Cryptococcosis (CC) in the pediatric population in Gauteng, South Africa (SA): epidemiology and characteristics of 34 cases identified during population-based CC surveillance in SA, 2002-2004

Morgan J 1, Wannemuehler K 1, Fridkin S 1, McCarthy K 2, Crewe Brown H 2, Hajjeh R 1

Author address: 

1 Centers for Disease Control and Prevention, Atlanta USA, 2 National Health Laboratory Service, South Africa


Background: CC is rare among HIV-infected children, in contrast to HIV-infected adults, in developing countries. The reason for this is unclear. We present the largest case series of CC in children from a population with high HIV prevalence infection, and compare the clinical presentation and outcome with adults with CC. Methods: Active population-based surveillance for CC was conducted in Gauteng province, SA, during March 2002 to March 2004. Incident cases were defined by the first positive India ink, latex agglutination, or isolation of C. neoformans from any biologic specimen in a Gauteng resident. Medical records of cases were reviewed and demographic, clinical, HIV-related, laboratory and outcome data were collected. Characteristics of pediatric cases (8804; 16 years of age) were compared to adult cases by chi-square. Results: During the two years of surveillance, 3018 incident cases of CC were identified; 2898 had age recorded and 34 (1.2%) were pediatric cases (median 8.5 years, range 3 months to 16 years). Twenty (59%) cases were male and all but one case was black. HIV status was known on 24, three (12.5%) tested negative. Of the 21 HIV-infected pediatric cases, four had a CD4 count performed (all were 8804;100), and this infection was the AIDS defining illness for 65%. Overall, the 34 pediatric cases were less likely than adults to present with meningitis: 53% vs. 79% had headache, 47% vs. 70% had neck stiffness and 12% vs. 31% had altered mental status (pediatric vs. adult cases respectively, all comparisons p0.05). Mortality during hospitalization for CC among pediatric and adults cases was similar: 24% of children died compared to 29% of adults (p>0.05). Among pediatric survivors, only 74% received fluconazole at the time of discharge from the hospital, compared to 98% of adult survivors (p

abstract No: 


Full conference title: 

15th Annual Focus on Fungal Infections
    • FFI 15th (2005)