Clinical characteristics of disseminated cryptococcosis in previously healthy children in China

Abstract

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.

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].…”

Pulmonary Cryptococcosis: comparison of Cryptococcal antigen detection and radiography in Immunocompetent and Immunocompromised patients

“…Some reports have shown that pulmonary cryptococcosis occurs more frequently in immunocompetent patients than in immunocompromised ones [4,5]. Compared with the current high incidence, the diagnosis of pulmonary cryptococcosis is still difficult because the clinical manifestations and imaging of pulmonary cryptococcosis have no obvious characteristics compared with other pulmonary diseases [6][7][8]. At present, diagnostic therapy and lung biopsy are mostly used to help diagnosis in China.…”

Factors Affecting the False Negative of Cryptococcal antigen in Patients with Cryptococcosis: Immunology and Radiology

“…Pulmonary cryptococcosis usually presents with nonspecific symptoms and computed tomography signs. [6][7][8] The methods used to confirm the infection are culture, direct microscopic, histopathology, serology, and molecular detection. [9,10]Some research shows that serum CrAg is a useful diagnostic tool [11][12][13],and CrAg can be an effective non-invasive means of detecting pulmonary cryptococcosis.…”