Cryptococcosis complicating diabetes mellitus: a scoping review

Lauryn Nsenga; Jonathan Kajjimu; Ronald Olum; Sandra Ninsiima; Andrew Peter Kyazze; Phillip Ssekamatte; Davis Kibirige; Joseph Baruch Baluku; Irene Andia-Biraro; Felix Bongomin

doi:10.1177/20499361211014769

Cryptococcosis complicating diabetes mellitus: a scoping review

Ther Adv Infect Dis. 2021 May 5:8:20499361211014769. doi: 10.1177/20499361211014769. eCollection 2021 Jan-Dec.

Affiliations

¹ School of Medicine, Kabale University, Kabale, Uganda.
² Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
³ Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda.
⁵ Department of Medicine, Uganda Martyrs Lubaga Hospital, Kampala, Uganda.
⁶ Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
⁷ Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box, 166, Gulu, Uganda.

Abstract

Background: A better understanding of the epidemiology of cryptococcal infection in HIV-negative 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.

Keywords: clinical characteristics; cryptococcosis; diabetes mellitus; mortality.

Publication types

Review