Original ArticleCryptococcosis in Nonhuman Immunodeficiency Virus-Infected Children
Introduction
Cryptococcosis is an invasive infection, usually opportunistic, and attributable to the yeast-like fungus Cryptococcus neoformans. The most common predisposing factor to cryptococcosis worldwide is acquired immune deficiency syndrome [1], [2]. Among pediatric populations, whether human immunodeficiency virus-infected or nonhuman immunodeficiency virus-infected, cryptococcosis is uncommon, for unclear reasons, but its capacity for morbidity and mortality poses a major health problem [3]. Cryptococcosis complicating pediatric acquired immune deficiency syndrome was reviewed previously [4], [5], [6]. To identify the clinical characteristics and outcomes of nonhuman immunodeficiency virus-infected children with cryptococcosis, we retrospectively reviewed these patients in a university-affiliated hospital in northern Taiwan during a 16-year period, from 1991-2006.
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Materials and Methods
Medical records of patients below age 18 years with a diagnosis of cryptococcosis, and treated at Chang Gung Children's Hospital (a university-affiliated hospital in northern Taiwan) between the years 1991-2006, were retrospectively reviewed. Those with microbiologic documentation of C. neoformans infection and no evidence of human immunodeficiency virus infection were included in this study. A diagnosis of cryptococcosis was rendered if one or more of the following parameters were evident: a
Results
Nine nonhuman immunodeficiency virus-infected children with cryptococcosis were identified during the study period. The clinical characteristics of patients are given in Table 1. Seven patients were female (age range, 9-16 years; mean age, 13.7 years). Five patients (56%) exhibited underlying diseases and were receiving either steroid or immunosuppressant treatment at time of disease onset.
Headache was the most common sign, and was associated with vomiting or nausea. Patient 1 had reported neck
Discussion
Cryptococcosis mainly involves the lungs, central nervous system, and skin [1]. Cough, fever, and chest pain are the major signs of pulmonary cryptococcosis [1], [7]. In this study, nearly 50% of patients presented with respiratory signs, and some presented abnormal chest radiography findings. However, no definite pulmonary cryptococcosis was diagnosed because of the lack of histologic or mycotic proof.
All patients in the present study manifested central nervous system cryptococcosis at time of
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