| Objective:To investigate the clinical characteristics and diagnosis of cryptococcosis in children,improve the understanding of children's cryptococcosis,reduce misdiagnosis and missed diagnosis,thus carries on the early diagnosis and treatment,to improve its prognosis.Methods: A total of 58 hospitalized patients with cryptococcosis admitted to the Children's Hospital of Chongqing Medical University from January 2009 to January 2019 were retrospectively analyzed.Results:1.Male patients 62.1%(36/58),female children 37.9%(22/58),male to female ratio 1.64:1,age of onset was 1.08-16.28 years old,the average age was 5 years old(3.83,5.17),the onset age was between 3and 6 years old accounted for 50%(29/58),6-9 years old accounted for15.5%(9/58),9-12 years old accounted for 13.8%(8/58).the first hospitalization course On 1-124 days,the average was 43.5 ± 33.39 days.2.84.5%(49/58)of children without underlying diseases and 15.5%(9/58)of those with underlying diseases,among which 7 children with basic diseases had a history of long-term use of immunosuppressive agents.There were24.1%(14/58)of children with a clear history of pigeon and poultryexposure.3.Fever accounted for 87.9%(51/58),due to different infection sites,clinical manifestations were different,of which cryptococcal brain accounted for 55.2%(32/58),disseminated cryptococcosis 43.1%(25/58),cryptococcus Sclerosing cholangitis is 1.7%(1/58).Disseminated cryptococcosis brain infection in 88%(22/25),lung infection 92%(23/25),abdominal infection 64%(16/25),20% of infected lymph nodes(5/25),skin infection 12%(3/25).4.Imaging examination: 1)Head MRI examination: 90.2%(37/41)of abnormalities,65.9%(27/41)of brain abnormal signals,and 36.6%(15/41)of hydrocephalus,meninges Intensive accounted for 14.6(6/41);2)CT scan of the head: 89.7%(26/29)of the abnormal children,62.1%(18/29)of the supratentorial ventricles,and41.4% of the suspicious low-density shadows %(12/29),hydrocephalus accounted for 34.5%(10/29);3)24 cases of chest CT examination showed lung lesions,manifested as pulmonary exudative changes or interstitial changes,hilar Lymph node lesions,mediastinal pleural effusion,pleural changes,etc.;4)13 cases of abdominal CT examination showed abnormalities,such as hepatosplenomegaly,uneven liver and spleen density,uneven enhancement,multiple nodules in the liver or Scattered lesions,intra-abdominal lymphadenopathy,calcification,necrosis,pelvic fluid,ascites,intrahepatic lymphatic deposition,etc.;5)16 cases of hepatobiliary,pancreas,spleen and kidney ultrasound,including liver,pancreatic head,mesentery,Left iliac vessels,spleen and other parts of the lymph nodelesions,hepatosplenomegaly,liver parenchyma echo heterogeneity,unequal amount of peritoneal effusion,gallbladder lesions,spleen parenchymal multiple nodules.5.Cryptococcus related laboratory tests: 57 cases of pathogens were detected in 58 children,and 1 case did not detect cryptococcus(diagnosis after diagnosis).The positive rate of cerebrospinal fluid smear ink staining was 83.6%(46/55);the positive rate of Cerebrospinal fluid cryptococci culture was 66.7%(36/54);the positive rate of C.oxysporum culture was 27.0%(10/37),and the positive rate of Cryptococcus mycelium culture 27.3%(6/22);Blood and cerebrospinal fluid cryptococcal capsular antigen positive rate was 85.7%(6/7);Plasma(1-3)-?-D dextran(1,3-?-D-glucan)Referred to as G test G-test),the positive rate was 33.3%(7/21);The positive rate of GM test was 33.3%(2/6);The positive rate of cryptococcal lymph node biopsy was 100%(4/4),and the positive rate of cryptococcal biopsy was 100%(1/1/ 1)The positive rate of skin biopsy Cryptococcus was 66.7%(2/3).Conclusions: 1.Children with cryptococcosis are more common in preschool and school age children.There are more male children than female children;the disease course is longer.2.Most children with cryptococcosis have no underlying disease;3.The clinical manifestations of children with cryptococcal infection are different.The clinical manifestations are mainly fever,which can affect the whole body system,the most easily involving the nervous system,followed by the respiratorysystem,digestive system,skin,lymph nodes,etc.;it is very difficult to diagnose by clinical manifestation alone,and must be combined with laboratory tests to assist Diagnosis;4.The imaging findings of cryptococcosis in children have no obvious specificity,and some characteristic manifestations can assist diagnosis.The diagnosis still needs to be combined with clinical manifestations and pathogenic examination;5.The pathogenic examination of cryptococci is the key to the diagnosis of cryptococcosis.Once cryptococcosis is suspected,the pathogens of cerebrospinal fluid,blood,bone marrow and other cryptococcal diseases(such as smear ink staining or culture),blood or cerebrospinal fluid should be actively improved.Cryptococcus capsular antigen test,GM-test and other assisted diagnosis,if necessary,complete histopathological examination and help. |
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