Zhang Xiao-Bo, Lin Huiying, Wu Xiao, Nong Guang-Min
Pediatric Department, First Affiliated Hospital of Guangxi Medical University, Guangxi Clinical Medical Research Center of Pediatric Diseases (Difficult and Critical illness Center), Guangxi, China.
Ital J Pediatr. 2025 Jun 7;51(1):177. doi: 10.1186/s13052-025-02011-w.
Disseminated cryptococcosis is a rare disease in children, especially in children with normal immunity. The understanding of this disease needs to be improved. This study aims to update the global situation of disseminated cryptococcosis in non-HIV infected children for the first time.
The clinical data of a child with disseminated cryptococcosis was retrospectively analyzed, and disseminated cryptococcosis clinical features of published studies were summarized. Electronic databases were searched in February 2025. Clinical studies that meet the criteria were included in the present study.
Totally 116 cases were analyzed in this study, including 1 case in our center and 115 cases from 45 studies. The cohort included 82 males (70.7%) and 34 females (29.3%), with ages ranging from 10 months to 18 years. The main clinical manifestations were fever (79.3%), respiratory symptoms (41.4%), and neurological symptoms (39.7%), followed by hepatosplenomegaly (35.3%), rash (27.6%), lymphadenopathy (18.1%), and gastrointestinal symptoms (16.4%). The most commonly affected organs were the lungs (77.6%), central nervous system (53.4%), and lymph nodes (51.7%). Immunodeficiency was present in 12.9% of children (3.4% domestic cases vs. 9.5% foreign cases). Elevated eosinophils were observed in 43 patients (37.1%), and elevated IgE levels in 35 patients (30.2%). The most common pathogen-positive specimens were cerebrospinal fluid (54 cases, 46.6%), blood cultures (49 cases, 42.2%), lymph node biopsies (26 cases, 22.4%), bone marrow (18 cases, 15.5%), and skin samples (8 cases, 6.9%). Combination therapy was administered to 89 patients (76.7%), while 21 patients (18.1%) received monotherapy. Clinical improvement occurred in 94 patients (81.0%), with 15 fatal cases.
Disseminated cryptococcosis in children often presents with fever, respiratory and neurological symptoms, with the lungs, central nervous system, and lymph nodes being the most frequently involved organs. Most cases do not have immunodeficiency or underlying diseases, and blood tests often reveal eosinophilia and elevated IgE levels. The positive detection rates of pathogens are relatively high in blood cultures, cerebrospinal fluid, bone marrow cultures, and lymph node biopsies. The majority of patients achieved favorable therapeutic outcomes with combination therapy.
播散性隐球菌病在儿童中是一种罕见疾病，尤其是在免疫功能正常的儿童中。对这种疾病的认识有待提高。本研究旨在首次更新非HIV感染儿童播散性隐球菌病的全球情况。
回顾性分析1例播散性隐球菌病患儿的临床资料，并总结已发表研究中播散性隐球菌病的临床特征。于2025年2月检索电子数据库。符合标准的临床研究纳入本研究。
本研究共分析116例病例，包括我中心1例及来自45项研究的115例。队列包括82名男性（70.7%）和34名女性（29.3%），年龄范围为10个月至18岁。主要临床表现为发热（79.3%）、呼吸道症状（41.4%）和神经症状（39.7%），其次为肝脾肿大（35.3%）、皮疹（27.6%）、淋巴结病（18.1%）和胃肠道症状（16.4%）。最常受累的器官是肺（77.6%）、中枢神经系统（53.4%）和淋巴结（51.7%）。12.9%的儿童存在免疫缺陷（国内病例为3.4%，国外病例为9.5%）。43例患者（37.1%）嗜酸性粒细胞升高，35例患者（30.2%）IgE水平升高。最常见的病原体阳性标本是脑脊液（54例，46.6%）、血培养（49例，42.2%）、淋巴结活检（26例，22.4%）、骨髓（18例，15.5%）和皮肤样本（8例，6.9%）。89例患者（76.7%）接受联合治疗，21例患者（18.1%）接受单药治疗。94例患者（81.0%）临床症状改善，15例死亡。
儿童播散性隐球菌病常表现为发热、呼吸道和神经症状，肺、中枢神经系统和淋巴结是最常受累的器官。大多数病例无免疫缺陷或基础疾病，血液检查常显示嗜酸性粒细胞增多和IgE水平升高。血培养、脑脊液、骨髓培养和淋巴结活检中病原体的阳性检出率相对较高。大多数患者接受联合治疗后取得了良好的治疗效果。
