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Open Access Research article

A case–control study of risk factors for HIV-negative children with cryptococcal meningitis in Shi Jiazhuang, China

Jianhua Guo14*, Jikun Zhou1, Shiyong Zhang1, Xin Zhang2, Jing Li3, Yinqi Sun3 and Shunxiang Qi3

Author Affiliations

1 Shi Jiazhuang Center for Disease Prevention and Control (CDC), Shi Jiazhuang 050011, People’s Republic of China

2 Hebei Provincial children's hospital, Shi Jiazhuang 050019, People’s Republic of China

3 Hebei Provincial Center for Disease Prevention and Control (CDC), Shi Jiazhuang 050011, People’s Republic of China

4 Institute for Epidemiology and Health Emergency, Shi Jiazhuang Center for Disease Prevention and Control (CDC), No.3 Li Kang Street, Shi Jiazhuang 050011, China

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BMC Infectious Diseases 2012, 12:376  doi:10.1186/1471-2334-12-376

Published: 26 December 2012

Abstract

Background

Although cryptococcal meningitis (CM) is an emerging disease worldwide, there have been few studies of the characteristics and risk factors of CM in children.

Methods

We used data collected from May 2007 through April 2012 in the Acute Meningitis-Encephalitis Syndrome Surveillance project in Shi Jiazhuang, China to describe the epidemiologic, clinical, and laboratory findings in children with CM. Furthermore, a matched case–control study was used to determine risk factors of CM.

Results

Overall 23 HIV-negative children with CM (median age: 10.91 years; range: 5 months-17 years) were enrolled in our study. The average annual incidence of CM was 0.43/100,000 with a fatality rate of 1.7%. Most patients were males (60.87%) and rural children (73.91%). Common clinical symptoms included increased intracranial pressure, such as headaches (78.3%), nausea (60.9%), altered mental status (56.5%), vomiting (52.2%), and seizures (43.5%), and frequent laboratory findings consisted of blood leukocytosis (87.0%), decreased CSF glucose (87.0%), pleocytosis (82.6%), increased intracranial pressure (73.9%) and elevated CSF proteins (65.2%). Epidemiologic, clinical, and laboratory findings were similar between patients with and without underlying diseases. Multivariate logistic regression analysis showed that children who had contact with birds/bird droppings or saprophytes were more likely to be infected than those without such contact (odds ratio(OR) =11.82; 95% confidence interval (CI), 2.21-62.24; P = 0.004). Patients with an interval of ≥20 days from onset to admission were at high risk for CM (OR= 5.31; 95%CI, 1.58-17.89; P = 0.007).

Conclusions

Our findings show that CM is an uncommon disease with a high mortality rate in children. Although additional studies are needed to find effective prevention and treatments for CM, clinicians should consider CM as a potential cause for pediatric meningitis in children, particularly boys from rural areas, who had contact with birds/bird droppings or saprophytes and in children who did not receive prompt medical attention.

Keywords:
Cryptococcosis; Cryptococcal meningitis; Epidemiologic characteristics; Clinical features; Bird droppings and sacrophytes; Risk factors; Children