Epidemiology of cryptococcal meningitis in the US: 1997-2009

Abstract

Cryptococcal meningitis (CM) causes significant morbidity and mortality globally; however, recent national trends have not been described. Incidence and trends for CM-associated hospitalizations in 18 states were estimated using the Agency for Healthcare and Research Quality (AHRQ) State Inpatient Databases (SID) datasets for 1997 through 2009. We identified 30,840 hospitalizations coded for CM, of which 21.6% were among HIV-uninfected patients. CM in-hospital mortality was significant (12.4% for women and 10.8% for men) with a total of 3,440 deaths over the study period. Co-morbidities of CM coded at increased frequency in HIV-uninfected CM hospitalized populations included hydrocephalus and acute/chronic renal failure as well as possible predispositions including transplantation, combined T and B cell defects, Cushing's syndrome, liver disease and hypogammaglobulinemia. Median hospitalization costs were significant for CM and higher for HIV-uninfected patients (16,803.01 vs. 15,708.07; p<0.0001). Cryptococcal meningitis remains a disease with significant morbidity and mortality in the U.S. and the relative burden among persons without HIV infection is increasing.

Figure 1. Geographic incidence of CM.

A) Map of the US showing, highlighted, states reporting to ARHQ continuously during the study period and their incidence of CM in HIV-infected and B) HIV-uninfected associated hospitalizations per million population.

Figure 2. Hospitalizations for CM in the US.

A) Hospitalization for CM per million population in HIV-infected and HIV-uninfected patients. B) In hospital mortality per million population in HIV-infected and HIV-uninfected patients.