title: A comparison of cases of paediatric-onset and adult-onset cryptococcosis detected through population-based surveillance, 2005-2007.
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.
  
  
  CONCLUSIONS
  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.
authors: National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, South Africa.
authors: Susan T
authors: ST
authors: Meiring
authors: Vanessa C
authors: VC
authors: Quan
authors: Cheryl
authors: C
authors: Cohen
authors: Halima
authors: H
authors: Dawood
authors: Alan S
authors: AS
authors: Karstaedt
authors: Kerrigan M
authors: KM
authors: McCarthy
authors: Andrew C
authors: AC
authors: Whitelaw
authors: Nelesh P
authors: NP
authors: Govender
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003453:Cryptococcosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D056285:Cryptococcus gattii / Q000276:immunology / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B