Nationwide Population-Based Epidemiologic Study of Cryptococcal Meningitis in Taiwan

Chen, Yen‐Yu; Lai, Chao-Hung

doi:10.1159/000323390

Cited by 20 publications

(15 citation statements)

References 36 publications

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“…Similar to the incidence in children of Taiwan with unknown HIV status reported previously [11], we found an average annual incidence of 4.3 cases of CM per million HIV-negative children with a fatality rate of 1.7% in mainland China.…”

Section: Discussionsupporting

confidence: 88%

A case–control study of risk factors for HIV-negative children with cryptococcal meningitis in Shi Jiazhuang, China

Guo¹,

Zhou²,

Zhang³

et al. 2012

BMC Infect Dis

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BackgroundAlthough cryptococcal meningitis (CM) is an emerging disease worldwide, there have been few studies of the characteristics and risk factors of CM in children.MethodsWe used data collected from May 2007 through April 2012 in the Acute Meningitis-Encephalitis Syndrome Surveillance project in Shi Jiazhuang, China to describe the epidemiologic, clinical, and laboratory findings in children with CM. Furthermore, a matched case–control study was used to determine risk factors of CM.ResultsOverall 23 HIV-negative children with CM (median age: 10.91 years; range: 5 months-17 years) were enrolled in our study. The average annual incidence of CM was 0.43/100,000 with a fatality rate of 1.7%. Most patients were males (60.87%) and rural children (73.91%). Common clinical symptoms included increased intracranial pressure, such as headaches (78.3%), nausea (60.9%), altered mental status (56.5%), vomiting (52.2%), and seizures (43.5%), and frequent laboratory findings consisted of blood leukocytosis (87.0%), decreased CSF glucose (87.0%), pleocytosis (82.6%), increased intracranial pressure (73.9%) and elevated CSF proteins (65.2%). Epidemiologic, clinical, and laboratory findings were similar between patients with and without underlying diseases. Multivariate logistic regression analysis showed that children who had contact with birds/bird droppings or saprophytes were more likely to be infected than those without such contact (odds ratio(OR) =11.82; 95% confidence interval (CI), 2.21-62.24; P = 0.004). Patients with an interval of ≥20 days from onset to admission were at high risk for CM (OR= 5.31; 95%CI, 1.58-17.89; P = 0.007).ConclusionsOur findings show that CM is an uncommon disease with a high mortality rate in children. Although additional studies are needed to find effective prevention and treatments for CM, clinicians should consider CM as a potential cause for pediatric meningitis in children, particularly boys from rural areas, who had contact with birds/bird droppings or saprophytes and in children who did not receive prompt medical attention.

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Section: Discussionsupporting

confidence: 88%

A case–control study of risk factors for HIV-negative children with cryptococcal meningitis in Shi Jiazhuang, China

Guo¹,

Zhou²,

Zhang³

et al. 2012

BMC Infect Dis

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“…A recent systemic review by Yuchong et al (21) summarized 1,032 reports of 8,769 cases of pulmonary cryptococcosis in mainland China between 1985 and 2010. Notably, these rates were similar to those reported in Taiwan, where the average annual incidence increased from 4.0 cases per million individuals in 2000 to 5.5 per million individuals in 2007 (22). Considering the aforementioned studies, it is evident that pulmonary cryptococcosis cases in China have been increasing over the recent decades (19,21,23).…”

Section: Discussionsupporting

confidence: 80%

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

et al. 2017

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Abstract. Pulmonary cryptococcosis is most commonly reported in immunocompromised patients, whereas immunocompetent hosts are rarely affected and may be asymptomatic, resulting in reduced diagnostic performance of computed tomography (CT) imaging. Thus, the aim of the present study was to review the plain and contrast-enhanced chest CT scan findings of primary pulmonary cryptococcosis in immunocompetent patients, with the aim of improving the diagnosis of this type of pulmonary disease. In the present study, a total of 27 immunocompetent patients of clinically confirmed pulmonary cryptococcosis were analyzed retrospectively. Of the 27 patients, 14 patients underwent plain and contrast-enhanced chest CT scans, while 13 patients only underwent plain chest CT scanning. The clinical and imaging characteristics, including the location, shape, size, number, edge and attenuation or intensity of each lesion, in unenhanced and contrast-enhanced CT scans were reviewed. The results indicated that the most common CT finding was pulmonary nodules (40.74%), with multiple nodules (25.93%) being more common compared with solitary nodules (14.81%). The majority of the nodules were poorly defined and inhomogeneous with observed air-bubble sign. Other findings included consolidation (25.93%), ground-glass opacities (GGO; 22.22%) and a mass (11.11%). The halo, air bronchogram and cavity signs were observed more frequently (22.22, 18.52 and 14.81%, respectively). The pulmonary lesions presented a predominant distribution in the lower lung lobes and peripheral area in 55.55 and 74.07% of the cases, respectively. On the contrast-enhanced CT images, the majority of nodules presented ring enhancement with the mean maximal enhancement value of 20.92±5.67 Hu, and masses demonstrated inhomogeneous enhancement with a mean maximal enhancement value of 35.61±8.32 Hu. In conclusion, familiarity with the CT findings and occupational environment exposure history will assist in earlier and easier diagnosis of pulmonary cryptococcosis in immunocompetent patients.

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“…However, different from tubercular meningitis, obliteration of basilar cistern and meningeal enhancement were less common in cryptococcal meningitis. Furthermore, cranial nerve impairment and intracranial venous sinus thrombosis were detected in our study, which was rarely reported before [6]. …”

Section: Discussionsupporting

confidence: 56%

“…This is followed by primary immunodeficiencies, diabetes, and requiring glucocorticosteroid therapy or organ transplantation. On the contrary, studies [5, 6] in China demonstrated that 50–77% of patients with cryptococcal meningitis exhibited normal immune function. However, disseminated cryptococcosis is rare in immunocompetent children, and is mostly localized in the brain or lungs [7].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of disseminated cryptococcosis in previously healthy children in China

Gao

Jiao

et al. 2017

BMC Infect Dis

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BackgroundDisseminated cryptococcosis is a rare and fatal disease, and limited data exist regarding it in children. This study aimed to investigate the clinical characteristics of disseminated cryptococcosis in previously healthy children in China.MethodsHospitalized patients with disseminated cryptococcosis were enrolled during January 1996 to December 2015 in Beijing Children’s Hospital, Capital Medical University, China. Data on clinical manifestations, laboratory tests, treatment, and prognosis were evaluated.ResultsA total of 52 pediatric patients with no underlying disease were enrolled, including 38 boys and 14 girls. Only 10 cases had a history of exposure to pigeon droppings. Fever, cough, and hepatomegaly were 3 main manifestations of disseminated cryptococcosis. However, headache was more common in patients with central nervous system (CNS) invasion than in patients with non-CNS invasion (P < 0.05). Lung (96.2%, 50/52) was the most commonly invaded organ, but only 9.6% (5/52) of patients had respiratory signs. The most common findings on chest imaging were hilar or mediastinal lymphadenopathy (46.8%, 22/47), and nodules (44.7%, 21/47), including small nodules in a scattered distribution (57.1%, 12/21) or miliary distribution (42.9%, 9/25), especially localized in subpleural area. Subsequent invasion occurred in the CNS, abdomen lymph nodes, liver, spleen, peripheral lymph nodes, and skin. In all patients, 42.3% (22/52) and 51.9% (27/52) had elevated eosinophils or IgE, respectively. The positive rate of serum cryptococcal antigen was higher, especially in patients with CNS invasion (approximately 83.3%), than with other primary methods used for pathogen detection, including cerebrospinal fluid (CSF) cryptococcal antigen, cultures of blood, bone marrow, or CSF, and CSF ink staining. The overall mortality rate of pediatric patients in our study was 11.5% (6/52). Some cases had long-term sequela, including hydrocephalus, cirrhosis, or blindness.ConclusionsDisseminated cryptococcosis can occur in previously healthy or immunocompetent children in China. Lung and CNS were most commonly invaded by this disease. Furthermore, most cases usually showed no obvious or specific symptoms or signs, and therefore pediatricians should pay more careful attention to identify this disease.

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Nationwide Population-Based Epidemiologic Study of Cryptococcal Meningitis in Taiwan

Cited by 20 publications

References 36 publications

A case–control study of risk factors for HIV-negative children with cryptococcal meningitis in Shi Jiazhuang, China

A case–control study of risk factors for HIV-negative children with cryptococcal meningitis in Shi Jiazhuang, China

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

Clinical characteristics of disseminated cryptococcosis in previously healthy children in China

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