About SCrEEN Project

Cryptococcosis is a life-threatening fungal infection caused by the encapsulated basidiomycetes yeasts Cryptococcus neoformans and C. gattii species complexes. The infection is probably acquired from the environment by inhalation of spores or small-size yeast cells that are able to penetrate in the pulmonary alveoli and then to disseminate trough the bloodstream causing soft tissue infections, pneumonia and most often meningoencephalitis.

C. neoformans species complex is a central driver of mortality in HIV-infected patients. An estimated one million cases of cryptococcal meningitis occur annually among people with HIV/AIDS worldwide, resulting in nearly 625,000 deaths. Since the introduction of antiretroviral therapy the cases of cryptococcosis and the number of deaths in people with advanced HIV infection have decreased substantially in developed countries. While cryptococcosis cases in HIV-infected patients have been decreasing, an increase in the number of cases has been reported in non-HIV patients due to the rising number of susceptible patients such as patients with hematological malignancies, organ transplant recipients, and patients affected by autoimmune diseases, but also in patients without any other risk factor except that they were exposed to the pathogen.

The real incidence of cryptococcosis is difficult to establish because the disease is only reportable in a few countries. Results from active, population-based surveillance in two US locations (Atlanta and Huston) in the year 2000 indicated that the annual incidence of cryptococcosis among persons with AIDS was between 2 and 7 cases per 1,000, and the overall incidence was 0.4 to 1.3 cases per 100,000 population; the case-fatality ratio was approximately 12%. More recently, an analysis of stored serum samples from HIV-infected persons with low CD4 counts enrolled in studies in the US during 1986–2012 found the prevalence of cryptococcal antigenemia to be 2.9%, indicating that the prevalence of cryptococcal infection among HIV patients is largely underestimated. In Europe the real epidemiology of cryptococcosis is even more obscure due to the few and not updated reports summarizing the situation in each country and the lack of coordination to collect the epidemiological data. Furthermore, the few data available have been reported only from some European countries and are very scarce or completely lacking from the other EU countries, particularly from Eastern European countries where the burden of HIV infection is higher than in Western Europe and therefore a higher incidence of cryptococcosis is expected. Due to its geographical location, Europe is also subjected to extensive immigration of people from both Asia and Africa where cryptococcosis represents the third highest cause of death among HIV-infected patients. This inevitably favors the spread of new genotypes through the European continent and thus the potential for geographic distribution of virulent strains. Furthermore, the high flow of people to and from Europe for business and tourism allows the emergence of cryptococcosis cases acquired in endemic areas. The recent cryptococcosis outbreaks occurring on Vancouver Island (Canada) and the Pacific Northwest of North America showed how this fungal threat could spread rapidly in the environment once it has found a favorable niche. The Centers for Disease Control and Prevention in the USA worked with local public health authorities to implement a plan to monitor the epidemiology of C. gattii in the states of Washington and Oregon where the reporting of this fungal disease is now mandatory. The coordination of such actions is a lengthy process in Europe and needs to be improved for early documentation of outbreaks as have been reported due to C. gattii species complex. The implementation of a wide European network to survey the cases of cryptococcosis and the distribution of C. neoformans and C. gattii species complexes in the environment will represent an important tool to organize a plan to face this fungal disease in case an outbreak, similar to that is occurring in North America, will involve the European continent.

The aim of the SCrEEN Project website is to supply an easy tool for data collection of clinical and environmental data. In addition, this on-line tool will help to expand the network and will contribute to obtain reliable and useful epidemiological data for public health management in Europe and in Mediterranean area.

HOW TO PARTICIPATE

SCrEEN Project is addressed to all clinicians and microbiologists who can contribute to add new epidemiological information about cryptococcosis and Cryptococcus. This website contains three different e-forms: one for clinical data collection, one for veterinary cases, and one for environmental data collection. In each form is mandatory to fill the fields concerning the researcher contact details in order to verify the information received. For environmental data it is also mandatory to include the geographical coordinates of the location where the survey has been performed.

All information are stored in three different databases accessible from this website. Databases are periodically updated.

A list of network participants is available at section Network, and will be updated on the basis of the information collected.

The website include also a technical section including classical and molecular methods for identification and typing of C. neoformans and C. gattii.

Finally you will find a section containing all results obtained by SCrEEN Project with graphics, maps and statistics. This last section will be updated periodically.