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Cryptococcosis in Colombian children and literature review
Jairo Lizarazo1, Patricia Escandón2, Clara Inés Agudelo2
1Hospital Universitario Erasmo Meoz, Cúcuta, Colombia.
Insights
Cryptococcosis is rare in children, with a low prevalence found in a Colombian survey. Meningitis was the most common presentation, often without a clear risk factor, highlighting the need for awareness in pediatric populations.
Area of Science:
- Infectious Diseases
- Pediatric Epidemiology
- Mycology
Background:
- Cryptococcosis is primarily an adult opportunistic infection, often associated with acquired immune deficiency syndrome (AIDS).
- Its occurrence in pediatric populations is considered infrequent globally.
- Understanding pediatric cryptococcosis epidemiology is crucial for early diagnosis and management.
Purpose of the Study:
- To analyze the epidemiological and clinical characteristics of cryptococcosis in children under 16 years old in Colombia.
- To determine the incidence and prevalence of pediatric cryptococcosis.
- To identify common clinical manifestations, risk factors, and causative agents.
Main Methods:
- Retrospective analysis of data from the National Survey on Cryptococcosis in Colombia (1993-2010).
- Inclusion of 41 pediatric cases (age < 16 years).
- Microbiological identification using India ink, latex agglutination in cerebrospinal fluid, and culture.
Main Results:
- A prevalence of 2.6% was observed in the survey, with a mean annual incidence of 0.017 cases/100,000 children.
- Norte de Santander showed a significantly higher incidence rate (0.122 cases/100,000).
- Headache, fever, and nausea/vomiting were common symptoms, with meningitis being the most frequent presentation (87.8%).
- Acquired immune deficiency syndrome (AIDS) was identified as a risk factor in 24.4% of cases.
- Cryptococcus neoformans var. grubii was the predominant species (94.1%).
- Amphotericin B was the primary initial treatment for 93.5% of patients.
Conclusions:
- Pediatric cryptococcosis, while unusual, presents with significant morbidity, primarily as meningitis.
- The study highlights regional variations in incidence within Colombia.
- Prompt microbiological diagnosis and appropriate antifungal therapy are essential for managing pediatric cryptococcosis.
Abstract:
Cryptococcosis is reported in adults and is often acquired immune deficiency syndrome (AIDS)-associated; however, its frequency in children is low. Based on the National Survey on Cryptococcosis conducted in Colombia, an epidemiological and clinical analysis was performed on cases of the disease observed in children less than 16 years old between 1993-2010. We found 41 affected children (2.6% prevalence) from the 1,578 surveys received. The country mean annual incidence rate was 0.017 cases/100,000 children under 16 years, while in Norte de Santander the incidence rate was 0.122 cases/100,000 (p < 0.0001). The average age of infected children was 8.4 and 58.5% were male. In 46.3% of cases, a risk factor was not identified, while 24.4% had AIDS. The most frequent clinical manifestations were headache (78.1%), fever (68.8%), nausea and vomiting (65.6%), confusion (50%) and meningeal signs (37.5%). Meningitis was the most frequent clinical presentation (87.8%). Amphotericin B was given to 93.5% of patients as an initial treatment. Positive microbiological identification was accomplished by India ink (94.7%), latex in cerebrospinal fluid (100%) and culture (89.5%). Out of 34 isolates studied, Cryptococcus neoformans var. grubii (VNI 85.3%, VNII 8.8%) was isolated in 94.1% of cases and Cryptococcus gattii (VGII) was isolated in 5.9% of cases. These data are complemented by a literature review, which overall suggests that cryptococcosis in children is an unusual event worldwide.
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