The incidences and outcomes of cryptococcosis among different risk populations in Taiwan: A nationwide, population-based study during 2003-2012

[[abstract]]Background: Cryptococcosis is the leading invasive fugnal disease globally, mainly if not all is community-acquired, and may vary from indolent benign course to rapidly fatal disease. Data for high-risk population other than HIV-infected persons and organ transplantation recipients are limted. The nationwide surveillance data are rare. With the advance of medical care and aggressive and early initiation of antiretroviral therapy, the incidence of crypto-coccosis is expected to be changed. This study aims to determine the time trends of the incidences and outcomes of cryptococcosis by different risk populations in Taiwan. Methods: Cases were identified with the ICD-9 code 321.0 (cryptococcal meningitis) and 117.5 (cryptococcosis) at discharge of the index hospitalization according to the Taiwan National Health Insurance Research Database from 2003 through 2012. Comorbidities coded within the preceding 6 months prior to the the date of admission of the index hospitalization were classified into four groups: HIV infection, solid organ transplantation (SOT), cirrhosis of liver, and others (NHNTNL). The length of hospitalization, intensive care unit (ICU) stay, in-hospital and 1-year all-cause mortality of each groups of patients were analyzed. Only the patient’s initial episode of hospitalization was used for the calculation of incidence and outsomce. Results: There were 588 cases of cryptococcal meningitis identified and the incidence per 100,000 population remianed stationary during the study period (0.70–0.88 cases). A total of 1020 cases of non-meningeal cryptococcosis were identified and the incidence per 100,000 population increased gradually from 0.81 cases in 2003 to 1.79 cases in 2012. Male predominated (68%). 19.2% of patients with cryptococcal meningitis were identified as having HIV infections, while only 5.8% of patients with non-meningeal cryptococcosis had HIV infection. The in-hospital mortality rate was highest in patients with cirrhosis of liver (38%), followed by HIV-infected patients (20%), NHNTNL patients (16%), and SOT recipients (9%). Similar trend of in-hospital maortilay was found in patients with non-meningeal cryptococcosis. The length of hospital stay of patients with cryptococcal meningitis was longest in NHNTNL group. Conclusion: The incidence of cryptococcosis, particularly non-meningeal cryptococcosis, increased during 2003–2012 and occurred mainly in HIV-uninfected population. The in-hospital mortality was highest in patients with cirrhosis of liver