Cryptococcosis complicating diabetes mellitus: a scoping review
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Therapeutic advances in infectious disease
Abstract
A better understanding of the epidemiology of cryptococcal infection in HIVnegative
individuals is an international research interest. Immune dysfunction in diabetes
mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due
to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well
documented.
Objective: The objective of this study was to determine the clinical characteristics and
outcomes of cryptococcal infections in persons living with DM.
Methods: MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were
searched in November 2020. The searches covered the period between 1980 and 2020.We
included studies that reported confirmed cryptococcosis in patients with DM. Reference lists
of included articles were also searched, and additional studies were included if appropriate.
No language restriction was applied. Single case reports, case series and original articles
were included whereas review articles were excluded.
Results: A total of 28 studies (24 single case reports, 4 retrospectives) were included involving
47 unique patients from Asia (17 cases), North America (six cases), South America (three
cases) and Africa (two cases). Men constituted 75% (n = 18) of the cases. Median age was 60.5
(range: 27–79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32)
followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease
one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through
either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology
(9/47) singly or in a combination. All-cause mortality was 38.3% (n = 18). Among those with
meningitis mortality was 36.2%.
Conclusion: A wide spectrum of cryptococcal infections with varying severity occurs in DM.
Mortality remains unacceptably high. There is a need for more studies to characterize better
cryptococcal disease in DM.
Description
Keywords
Clinical characteristics, Cryptococcosis, Diabetes mellitus, Mortality
Citation
Nsenga, L., Kajjimu, J., Olum, R., Ninsiima, S., Kyazze, A. P., Ssekamatte, P., ... & Bongomin, F. (2021). Cryptococcosis complicating diabetes mellitus: a scoping review. Therapeutic advances in infectious disease, 8, 20499361211014769. DOI: 10.1177/ 20499361211014769