Neuromeningeal Cryptococcosis in children: Clinical and prognostic aspects in a Pediatric hospital in Yaoundé - Cameroon

Abstract

Aim: To determine the clinical, paraclinical, and prognostic profile of pediatric neuromeningeal cryptococcosis. Methods and Material: This descriptive, retrospective study was conducted in children under 15 years of age hospitalized from March 1st, 2010 to March 31st, 2018 for neuromeningeal cryptococcosis in the infectious diseases department of the Mother and Child Center of the Chantal Biya Foundation in Yaounde. Diagnosis of neuromeningeal cryptococcosis was confirmed by direct examination of the cerebrospinal fluid (CSF) and subsequent staining with India ink and/or culture on Sabouraud medium. Hospital records were assessed for clinical features and laboratory parameters. The univariate logistic regression model was used to identify factors associated with prognosis. The significance level of the comparisons was p <0.05. Results: Total 331 children were hospitalized for infectious meningitis with 12 (3.6%) being confirmed cases of neuromeningeal cryptococcosis. All 12 patients were HIV infected. The mean age at presentation was 11 years with a range of 1-15 years. Clinical manifestations were headache (75%), fever (66.7%), nausea or vomiting (58.3%), convulsions (58.3%), and on clinical examination signs of meningeal irritation (83.5%). All patients had received fluconazole monotherapy. Intra-hospital mortality was 58.3%. Marginally increased cells in the CSF (p=0.04), hypoglycorrhachia (p=0.04), high HIV viral load (p=0.03), and deterioration of consciousness during treatment (p=0.001) were associated with this high mortality. Conclusion: Neuromeningeal cryptococcosis is a severe opportunistic mycosis in HIV-infected children. In our study, it is associated with a high mortality rate, hence the need for early diagnosis and appropriate treatment to improve the prognosis is needed. [ABSTRACT FROM AUTHOR]