Abstract
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.
Highlights
Cryptococcal meningitis (CM) is an emerging disease worldwide, there have been few studies of the characteristics and risk factors of cryptococcal meningitis (CM) in children
Epidemiologic characteristics Over a 5-year study period, 23 cases of pediatric CM (Median age: 10.91 years; Range: 5 months-17 years) due to C. neoformans were confirmed from positive cerebrospinal fluid (CSF) cultures of HIV-negative children
In summary, we found that CM is not common in HIV-negative children, the mortality rate associated with CM is high in HIV-negative children
Summary
Cryptococcal meningitis (CM) is an emerging disease worldwide, there have been few studies of the characteristics and risk factors of CM in children. Cryptococcosis is responsible for cryptococcal meningitis (CM), the most common fungal infection of the central nervous system and a significant cause of morbidity and mortality among patients with HIV/AIDS [1]. Higher numbers of CM cases in children have been reported worldwide [3,4,5,6,7,8,9,10,11,12,13]. Data on the overall incidence of children with CM are scarce, and understanding which children are at highest risk of CM is lacking
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