SURVEILLANCE OF CRYPTOCOCCOSIS IN ALABAMA, 1992-1994

PURPOSE: Although cryptococcosis is a significant opportunistic infect ion among patients with human immunodeficiency virus (HIV), there is c onflicting information on rates of cryptococcosis among HIV-positive a nd HIV-negative patients. Precise state-wide epidemiologic data for cr yptococcosis are not available in Alabama. METHODS: We conducted an ac tive laboratory and hospital medical record-based surveillance Fur cry ptococcosis in Alabama from October 1, 1992 to September 30, 1994. A c ase of cryptococcosis was defined as a patient's initial episode of cr yptococcal disease and based on either a positive culture for C. neofo rmans from any normally sterile site, a positive latex agglutination s erologic test for cryptococcal antigen in CSF or serum, or histopathol ogic findings consistent with C. neoformans. RESULTS: Over the two yea r period, 153 cases were identified, The diagnosis was based on positi ve culture (37%), positive antigen (24%), positive autopsy culture (2% ), and histopathologic findings (4%). Further, 33% of the total cases were diagnosed from combined positive culture, antigen, or histopathol ogy. Of the total 153 cases, 55% were in HIV-positive patients omit 44 % were in HIV negative individuals and one case (1%) had an unknown HN status. The overall annual incidence rate of cryptococcosis was 1.89 cases per 100,000 population. The incidence was 1638.7 per 100,000 in the HIV-positive population and 0.84 per 100,000 in the HIV-negative p opulation CONCLUSION: The first Alabama statewide active surveillance system for cryptococcosis confirms previous observations that rates of cryptococcosis are consistently higher in HIV-infected individuals th an in their HIV-negative counterparts. In Alabama, cryptococcosis occu rs more commonly in urban residents and in men. Cryptococcosis in HIV- positive persons is more likely to occur in the 20 to 44 year age grou p, whereas cryptococcosis in HIV-negative persons is more likely to oc cur in those greater than 45 years old. (C) 1998 Elsevier Science Inc.