AEGiS-13IAC: Cryptococcosis in HIV-1 infected children.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Cryptococcosis in HIV-1 infected children.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoPeB2299)

Oprea C, Duiculescu D, Ungureanu E, Radoi R, Dorobat O, Ispas D, Erscoiu S, Patru C, Paun L
C. Oprea, Dr. V. Babes Hospital, Str. Soseaua Mihai Bravu 281, Bucharest 3, Romania, Tel.: +40 132 341 10, E-mail: dandui@pcnet.ro

BACKGROUND: To assess the prevalence, clinical features and evolution of cryptococcus infection (c.i) in HIV infected children.

METHODS: A 10 years (1989-1999) retrospective study on c.i. in HIV infected children from "Dr. V. Babes" Hospital Bucharest, Romania. Diagnosis was established by cultures; India ink smears and agglutination reaction for cryptococcal antigen.

RESULTS: There were 15 (1.2%) cases (infected parenterally,9 males, 6 females) with c.i. from 1196 HIV infected children. The median age at diagnosis was 9.7 years. At the onset of c.i, 10 children were in stage B and 5 children in stage C. The median of CD4 cells count was 70/il. Clinical characteristics were headache (11 cases), fever (11 cases), seizures (10 cases), changes in mental status (9 cases), nuchal rigidity (8 cases), focal neurological signs (5 cases), malaise (5 cases), myalgia (4 cases). Disseminated cryptococcosis was diagnosed in 8 children and 7 children had only meningeal involvement. Cutaneous lesions were present in 5 children. Two children had also a concomitant tuberculous meningitis. Cultures for Cryptococcus neoformans were positive in CSF (9 cases), blood (6 cases), urine (5 cases), cutaneous lesions (3 cases), sputum (1 case). Cryptococcal antigen was detected in 5 cases in CSF. The India ink smears in CSF were positive in 14 cases. Specific treatment was used and in one case amphotericin B was administrated intrathecally. Out of five, fungigram revealed two resistant strains to flouconasole.Twelve children died (8 due to the c.i.) after a median survival time of 40 days (range 20 days - 1.5 years).

CONCLUSIONS: 1.C.i. occurred in children of older age with severe immunosuppression.2. Headaches, fever, seizures and changes in mental status were the predominant symptoms; only half of the children had nuchal rigidity.3.The prevalence of c.i. in children was higher than that reported in literature.4. We found a high incidence of cutaneous lesions .

Keywords: AEGIS, Cryptococcosis, HIV-1, Cryptococcus neoformans, HIV Seropositivity, HIV Infections, Amphotericin B, CD4 Lymphocyte Count, Incidence, Prevalence, Retrospective Studies, Romania, Child, Human, Female, Male
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MoPeB2299