Cryptococcus neoformans meningoencephalitis in African children with acquired immunodeficiency syndrome

Abstract

Background: The number of children with AIDS in Africa is high. Such children may be at risk for cryptococcal meningoencephalitis, but data are scarce regarding this disease in our population.

Methods: We examined records of HIV-infected children (< or =16 years) diagnosed with cryptococcal meningoencephalitis in Harare, Zimbabwe, between 1995 and 2000. To elucidate features unique to pediatric disease, the children were compared with adult patients with HIV-associated cryptococcal meningoencephalitis.

Results: Thirteen children presented to our institution with headache (85%), nuchal rigidity (69%), vomiting (46%), impaired mental status (38%), convulsions (38%) and focal neurologic signs (23%). The mean duration of symptoms before diagnosis was 9 days. Cerebrospinal fluid examination revealed normal white blood cell counts in 64%, protein value in 67% and glucose concentration in 57% of patients. Children were more likely than adults to have seizures (38% vs. 11%, P = 0.02) and normal cerebrospinal fluid protein (67% vs. 10%, P < 0.01). The in-hospital mortality was 43%. Convulsions (P = 0.05) and impaired mental status (P < 0.01) were associated with increased mortality

Conclusions: Cryptococcal meningoencephalitis in African children presents acutely or subacutely, can have a fulminant picture and is consistent with progressive meningoencephalitis.