Characterization And Estimation Of Incidence Rates Of Brain Cryptococcosis In Colombia, 2009-2016

Background: Brain cryptococcosis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV) infection, which is the case of Colombia. Although that, studies estimating its population-based incidence lack in Latin America and Colombia. Methods & Materials: Observational, retrospective study in which the incidence of brain cryptococcosis (ICD-10 code B45.1) in Colombia, 2009-2016, was estimated based on data extracted from the personal health records system (Registro Individual de Prestación de Servicios, RIPS). Using official population estimates of National Statistics (DANE), crude and adjusted incidence rates were estimated (cases/1,000,000pop). Results: During the period, 748 cases were reported (median of 95/year, increasing from 68 cases in 2010 to 164 in 2015, r2 = 0.4687, p < 0.05), for period-cumulated crude national rate of 15.96 cases/1,000,000pop. Cases were reported in 31 out of 32 departments of the country plus Bogota DC. The department with the highest incidence rate was Guainía (50.12 cases/1,000,000pop), followed by Meta (42.57 cases/1,000,000pop) and Norte de Santander (29.39 cases/1,000,000pop), 9 geographical information system (GIS)-based maps were generated. Of the total cases, 23.4% corresponded to age group of 30-39 y-old, followed by 40-49 y-old (21.4%) and 20-29 y-old (18.9%); 8.96% of cases occurred in < 10 y-old; 71.78% of cases were males. From the total, 43.8% required to be hospitalized (mean of 6.3 days). Case fatality rate was 15%. Estimated costs were US$ 4.69 million. Conclusion: Cryptococci are encapsulated saprophytic yeasts. Two species, transmitted by inhalation, are the principal human pathogens: Cryptococcus neoformans and Cryptococcus gattii. In Colombia there is a lack of clinical and epidemiological studies. Our analysis shows a significant increasing trend over the study period enhancing the need for further studies and analysis, including geographical distribution that shows higher incidence in peripheral areas of the country.