Neurological Sequelae After Paediatric Cryptococcal Meningitis

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.