Mortality by cryptococcosis in Brazil from 2000 to 2012: A descriptive epidemiological study.

BACKGROUND: Cryptococcosis is a neglected and predominantly opportunistic mycosis that, in Brazil, poses an important public health problem, due to its late diagnosis and high lethality. METHODS: The present study analysed cryptococcosis mortality in Brazil from January 2000 to December 2012, based on secondary data (Mortality Information System/SIM-DATASUS and IBGE). RESULTS: Out of 5,755 recorded deaths in which cryptococcosis was mentioned as one of the morbid states that contributed to death, two distinct groups emerged: 1,121 (19.5%) registered cryptococcosis as the basic cause of death, and 4,634 (80.5%) registered cryptococcosis associated with risk factors, mainly AIDS (75%), followed by other host risks (5.5%). The mortality rate by cryptococcosis as the basic cause was 6.19/million inhabitants, whereas the mortality rate by cryptococcosis as an associated cause was 25.19/million inhabitants. Meningitis was the predominant clinical form (80%), males were the more affected (69%), and 39.5 years old was the mean age. The highest mortality rate due to cryptococcosis as basic cause occurred in the state of Mato Grosso (10.96/million inhabitants). Mortality rates due to cryptococcosis as associated cause were highest in the states of Santa Catarina (70.41/million inhabitants) and Rio Grande do Sul (64.40/million inhabitants), both in the South Region. Southeast, Northeast and South showed significant time trends in mortality rates. CONCLUSIONS: This study is relevant because it shows the magnitude of cryptococcosis mortality linked to AIDS and removes the invisibility of a particular non-AIDS-related disease, accounting for almost 20% of all cryptococcosis deaths. It can also contribute to control and surveillance programs, beyond highlighting the urgent prioritization of early diagnosis and proper treatment to reduce the unacceptable mortality rate of this neglected mycosis in Brazil.

A possible case of mycosis in a post-classical burial from La Selvicciola (Italy).

An examination of an adult male buried from the post-classical necropolis of La Selvicciola (Viterbo, Latium, Italy; 4th-6th centuries AD) revealed a series of skeletal lesions. The lesions, both proliferative and lytic, ranging in size from small (around 0.01 mm) to extensive (up to 16.00 mm) pits, occurred at multiple sites. A holistic approach assessed lesion type, frequency and location in a differential diagnosis, which included myeloma, metastatic carcinoma, tuberculosis, leukemia, osteomyelitis, and mycoses. It was concluded that a mycosis, specifically Cryptococcosis, was the most likely cause of these lesions. Both macroscopic analyses and X-ray scans support our diagnosis. We also provide a methodological scheme as a model for examining unknown lesion patterns.

Cryptococcus neoformans: historical curiosity to modern pathogen.

The importance of the Basidiomycete Cryptococcus neoformans to human health has stimulated its development as an experimental model for both basic physiology and pathogenesis. We briefly review the history of this fascinating and versatile fungus, some notable aspects of its biology that contribute to virulence, and current tools available for its study.

One hundred years ago: the history of cryptococcosis in Greifswald. Medical mycology in the nineteenth century.

Medico-mycological investigations began at Greifswald in Germany as early as 1842 when Wilhelm Baum (1799-1883) was appointed to the chair of surgery of the university. This is shown by some theses of the time, as well as by the discovery of the contagious nature of pityriasis versicolor by Carl Ferdinand Eichstedt (1816-92), who identified a fungus as the cause (1846), later named Microsporon furfur (C. Robin 1853). In 1868 the physician Karl Friedrich Mosler (1831-1911) published clinical-mycological studies and investigations about animal feeding with yeasts. Some time later (1870) Friedrich Grohé (1830-86) and his assistants, Alwin R.A. Block (1843-?) and M.R. Roth of the Pathological Institute, described the results of transmission studies with 'Aspergillus glaucus, Penicillium glaucum and yeast'. His successor in the chair, Paul Grawitz (1850-1932), also published the results of his own mycological investigations. Finally, on 7 July 1894, at an evening lecture of the Greifswald Medical Society, Abraham Buschke (1868-1943) from the Hospital of Surgery gave a talk 'on a peculiar disease caused by coccidia', which was followed by a talk by the pathologist Otto Busse (1867-1922) on a 'demonstration of a pathogenic coccidia species'. Busse's subsequent publications are the first proper descriptions of cryptococcosis (1894 ff.). However, Cryptococcus neoformans was named after F. Sanfelice, whose results were published later (1895).

[One hundred years of cryptococcosis. Medical mycology in the 19th century in Greifswald]. / Hundert Jahre Cryptococcose. Medizinische Mykologie im 19. Jahrhundert in Greifswald.

Not later than 1842 medico-mycological investigations began at Greifswald in Germany following the appointment of Wilhelm Baum (1799-1883) to the chair of surgery at the university. This is indicated by some theses as well as by the discovery of the contagious characteristics of pityriasis versicolor by Carl Ferdinand Eichstedt (1816-1892) who found a fungus as the cause (1846), which was named Microsporon furfur later (C. Robin 1853). In 1868 the physician (Karl) Friedrich Mosler (1831-1911) published clinical-mycological studies and investigations on animal feeding with yeasts. Some time later (1870) Friedrich Grohé (1830-1886) and his assistants Alwin R. A. Block (1843-?) and M. R. Roth of the Pathological Institute described results of transmission-studies with "Aspergillus glaucus, Penicillium glaucum and yeast". The successor to the chair, Paul Grawitz (1850-1932), also published results of his own mycological investigations. Finally, on 7 July, 1894, during the evening lecture of the Greifswald Medical Society Abraham Buschke (1868-1943) from the Hospital of Surgery gave a talk "on a peculiar disease caused by coccidia" followed by the talk of pathologist Otto Busse (1867-1922) on a "demonstration of a pathogenic coccidia species". Busse's subsequent publications are the first proper descriptions of cryptococcosis (1894 f). Nevertheless, Cryptococcus neoformans has been named in connection with F. Sanfelice, whose results were published later (1895).