Gao Li-Wei, Jiao An-Xia, Wu Xi-Rong, Zhao Shun-Ying, Ma Yun, Liu Gang, Yin Ju, Xu Bao-Ping, Shen Kun-Ling
Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Respiratory Diseases, Beijing, China.
BMC Infect Dis. 2017 May 22;17(1):359. doi: 10.1186/s12879-017-2450-5.
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.
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.
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.
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.
播散性隐球菌病是一种罕见的致命疾病，关于儿童播散性隐球菌病的数据有限。本研究旨在调查中国既往健康儿童播散性隐球菌病的临床特征。
选取1996年1月至2015年12月在中国首都医科大学附属北京儿童医院住院的播散性隐球菌病患者。对临床表现、实验室检查、治疗及预后的数据进行评估。
共纳入52例无基础疾病的儿科患者，其中男孩38例，女孩14例。仅10例有接触鸽粪史。发热、咳嗽和肝肿大是播散性隐球菌病的3个主要表现。然而，中枢神经系统（CNS）受累患者的头痛比非CNS受累患者更常见（P<0.05）。肺是最常受累的器官（96.2%，50/52），但仅有9.6%（5/52）的患者有呼吸道症状。胸部影像学最常见的表现是肺门或纵隔淋巴结肿大（46.8%，22/47）和结节（44.7%，21/47），包括散在分布的小结节（57.1%，12/21）或粟粒样分布（42.9%，9/25），尤其以胸膜下区域为主。随后可累及CNS、腹部淋巴结、肝脏、脾脏、外周淋巴结和皮肤。所有患者中，分别有42.3%（22/52）和51.9%（27/52）的患者嗜酸性粒细胞或IgE升高。血清隐球菌抗原的阳性率较高，尤其是在CNS受累患者中（约83.3%），高于其他用于病原体检测的主要方法，包括脑脊液（CSF）隐球菌抗原、血液、骨髓或CSF培养以及CSF墨汁染色。本研究中儿科患者的总死亡率为11.5%（6/52）。部分病例有长期后遗症，包括脑积水、肝硬化或失明。
播散性隐球菌病可发生于中国既往健康或免疫功能正常的儿童。肺和CNS是该病最常受累的部位。此外，大多数病例通常无明显或特异性症状或体征，因此儿科医生应更加仔细地关注以识别该病。
