| Objectives: To explose the characteristics of Cryptococcal Meningitisin children, improving diagnosis and treatment.Methods: A retrospective study was performed on patients diagnosedas cryptococcal meningitis in children from Dec2001to Dec2011. Theclinical manifestations, laboratory examination, therapeutics and outcomewere collected, followed by statistical analysis using SPSS19.0.Results:1. Generals:21males (70.00%) and9female (30.00%) wereanalysised, and mean age was7.25±3.75years.11cases co-existedunderlying diseases or risk factors.2. Clinical manifestations: In30children, the main clinicalmanifestations were: fever (96.67%), vomiting (86.67%), headache(76.67%), neck rigidity (73.33%), altered mental status(36.67%),convulsion (26.67%).5cases showed acute onset.15cases were subacuteonset, and10cases were chronic onset.3. Auxiliary examination: (1) General examination:30cases underwent Lumbar Puncture, foundout22cases (73.33%) had an increased protein, Among them,13cases≥1.0g/L.16cases (53.33%) with a glucose reduction,3cases (10.00%) withchloride reduction.11of16cases showed abnormal of cranial CT,13of14cases showed abnormal of cranial MRI,14of15cases showed abnormal ofEEG, and most of them showed the slow wave increased.(2) Etiological examination:27cases (90.00%) had a positive in Indiaink smear.23cases (76.67%) had a positive cryptococcus neoformansculter in cerebrospinal fluid.10cases underwent medicine sensitive tests.3of10cases were resistant to amphotericin B, and8of9cases were resistantto fluconazole.4. Antifungal therapies:22cases were treated by antifungal therapiesmore than7days.2cases used single antifungal medicine. one cases usedfluconazole, and the other one uesed amphotericin B. the rest20cases weretreated by amphotericin B (or amphotericin B liposomes), joint withfluconazole (14cases),5-flucytosine (3cases) or itraconazole (3cases).Total dosage of amphotericin B (or amphotericin B liposome), the averagedose per Kg, course of treatment in2007-2011were higher than these in2001-2006(P<0.05).5. Outcomes: In22cases who had antifungal treatment>7days,2cases cured,15cases improved. There was no satistical significance when Amphotericin B (or amphotericin B liposomes) combined with flucytosine,fluconazole or itraconazole.6. Misdiagnosis: Pre-hospital misdiagnosis rate was76.67%,17.39%of which were misdiagnosed as tuberculous meningitis.Conclusion:Cryptococcal meningitis in children mainly occured in preschool andschool age Children who had no basic diseases, or risk factors, and mainlyhad normal immune function. Males were mainly susceptible. Most caseswere subchronic or chronic in onset. The main clinical manifestationsincluded fever, headache, vomiting and neck rigidity. In children with CM,cerebrospinal fluid mainly represented protein increased obviously, glucosereduced, chloride normal. India ink smear and fungi culture are "goldstandard" for the diagnosis of cryptococcal meningitis. Amphotericin B (oramphotericin B liposomes) was the main medicine to treat CM. There wasno significant difference in outcome among three difference antifungaltreatments, which were the amphotericin B（or amphotericin B liposomes）combination of Fluconazole,5-flucytosine or itraconazole. It is moredifficult to treat this disease than five years before, the possible reason isthat cryptococcus neoformans is resistant to fluconazole seriously, andsome cryptococcus neoformans start to resistant to cryptococcusneoformans recently. Children with CM are easily misdiagnosed as tuberculous meningitis. If a patient is considered of tuberculous meningitis,but no effection of anti-tuberculosis treatment, we need to consider CM. |
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