Characteristics and outcomes of cryptococcal meningitis in HIV seronegative children in Beijing, China, 2002–2013

Abstract

BackgroundData regarding HIV-seronegative pediatric patients with cryptococcal meningitis (CM) have been very limited.MethodsWe retrospectively reviewed non-HIV-infected in patients with CM from January 2002 through December 2013 in Beijing Children’s Hospital. Records of the all patients were obtained and compared.ResultsThe 34 children had a median age of 5.6 years. Most of the patients were male (67.6 %). Only 23.5 % of the cases had identifiable underlying diseases. The sensitivity of the CSF cryptococcal antigen, India ink smear and CSF culture in our study were 81.5, 85.3 and 82.4 %, respectively. And the sensitivity of combinations of these tests was 91.2 %. Out of the 34 patients, 16 (47.1 %) had other organs involvement in addition to the brain. The main abnormal features via magnetic resonance imaging (MRI) were Virchow-Robin space dilatation (44.4 %), hydrocephalus (38.9 %), gelatinous pseudocysts (33.3 %), brain atrophy (33.3 %), meningeal enhancement (27.8 %) and local lesions (27.8 %). In total, 64.7 % of the patients were successfully treated at discharge, whereas treatment failed in 35.3 % of the patients.ConclusionsCryptococcal meningitis is an infrequent disease with a high fatality rate in children in China. The majority of patients were apparently healthy. Clinicians should consider cryptococcal infection as a potential pathogen of pediatric meningitis. Cryptococcal antigen, India ink smear and culture tests are recommended for diagnosis.

Fatal neurocryptococcosis in a Colombian underage patient

“…Intense headache, vomiting and confusion were present in this case as well as in the Colombian children study where the most frequently reported symptoms were headache (78.1%), fever (68.8%), nausea and vomiting (65.6%), confusion (50%) and meningeal signs (37.5%). Except for the fever and meningeal signs not observed, clinical findings in this case are consistent with those found by other authors [3,[6][7][8]10].…”

“…Regarding Colombian minors, Lizarazo et al reported that almost half (46.3%) of the patients in their study did not have underlying conditions. Other reports about this mycosis in underage patients in Brazil, Cuba, China and Taiwan indicate that in most cases there were no risk factors associated [3,[6][7][8]. Almost 20% of patients diagnosed with cryptococcosis in many health care facilities are clinically non-immunocompromised and there is evidence that within this population, innate or acquired immunodeficiencies may underlie [6,9].…”

Adaptive Immunity to Cryptococcus neoformans Infections

“…X-linked hyper IgM syndrome is a genetic defect in the gene encoding CD40 ligands on activated CD4 T cells, and is required for normal B cells activation [ 90 , 91 , 93 ]. C. neoformans infections are also linked to a total absence of B cells, such as in Burton’s agammaglobulinaemia in non-HIV patients [ 94 , 95 ]. These examples show that B cells and antibodies play an important role in controlling cryptococcal infection.…”

Cryptococcal meningitis in young adults: clinical characteristics and therapeutic outcomes

“…CM is associated with high rates of mortality and morbidity, and as with other CNS fungal infections, Therefore, CM has a severe economic impact on healthcare systems [2,3]. A paediatric study of CM from China reported that the majority of patients were apparently normal, and only 23.5% had identifiable underlying conditions [4]. Paediatric cryptococcosis has been reported in both HIV-negative and -positive patients [5,6], however other immunocompromising medical conditions are usually seen in HIV-negative patients [5].…”