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Neurological Sequelae After Paediatric Cryptococcal Meningitis
Alison Gifford1, Simran Atulkumar Patel2,3, Masilo Matlakala2,3
1Medical Research Council Centre for Medical Mycology at the University of Exeter, Department of Biosciences, Faculty of Health and Life Sciences, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK.
Insights
Cryptococcal meningitis (CM) in children can cause lasting neurological issues, especially in those with HIV. Standard neurodevelopmental assessments are crucial for better outcomes and rehabilitation after CM.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurodevelopmental Disorders
Background:
- Infectious insults to developing brains can cause lifelong neurological deficits.
- Adult cryptococcal meningitis survivors experience sequelae like blindness and motor weakness.
- Outcomes for children surviving cryptococcal meningitis are poorly understood.
Purpose of the Study:
- To investigate the neurological and neurodevelopmental consequences of cryptococcal meningitis in children.
- To identify risk factors and common sequelae in pediatric CM survivors.
- To highlight the need for standardized neurodevelopmental assessments.
Main Methods:
- Systematic literature review of PubMed and Ovid Global Health databases.
- Inclusion of children (<19 years) with proven central nervous system cryptococcal disease.
- Analysis of 868 children from 108 publications (October 2024 data cutoff).
Main Results:
- Mortality rate was 24%. No formal neurodevelopmental assessments were documented.
- 20% of survivors experienced neurological sequelae, higher in HIV-positive children (25%).
- Visual impairment (13%) was common, particularly with *Cryptococcus gattii* (32%). Other sequelae included limb weakness, learning difficulties, hearing loss, and seizures.
Conclusions:
- Cryptococcal meningitis poses significant risks for long-term neurological sequelae in children.
- HIV-positive children and those with *C. gattii* meningitis face higher risks.
- Standardized neurodevelopmental assessments are vital for rehabilitation and optimizing functional outcomes in pediatric CM survivors.
Abstract:
An infectious insult to a child's developing brain has the potential to result in life-long neurological and neurodevelopmental consequences. Adult survivors of cryptococcal meningitis (CM) can suffer from long-term neurological sequelae such as blindness and motor weakness, but little is known about outcomes in children. A PubMed and Ovid Global Health search identified all children <19 yrs of age with proven cryptococcal disease of the central nervous system until October 2024. A total of 868 children were included from 108 publications. In total, 555 (67%) were HIV positive, 67 (8%) non-HIV immunocompromised and 204 (25%) immunocompetent. The mortality rate was 24% (104/430). No child had a documented formal neurodevelopmental assessment after CM. Of those with a documented clinical outcome, 20% (36/184) had neurological sequelae, but this was higher in HIV-positive children (25%, 11/44). Visual impairment was most commonly observed (13%, 23/184) and remarkably higher in those with Cryptococcus gattii meningitis (32%, 10/31). Other sequelae included limb weakness (n = 8), learning difficulties (n = 7), hearing loss (n = 3) and recurrent seizures (n = 2). The burden of neurological sequelae is likely even more extensive than captured, with little data available from the populations most affected by CM. It is vital that neurodevelopmental assessment of children after CM is standard in all countries to support rehabilitation and the best functional outcomes.
