Clinical characteristics of disseminated cryptococcosis in previously healthy children in China

BMC Infectious Diseases

Research Article

Gang Liu¹  Shun-Ying Zhao²  Yun Ma²  Xi-Rong Wu³  An-Xia Jiao³  Ju Yin³  Kun-Ling Shen³  Bao-Ping Xu³  Li-Wei Gao³ 

[1] Department of Infectious Diseases, Beijing Children’s Hospital, Capital Medical University, Beijing, China;Respiratory Department, Beijing Children’s Hospital, Capital Medical University, Beijing, China;Respiratory Department, Beijing Children’s Hospital, Capital Medical University, Beijing, China;China National Clinical Research Center for Respiratory Diseases, Beijing, China;

关键词: Disseminated cryptococcosis;    Healthy;    Immunocompetent;    Children;   

DOI  :  10.1186/s12879-017-2450-5

 received in 2016-11-23, accepted in 2017-05-08,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017