Neuroimaging findings of disseminated cryptococcosis in children and correlation with prognosis

Abstract

Background: Disseminated cryptococcosis is a rare and fatal disease involving the central nervous system (CNS) that often presents with severe clinical symptoms and a poor prognosis.

Objective: To describe the neuroimaging findings of disseminated cryptococcosis in children and investigate their correlation with patients' prognosis.

Materials and methods: The information of hospitalized patients with disseminated cryptococcosis was collected between January 2012 and December 2023. The study comprehensively evaluated clinical manifestations, laboratory tests, imaging findings, and long-term outcomes.

Results: Forty cases of disseminated cryptococcosis were identified; headache was more common in patients with CNS involvement than in those without (P < 0.05). The most commonly affected organs were the lungs (n = 38; 92.5%), lymph nodes (n = 30; 75.0%), and CNS (n = 23; 57.5%). Among the 19 patients with CNS involvement, 11 (57.9%) had parenchymal lesions, and three (15.8%) showed restricted diffusion. Seven patients (50.0%) showed parenchymal enhancing lesions, and six patients (42.9%) showed leptomeningeal enhancement. Seizures (P = 0.022), parenchymal findings (P = 0.036), and lesions with enhancement (P = 0.019) were associated with poor outcomes, whereas lymph node involvement (P = 0.017) was associated with good outcomes.

Conclusion: Neuroimaging manifestations of disseminated cryptococcosis with CNS involvement frequently include brain parenchymal lesions. Furthermore, patients presenting with brain parenchymal lesions or seizures often have poor outcomes; therefore, early detection and intervention are imperative to improve patient prognosis.

Keywords: Central nervous system; Child; Cryptococcosis; Magnetic resonance imaging.