Cryptococcal Meningitis: How Healthcare Access Can Make the Difference


This fungal infection is an example of either being a treatable ailment or one that can cause severe disease and death depending on access to diagnostic and treatment resources.

C neoformans is a fungus that causes cryptococcal meningitis, and according to the CDC, an estimated 152,000 cases of cryptococcal meningitis occur worldwide each year. The federal agency reports these infections are rare among people with health immune systems, but can be a severe cause of illness in people living with HIV and are immunosuppressed.

In the United States, according to one study, cryptococcal meningitis was estimated to have decreased by approximately 90% in the 1990s. With earlier diagnosis and the use of antiretroviral therapy, it has all but made it not existent in this country for people living with HIV, according to the CDC.

And if diagnosed and treated early, over 70% of people survive cryptococcal meningitis; however, as with much of medicine, it really is an issue of access.

A majority of cases are seen on the African continent, causing tens of thousands of deaths from HIV-related cryptococcal meningitis annually. In fact it is the second most common AIDS-defining opportunistic infection in Sub-Saharan Africa.

There is a lack of access to existing diagnostic tests and therapies for prevention and treatment in Africa.

“The problem is that life-saving tools and treatments are not accessible where they are most needed,” Professor David Denning, Chief Executive of the Global Action Fund for Fungal Infections (GAFFI) and of the University of Manchester, said in a statement.

Back in 2021, a collaborative group, led by the Drugs for Neglected Diseases initiative (DNDi), developed an initiative calling for the end of deaths from cryptococcal meningitis by 2030. However, as with other neglected diseases and infections, there remains limitations, and a small number of people working on the problem.

On the research side, Joshua Rhein, MD, has been on the frontlines seeing firsthand what the effects of this infection are in Uganda, where it is prevalent.

Rhein is an infectious disease faculty, assistant professor, Division of Infectious Diseases and International Medicine Cryptococcal Meningitis, HIV/AIDS, Tropical Medicine at the University of Minnesota, director of Training and Research for the University of Minnesota Health Sciences Uganda, and has been studying cryptococcal meningitis and other AIDS-related opportunistic infections.

He has been an investigator on several large, guideline-informing clinical trials on HIV-associated meningitis, and was involved in studying the long-term effects of antiretroviral therapy on outcomes in cryptococcal meningitis.

He spoke recently about his experience studying the opportunistic infection and transitioning back to the United States and working on other HIV-related studies.

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