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Cryptococcus neoformans meningoencephalitis in African children with acquired immunodeficiency syndrome
Tawanda Gumbo1, Gerard Kadzirange, Jens Mielke
1Department of Medicine, University of Zimbabwe Medical School, Harare, Zimbabwe. gumbot@mail.amc.edu
Insights
Cryptococcal meningoencephalitis is a serious risk for children with AIDS in Africa. This study highlights its acute presentation, common symptoms like seizures, and high mortality rate in pediatric cases.
Area of Science:
- Pediatric Infectious Diseases
- Neuroscience
- Global Health
Background:
- Sub-Saharan Africa has a high prevalence of pediatric Acquired Immunodeficiency Syndrome (AIDS).
- Limited data exist on the incidence and characteristics of cryptococcal meningoencephalitis in African children.
- HIV-infected children are potentially at risk for this opportunistic infection.
Purpose of the Study:
- To describe the clinical features, diagnostic findings, and outcomes of cryptococcal meningoencephalitis in HIV-infected children in Harare, Zimbabwe.
- To compare pediatric cases with adult cases of HIV-associated cryptococcal meningoencephalitis to identify disease-specific characteristics.
- To understand the epidemiology and clinical presentation of this serious neurological complication in a vulnerable population.
Main Methods:
- Retrospective review of medical records of HIV-infected children (<=16 years) diagnosed with cryptococcal meningoencephalitis between 1995 and 2000.
- Comparison of clinical and laboratory data between pediatric patients and adult patients with HIV-associated cryptococcal meningoencephalitis.
- Analysis of presenting symptoms, cerebrospinal fluid findings, and mortality rates.
Main Results:
- Thirteen pediatric cases were identified, with headache, nuchal rigidity, and vomiting as common symptoms.
- Children were significantly more likely than adults to experience seizures and have normal cerebrospinal fluid protein levels.
- The in-hospital mortality rate was high at 43%, with convulsions and impaired mental status predicting increased mortality.
Conclusions:
- Cryptococcal meningoencephalitis in African children often presents with acute or subacute symptoms and can progress rapidly.
- The disease can manifest as a severe, progressive meningoencephalitis in this population.
- Findings underscore the need for increased awareness and timely diagnosis in at-risk children.
Background:
The number of children with AIDS in Africa is high. Such children may be at risk for cryptococcal meningoencephalitis, but data are scarce regarding this disease in our population.
Methods:
We examined records of HIV-infected children (< or =16 years) diagnosed with cryptococcal meningoencephalitis in Harare, Zimbabwe, between 1995 and 2000. To elucidate features unique to pediatric disease, the children were compared with adult patients with HIV-associated cryptococcal meningoencephalitis.
Results:
Thirteen children presented to our institution with headache (85%), nuchal rigidity (69%), vomiting (46%), impaired mental status (38%), convulsions (38%) and focal neurologic signs (23%). The mean duration of symptoms before diagnosis was 9 days. Cerebrospinal fluid examination revealed normal white blood cell counts in 64%, protein value in 67% and glucose concentration in 57% of patients. Children were more likely than adults to have seizures (38% vs. 11%, P = 0.02) and normal cerebrospinal fluid protein (67% vs. 10%, P < 0.01). The in-hospital mortality was 43%. Convulsions (P = 0.05) and impaired mental status (P < 0.01) were associated with increased mortality
Conclusions:
Cryptococcal meningoencephalitis in African children presents acutely or subacutely, can have a fulminant picture and is consistent with progressive meningoencephalitis.