title: A case-control study of risk factors for HIV-negative children with cryptococcal meningitis in Shi Jiazhuang, China.
abstract: BACKGROUND
  Although cryptococcal meningitis (CM) is an emerging disease worldwide, there have been few studies of the characteristics and risk factors of CM in children.
  
  
  METHODS
  We used data collected from May 2007 through April 2012 in the Acute Meningitis-Encephalitis Syndrome Surveillance project in Shi Jiazhuang, China to describe the epidemiologic, clinical, and laboratory findings in children with CM. Furthermore, a matched case-control study was used to determine risk factors of CM.
  
  
  RESULTS
  Overall 23 HIV-negative children with CM (median age: 10.91 years; range: 5 months-17 years) were enrolled in our study. The average annual incidence of CM was 0.43/100,000 with a fatality rate of 1.7%. Most patients were males (60.87%) and rural children (73.91%). Common clinical symptoms included increased intracranial pressure, such as headaches (78.3%), nausea (60.9%), altered mental status (56.5%), vomiting (52.2%), and seizures (43.5%), and frequent laboratory findings consisted of blood leukocytosis (87.0%), decreased CSF glucose (87.0%), pleocytosis (82.6%), increased intracranial pressure (73.9%) and elevated CSF proteins (65.2%). Epidemiologic, clinical, and laboratory findings were similar between patients with and without underlying diseases. Multivariate logistic regression analysis showed that children who had contact with birds/bird droppings or saprophytes were more likely to be infected than those without such contact (odds ratio(OR) =11.82; 95% confidence interval (CI), 2.21-62.24; P = 0.004). Patients with an interval of ≥20 days from onset to admission were at high risk for CM (OR= 5.31; 95%CI, 1.58-17.89; P = 0.007).
  
  
  CONCLUSIONS
  Our findings show that CM is an uncommon disease with a high mortality rate in children. Although additional studies are needed to find effective prevention and treatments for CM, clinicians should consider CM as a potential cause for pediatric meningitis in children, particularly boys from rural areas, who had contact with birds/bird droppings or saprophytes and in children who did not receive prompt medical attention.
authors.affiliation: Shi Jiazhuang Center for Disease Prevention and Control, Shi Jiazhuang 050011, People's Republic of China. guoflowers@163.com
authors.forename: Jianhua
authors.initials: J
authors.lastname: Guo
authors.forename: Jikun
authors.initials: J
authors.lastname: Zhou
authors.forename: Shiyong
authors.initials: S
authors.lastname: Zhang
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Yinqi
authors.initials: Y
authors.lastname: Sun
authors.forename: Shunxiang
authors.initials: S
authors.lastname: Qi
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000453:epidemiology*; D015999:Multivariate Analysis; D012307:Risk Factors