ICCC in Uganda: Fighting Cryptococcus Worldwide

Cryptococcus is a fungus that will not normally affect individuals who have healthy immune systems. However, individuals who are immunocompromised from advanced HIV or immunity-suppressing medicines or conditions are at serious risk of meningitis illness and death. In 2020, approximately 112,000 individuals died from cryptococcus. Of all AIDS deaths worldwide, 19% were from cryptococcus.

Recently, Matthew Pullen, MD, spoke to Infection Control Today^® about his trip to Uganda for the International Conference on Cryptococcus Cryptococcosis (ICCC). He discusses what cryptococcus is, what Uganda is like, and what further information ICT^®’s audience can receive from the conference.

Pullen is a clinical researcher at the University of Minnesota Medical School and an assistant professor of infectious disease and international medicine. He practices at M Health Fairview University of Minnesota Medical Center.

ICT®: You recently went to Uganda for an infectious disease conference. Would you mind giving ICT's audience an overview of that conference?

It is an offshoot of partly our university’s relationship with Makerere University, Kampala, Uganda, and the Uganda Infectious Disease Institute. The conference itself is called The International Conference on Cryptococcus Cryptococcosis (ICCC). Cryptococcus is a fungus, one of the opportunistic infections that you can see in advanced HIV.

This was a week-long conference where we gathered clinicians, clinical researchers, and basic science researchers. We shared new and upcoming data and had panel discussions about the best ways to care for these patients and our experiences with some of the new guidelines and therapies that have come out in the last few years.

ICT^®: What is Uganda like?

It's great. I lived there for a little over a year back in 2017 or 2018, when I was a fellow. I had a Fogarty fellowship from the NIH [National Institutes of Health] and spent a year there, doing some research, seeing patients, and working with some of the doctors in Mbarara Regional Referral Hospital [in Mbarara City, Uganda].

Our research group is led by David Boulware [MD, MPH, professor of medicine, University of Minnesota]. We've been working over there for about 15 years now. We always have a presence there, whether it's fellows, residents, medical students, or staff.

We have quite a lot of experience there, and they have phenomenal research capabilities. One of our main collaborators is David Meya, [MBChB, MMed, PhD, Assoc Pro Makerere University, Kampala, Uganda], who is a titan of research and clinical work in Uganda. We value our partnership with him quite a lot. He was one of the scientific chairs of the ICCC. It was great to meet him again and work with him.

ICT^®: Would you mind explaining what cryptococcus is and how it affects the patient?

It's a fungus that exists in nature and that, in a normally immunocompetent person, is rarely ever a cause of infection.

But when someone has severe immunocompromised, whether it's through HIV or immunosuppressive medications, things like that, it can lead to most often meningitis, so [the patient] will develop a severe headache, confusion, and can even lead to coma and death.

In parts of the world where advanced HIV is more common, it's a very severe problem, about 15% of AIDS-related deaths worldwide, which comes up to about 180,000 people a year, are attributable to cryptococcal meningitis. It's not a small portion of people at all.

There's a lot of work within our group and others focused on finding new and better ways to screen [individuals] who might be at risk for cryptococcal meningitis and finding effective, more effective treatments for cryptococcal meningitis, whether that means more cost-effective or less toxic medications.

ICT^®: Do you ever find individuals here in the United States who have cryptococcus?

It's less common in the United States. There's a very good website that, not to shamelessly plug myself, but I worked with the Clinton Health Access Initiative last year. They do a lot of work in the cryptococcal meningitis space and wanted an easily accessible website that shows the incidence of cryptococcal meningitis around the world. If you go to https://burdenofcrypto.com/, I created an interactive map where you can look at every country that we have data for, and it gives you an idea of the incidents in those countries. You can look it up under Uganda, for example, and the website will give you an idea of how many people there are living with HIV percentage with people who know their status and the number of cryptococcal deaths for 2020.

It's a widespread infection, particularly in low- and middle-income countries where advanced HIV is, unfortunately, more common due to resource limitations.

ICT^®: Do you ever get Cryptococcus if you don't have HIV?

You can. There is a subgroup called HIV-negative cryptococcal meningitis. It's very uncommon, but not unheard of. There's still a lot of research being done to see what sort of immunologic quirks or risk factors might predispose someone to that, but it's very uncommon barring immunosuppressive medications. That would be another reason to have it without HIV, anything that would significantly decrease your ability to fight infection.

ICT^®: About 30 years ago, a friend of mine who had cerebral palsy died from meningitis. I don't know what kind, and so that was why I asked.

Yes, if they were on any kind of immunosuppression or chronic kind of steroids like that would increase their risk in America. When you don't have those risk factors, other causes of meningitis are a lot more likely—bacterial and viral being the 2 most prominent.

ICT^®: Do you have anything else you would like to add to tell ICT®’s audience?

If you are interested in some of the research discussed at the conference, I am also the sole developer of the conference app. It's on the Apple and Google stores under the title ICCC 2023 app. It has all the abstracts that were presented at the conference in it, so you can see what sort of research was presented there.

Many of those are pending publication as well. The full papers are likely due to come out in the next 6 months to a year. You get a preview of what is to come and look up researchers who maybe have interests that align with your own and look up some of their other work as well.

ICT^®: Did you do any research for this conference?

I didn't have any presentations at this conference. No, I mostly went to meet with all my collaborators for other research and to provide onsite tech support for the app using a live database, so I wanted to be able to make changes as they came up during the conference for scheduled changes.