1
|
O'Reilly DA. A rare case of neonatal cryptococcal meningitis in an HIV-unexposed 2-day-old infant: the youngest to date? Paediatr Int Child Health 2016; 36:154-6. [PMID: 25839243 DOI: 10.1179/2046905515y.0000000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cryptococcal meningitis is uncommon in children, particularly in infants. A 2-day-old boy was admitted with signs suggestive of meningitis. Lumbar puncture confirmed meningitis and cryptococcal infection (cryptococcal antigen and Indian ink stain-positive). His mother was HIV-negative. This is thought to be the youngest case of cryptococcal meningitis to be reported. Cryptococcal infection should be considered in children of all ages with meningitis where there is possible immunodeficiency or failure to respond to initial treatment with antibiotics.
Collapse
|
2
|
Zhu L, Huang R, Guo H, Zhang J, Dong C, Han H. Cryptococcal meningitis: description of 3 cases and estimation of T-cell subsets. Indian J Pediatr 2014; 81:536-40. [PMID: 23775204 DOI: 10.1007/s12098-013-1087-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe three cases of cryptococcus neoformans meningitis and evaluate their cellular immunity. METHODS This study involved three cases of cryptococcus neoformans meningitis admitted to Children's Hospital of Shanxi Province between July 2010 and July 2011. Clinical presentations, laboratory findings, treatment and outcome in these cases has been discussed. RESULTS Staining cerebrospinal fluid (CSF) with India ink showed Cryptococcus neoformans. Flow cytometric analysis of T-cell subsets revealed that their cellular immunity were depressed, which mainly embodies decline in CD4+ levels. CONCLUSIONS The authors speculate that decreased CD4+ T lymphocyte counts are attributed to cryptococcal infection, emphasizing the significance and importance of evaluating cellular immunity in patients who present with unusual infections. Early diagnosis of cryptococcal meningitis and appropriate antifungal therapy are essential to achieve a better outcome.
Collapse
Affiliation(s)
- Lei Zhu
- Department of Laboratory, Children's Hospital of Shanxi Province, Taiyuan, 030001, China,
| | | | | | | | | | | |
Collapse
|
3
|
Meiring ST, Quan VC, Cohen C, Dawood H, Karstaedt AS, McCarthy KM, Whitelaw AC, Govender NP. A comparison of cases of paediatric-onset and adult-onset cryptococcosis detected through population-based surveillance, 2005-2007. AIDS 2012; 26:2307-14. [PMID: 22739390 DOI: 10.1097/qad.0b013e3283570567] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We compared the epidemiology of laboratory-confirmed paediatric cryptococcal disease with adult-onset disease in the South African population. METHODS The study was an active, prospective, population-based, laboratory-based surveillance in South Africa. We compared cases of paediatric cryptococcosis (<15 years) with cases of adult-onset cryptococcosis that were reported to the surveillance programme between 1 January 2005 and 31 December 2007. The case definition was based on a positive India ink test, cryptococcal antigen test or cryptococcal culture. Clinical case data were obtained at enhanced surveillance sites. RESULTS Of 16,192 incident episodes of cryptococcosis in South Africa, 361 (2%) episodes occurred among children. In 2007, incidence was one and 19 cases per 100,000 persons in the general paediatric and adult populations and was 47 and 120 cases per 100,000 persons for HIV-infected children and adults, respectively. Among children, a bimodal peak in incidence was evident in the less than 1-year age group and in the 5 age group. Most children (64%) and adults (63%) were severely immunocompromised (CD4 T-lymphocyte cell count < 50 cells/μl) at the time of diagnosis. On multivariable analysis, children were significantly more likely than adults to be male, diagnosed on blood culture, infected with Cryptococcus gattii, treated with amphotericin B and admitted for a longer stay in hospital. CONCLUSION This series of 361 cases of paediatric cryptococcosis is by far the largest described to date. The diagnosis of cryptococcosis should be considered in the paediatric HIV-infected population, especially among those who are severely immunocompromised.
Collapse
|
4
|
Soni ZJ, Reubenson G, De Maayer T, Coovadia A, Lazarus EM. Neonatal Cryptococcosis: Beware of False-positive Results. J Pediatric Infect Dis Soc 2012; 1:250-3. [PMID: 26619410 DOI: 10.1093/jpids/pis037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/31/2012] [Indexed: 11/14/2022]
Abstract
Although cryptococcal meningitis is uncommon in children and rare in neonates, it does occur. We highlight circumstances in which the diagnosis should be considered and methods required to confirm the diagnosis in young patients.
Collapse
Affiliation(s)
- Zaheera J Soni
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tim De Maayer
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashraf Coovadia
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica M Lazarus
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Patel M, Beckerman KP, Reznik S, Madan RP, Goldman DL. Transplacental transmission of Cryptococcus neoformans to an HIV-exposed premature neonate. J Perinatol 2012; 32:235-7. [PMID: 22370896 DOI: 10.1038/jp.2011.112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cryptococcosis during pregnancy is well documented, but transmission of infection to the fetus is rare. We describe a premature neonate born to a mother with congenitally acquired human immunodeficiency virus (HIV) and active cryptococcosis. Histological examination of the placenta revealed Cryptococcus neoformans within the maternal intervillous space with focal invasion into the chorionic villi. A positive serum cryptococcal antigen (1:2) was detected on days 1 and 5 of life. The neonate had no evidence of central nervous system disease and was treated with fluconazole with resolution of antigenemia. This case highlights both the potential for transplacental transmission of C. neoformans infection and the complexities of caring for pregnant mothers who themselves are congenitally infected with HIV.
Collapse
Affiliation(s)
- M Patel
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | | | | | | |
Collapse
|
6
|
Yuanjie Z, Jianghan C, Nan X, Xiaojun W, Hai W, Wanqing L, Julin G. Cryptococcal meningitis in immunocompetent children. Mycoses 2011; 55:168-71. [PMID: 21762212 DOI: 10.1111/j.1439-0507.2011.02063.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To describe clinical characteristics, treatment and outcome of cryptococcal meningitis in immunocompetent children. Immunocompetent children with cryptococcal meningitis who attended Changzheng Hospital between 1998 and 2007 were retrospectively reviewed. During the 10 years reviewed, 11 children with cryptococcal meningitis were admitted to Changzheng hospital and identified as immunocompetent. The 11 children had a median age of 7.25 years. Headache (100%), fever (81.8%), nausea or vomiting (63.6%) and visual or hearing damage or loss (36.4%) were the most common symptoms before treatment. There is no evidence for other site infection of cryptococcus although all the cryptococcal antigen titre is high in blood. All the patients received amphotericin B or AmB liposome with 5-flucytosine for at least 6 weeks followed by fluconazole or itraconazole as consolidation treatment for at least 12 weeks. Nine patients were cured mycologically; however, sequela of visual damage was showed in one patient. Cryptococcal meningitis seems to be uncharacteristic of symptoms, and central nervous system may be the only common site for infection. Amphotericin B with 5-flucytosine should be the choice of induction treatment in this group of patients.
Collapse
Affiliation(s)
- Zhu Yuanjie
- Mycology Center & Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | | | | | | | | | | | | |
Collapse
|
7
|
Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis 2010; 50:291-322. [PMID: 20047480 PMCID: PMC5826644 DOI: 10.1086/649858] [Citation(s) in RCA: 1695] [Impact Index Per Article: 121.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
Collapse
Affiliation(s)
- John R Perfect
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Peres LC, Saggioro FP, Dias LB, Alves VAF, Brasil RA, Luiz VEDDB, Neder L, Rosman FC, Fleury RN, Ura S, Orsi AT, Talhari C, Ferreira LCDL, Ramos SG, Rey LC, Martinez-Espinosa FE, Sim F, Filho OEDS, Duarte MIS, Lambertucci JR, Chimelli LMC, Rosa PS, Belone ADFF. Infectious diseases in paediatric pathology: experience from a developing country. Pathology 2008; 40:161-75. [PMID: 18203038 DOI: 10.1080/00313020701816357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Infectious and parasitic diseases have always challenged man. Although many of them are typically seen in some areas of the world and can be adequately managed by just improving socioeconomic status and sanitary conditions, they are still quite prevalent and may sometimes be seen outside their original geographical areas. Human migration due to different reasons, tourism, blood transfusion and solid organ transplantation has created new concerns for health professionals all over the world. If not for diagnostic purposes, at least these tropical and infectious diseases should be largely known because their epidemiology, pathogenesis, host/parasite interaction, inflammatory and reparative responses are quite interesting and teach us about human biology. Curiosity is inherent to pathology practice and so we are compelled to look for things other than tumours or degenerative diseases. This review focuses on infectious and parasitic diseases found in a developing country and brings up-to-date information on diseases caused by viruses (dengue, yellow fever), bacteria (typhoid fever, leprosy), parasites (Chagas' disease, cutaneous and visceral leishmaniasis, amoebiasis, Capillaria hepatica, schistosomiasis, cysticercosis) and caused by fungi (paracoccidioidomycosis, cryptococcosis, histoplasmosis) that may be useful for pathologists when facing somewhat strange cases from developing countries.
Collapse
Affiliation(s)
- Luiz Cesar Peres
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
|
10
|
Estudio clínico y epidemiológico de la criptococosis en Colombia: resultados de nueve años de la encuesta nacional, 1997-2005. BIOMEDICA 2007. [DOI: 10.7705/biomedica.v27i1.236] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
Castro G, Cervi MC, Martinez R. Vertical transmission of Cryptococcus neoformans from a mother coinfected with human immunodeficiency virus: case report. Rev Soc Bras Med Trop 2007; 39:501-3. [PMID: 17160332 DOI: 10.1590/s0037-86822006000500016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 08/10/2006] [Indexed: 11/22/2022] Open
Abstract
Disseminated infection with Cryptococcus neoformans was observed in a newborn infant who presented fever and respiratory symptoms since the 52 nd day of life. The mother was infected by human immunodeficiency virus and presented pulmonary and meningeal cryptococcal infection. This is a rare case of cryptococcal infection with probable maternal-fetal transmission.
Collapse
Affiliation(s)
- Gleusa Castro
- Departament of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brasil
| | | | | |
Collapse
|
12
|
Abstract
Cryptococcal meningitis was diagnosed in a 92-day-old boy who was not HIV-1-infected and who survived after treatment, although with hydrocephalus. The mother was HIV-1-infected, delivered prematurely, had peripartum cryptococcal meningitis and died 14 days postpartum. There was no other possible source for cryptococcal infection in this infant. This is believed to be a case of mother-to-child transmission of cryptococcosis.
Collapse
Affiliation(s)
- Sayomporn Sirinavin
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Srivichai-2 Hospital, Bangkok, Thailand
| | | | | |
Collapse
|