| Objective:To understand the clinical features of cryptococcal meningitis in children and to analyze risk factors for death.Methods:Analyze the clinical data of 55 children with cryptococcal meningitis.Results:1.General conditions: 55 children,the youngest is 1 year old and October,the largest is 16 years old and July,the average is(6.78±3.63)years old,male to female ratio is 1.89:1.Infants and young children accounted for 10.91%(6/55),preschool age accounted for 45.45%(25/55),school age accounted for 30.91%(17/55),and puberty accounted for12.73%(7/55).Acute onset accounted for 10.91%(6/55),subacute accounted for 36.36%(20/55),and chronic onset accounted for 52.73%(29/55).Spring incidence accounted for 27.27%(15/55),summer incidence accounted for 18.18%(10/55),autumn incidence accounted for 23.64%(13/55),and winter incidence accounted for 30.91%(17/55).20.00%(11/55)had a history of pigeon contact and 14.55%(8/55)had a basic disease.2.Clinical manifestations: fever 100%(55/55),high fever 81.82%(45/55),medium and low fever 18.18%(10/55),headache 80.00%(44/55),vomiting 89.09%(49/55),convulsion The attack was 34.55%(19/55),the disturbance of consciousness was 45.45%(25/55),the cranial nerve damage was 23.64%(13/55),and the personality change was 7.27%(4/55).Physical examination: 76.36%(42/55)of meningeal irritation,45.45%(25/55)of pathological signs,20.00%(11/55)of muscle strength,and18.18%(10/55)of muscle tone.3.Laboratory examination: white blood cells fluctuated between(3.50~43.20)*10^9/L,median 13.18*10^9/L,elevated 65.45%(36/55),neutrophil ratio fluctuated from 0.09~0.94,The median was 0.70,and the lymphocyte ratio fluctuated between 0.02 and 0.87 with a median of 0.20.Cerebrospinal fluid leukocytes fluctuated between(2.00~1053.00)*10^6/L,median 74.00*10^6/L,increased by 78.18%(43/55);cerebrospinal fluid protein fluctuated from(0.10~13.60)g/L,median 0.51g/L,increased by60.00%(33/55);cerebrospinal fluid glucose fluctuations in(0.17~4.39)mmol /L,median 2.24mmol/L,lower by 54.55%(30/55);chloride fluctuations in(99.20 ~131.40)mmol/L,the median 116.20 mmol L,the decrease was 7.27%(4/55).4.Imaging findings: 50 children underwent cranial imaging examination,hydrocephalus 62.00%(31/50),intracranial high-density shadow 6.00%(3/50),intracranial low-density shadow 16.00%(8/50)Consider 14.00%(7/50)of infection,12.00%(6/50)of meningitis,8.00%(4/50)of softening lesion,6.00%(3/50)of subdural effusion,4.00% of small nodules(2/50),cerebral edema 4.00%(2/50),cerebral palsy 2.00%(1/50).5.Diagnosis: 41.82%(23/55)was misdiagnosed as brain and anti-tuberculosis treatment,the shortest time from onset to the first lumbar puncture for 2 days,the longest 136 days,the median 24 days,the first lumbar puncture confirmed cases 63.64%(35/55),the first lumbar cerebrospinal fluid ink staining positive 52.73%(29/55),the first cerebrospinal fluid culture positive 21.82%(12/55).6.Treatment: The shortest time from onset to onset of antifungal treatment was 7 days,the longest was 139 days,the median was 28 days,the hospital stay was 2 days,the longest was 123 days,and the median was44 days.39 patients underwent antifungal therapy for more than 1 week,10.26%(4/39)patients received medication alone,89.74% of patients received combination therapy(35/39),and 51.43%(18/35)amphiric mold in combination therapy.B combines 5-fluorocytosine,42.86%(15/35)amphotericin B in combination with fluconazole,5.71%(2/35)amphotericin B in combination with itraconazole.18.18%(10/55)of the children underwent intrathecal injection,16.36%(9/55)surgical intervention,and 43.64%(24/55)used small doses of hormone.7.Adverse drug reactions: 60.00%(33/55)of adverse drug reactions,45.45%(25/55)of low potassium,14.55%(8/55)of liver damage,20.00%(11/55)of kidney damage,12.73% of fever(7/55),gastrointestinal symptoms 12.73%(7/55).8.Risk factors for death:The results of single factor COX regression analysis : shorter hospital stay(P<0.001),high fever(P=0.010),higher cerebrospinal fluid protein(P=0.006),lower cerebrospinal fluid glucose(P=0.009),lower cerebrospinal fluid chloride(P=0.018)and hypokalemia(P< 0.001)were the influencing factor of death;The results of multivariate COX regression analysis: hyperthermia(P=0.016),short hospital stay(P<0.001),high cerebrospinal fluid white blood cell count(P<0.001),hypokalemia(P=0.009)were independent risk factors for death.Conclusion:The shorter the hospital stay,the high fever,the higher the number of white blood cells in the cerebrospinal fluid,and the hypokalemia may increase the risk of death. |
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