Clinical characteristics of disseminated cryptococcosis in previously healthy children in China.
BACKGROUND
Disseminated 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.


METHODS
Hospitalized 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.


RESULTS
A 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.


CONCLUSIONS
Disseminated 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.
['Gao|Li-Wei|LW|', 'Jiao|An-Xia|AX|', 'Wu|Xi-Rong|XR|', 'Zhao|Shun-Ying|SY|', 'Ma|Yun|Y|', 'Liu|Gang|G|', 'Yin|Ju|J|', 'Xu|Bao-Ping|BP|', 'Shen|Kun-Ling|KL|']
D000935:Antifungal Agents D000946:Antigens, Fungal D002648:Child D002675:Child, Preschool D002681:China D003371:Cough D003453:Cryptococcosis D004804:Eosinophils D005260:Female D005334:Fever D006261:Headache D006529:Hepatomegaly D006801:Humans D006849:Hydrocephalus D008172:Lung Diseases, Fungal D008198:Lymph Nodes D008297:Male D011379:Prognosis D013902:Radiography, Thoracic D012189:Retrospective Studies
Disseminated cryptococcosis Healthy Children Immunocompetent