title: Cryptococcal meningitis in immunocompetent children.
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.
authors.affiliation: Mycology Center & Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Yuanjie
authors.forename: Chen
authors.initials: C
authors.lastname: Jianghan
authors.forename: Xu
authors.initials: X
authors.lastname: Nan
authors.forename: Wang
authors.initials: W
authors.lastname: Xiaojun
authors.forename: Wen
authors.initials: W
authors.lastname: Hai
authors.forename: Liao
authors.initials: L
authors.lastname: Wanqing
authors.forename: Gu
authors.initials: G
authors.lastname: Julin
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003455:Cryptococcus neoformans; D004334:Drug Administration Schedule; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use; D005437:Flucytosine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal; C068538:liposomal amphotericin B; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine