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Clinical characteristics and prognosis of pediatric cryptococcosis in Beijing Children’s Hospital, 2002–2014

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Abstract

Cryptococcosis is a rare pediatric disease. The aim of the study is to describe clinical characteristics and prognosis of pediatric cryptococcosis from 2002 to 2014 in Beijing Children’s Hospital. A total of 53 cases of cryptococcosis were identified, 69.8% of which were males. The mean age was 7 years. Forty-one (77.4%) patients had no underlying conditions. Fever, headache, and vomiting were the most common symptoms. The most common sites were the central nervous system (CNS), followed by the lungs. Most patients received a combination of amphotericin B and fluconazole with or without flucytosine as their initial regimen. Twenty-seven patients received a follow-up and six patients (22.2%) had died. The factors associated with neurological complications or death were headache (P = 0.008), seizures (P = 0.006), visual impairment (P = 0.011), neck stiffness (P = 0.008), low erythrocyte sedimentation rate (ESR) (P = 0.024), and a cerebral spinal fluid (CSF) cryptococcal antigen titer ≥ 1:1024 (P = 0.038).

Conclusions: The majority of cryptococcosis cases in China occurred in children without underlying conditions, causing multiple organ damage. The CNS was the most common site. Patients who had headaches, seizures, or high CSF antigen titers experienced neurological complications or died.

What is known:

• Cryptococcosis is a rare cause of infection in children.

What is new:

• This review gives a brief overview over pediatric cryptococcosis in China.

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Abbreviations

5-FC:

5-Flucytosine

AIDS:

Acquired immune deficiency syndrome

AmB:

Amphotericin B deoxycholate

CM:

Cryptococcal meningitis

CNS:

Central nervous system

CRP:

C-reactive protein

CSF:

Cerebrospinal fluid

ESR:

Erythrocyte sedimentation rate

Flu:

Fluconazole

HIV:

Human immunodeficiency virus

MBL:

Mannose-binding lectin

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

MRV:

Magnetic resonance venography

VOR:

Voriconazole

WBC:

White blood cell

XLA:

X-linked agammaglobulinemia

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Acknowledgements

We thank Dr. Mobeen Rathore for his valuable suggestions and critical review of this manuscript.

Author information

Author notes

  1. Linlin Liu and Lingyun Guo contributed equally to this manuscript.

Authors and Affiliations

  1. Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, National Clinical Research Centre for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Department of Infectious Diseases, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045, China

    Linlin Liu, Lingyun Guo, Tianming Chen, Shaoying Li & Gang Liu

  2. Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, National Clinical Research Centre for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Children’s Hospital, Beijing Pediatric Research Institute, Capital Medical University, Beijing, China

    Lingyun Guo & Yonghong Yang

  3. Department of Radiology, Beijing Children’s Hospital, Capital Medical University, Beijing, China

    Yue Liu

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  1. Linlin Liu
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Contributions

All of the authors had access to the full dataset (including the statistical reportsand tables) and take responsibility for the integrity of the data and the accuracy of the data analysis. Gang Liu, Yonghong Yang, Lingyun Guo, Linlin Liu, Yue Liu and Shaoying Li conceived and designed thestudy. Gang Liu, Lingyun Guo, Linlin Liu, Yue Liu and Tianming Chen collected the data and designed the analysis. Gang Liu, Yonghong Yang, Lingyun Guo, Linlin Liu and Yue Liu interpreted the data. Lingyun Guo and Linlin Liu wrote the first draft of the paper. Gang Liu, Lingyun Guo and Linlin Liu reviewed and approved the final report.

Corresponding author

Correspondence to Gang Liu.

Ethics declarations

Funds

This work was supported by the Beijing Municipal Administration of Hospitals Incubating Program (No. PX2016035) and the Beijing Health System Top Level Health Technical Personnel Training Plan (No. 2015-3-082).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval and informed consent

This study was reviewed and approved by the Ethics Committee of Beijing Children’s Hospital Affiliated to Capital Medical University (2017-k-26). Because this is a retrospectively study, we obtained the data of patients from the Medical Records and Statistics Room and we analyzed the data anonymously; thus, informed consent was not required.

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Communicated by Nicole Ritz

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Liu, L., Guo, L., Liu, Y. et al. Clinical characteristics and prognosis of pediatric cryptococcosis in Beijing Children’s Hospital, 2002–2014. Eur J Pediatr 176, 1235–1244 (2017). https://doi.org/10.1007/s00431-017-2974-0

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