIV-related cryptococcosis and common infectious diseases excluding HIV (adapted from Park et al. [ ]).

Citation: Park B, Lockhart S, Brandt M, Chiller T. 2011. Public Health Importance of Cryptococcal Disease: Epidemiology, Burden, and Control, p 585-593. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch43
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Image of FIGURE 2
FIGURE 2

Spectrum of case-based disease surveillance. (a) Without a formal surveillance, only large outbreaks or unusual disease can be detected. (b) Syndromic surveillance is based on groups of signs or symptoms indicative of a common diagnosis, such as acute meningitis. (c) Laboratory-based surveillance relies on laboratory-confirmed pathogens.

Citation: Park B, Lockhart S, Brandt M, Chiller T. 2011. Public Health Importance of Cryptococcal Disease: Epidemiology, Burden, and Control, p 585-593. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch43
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Tables

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TABLE 1

Estimated cryptococcal meningitis cases and deaths among 10 UNAIDS global regions by using published incidence rates from studies conducted in those regions

Citation: Park B, Lockhart S, Brandt M, Chiller T. 2011. Public Health Importance of Cryptococcal Disease: Epidemiology, Burden, and Control, p 585-593. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch43

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