Cryptococcus gattii infection complicated by immune reconstitution inflammatory syndrome in three apparently immunocompetent children.
Background: Paediatric Cryptococcus gattii disease is rare, with only two previous cases recorded in the Northern Territory (NT) over the last 54 years. Immune reconstitution inflammatory syndrome (IRIS) is a recognised complication of C. gattii infection, even in the absence of an identified immuno...
| Publicado en: | Journal of Paediatrics & Child Health Vol. 55; no. 8; pp. 943 - 948 |
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| Autores principales: | , , , |
| Formato: | case study Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=137924799&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 137924799 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10344810 81V jtl: Journal of Paediatrics & Child Health issn: 10344810 maglogo: Y pubinfo: dt: Aug2019 vid: 55 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 137924799 137924799 NLM30536470 137924799 10.1111/jpc.14321 NLM30536470 137924799 ppf: 943 ppct: 5 formats: tig: atl: Cryptococcus gattii infection complicated by immune reconstitution inflammatory syndrome in three apparently immunocompetent children. aug: au: O'Brien, Matthew P Ford, Timothy J Currie, Bart J Francis, Joshua R affil: Department of Paediatrics, Royal Darwin Hospital, Darwin Northern Territory, Australia sug: subj: Immunocompromised Host Cryptococcus Cryptococcosis Physiopathology Immune Reconstitution Inflammatory Syndrome Complications Northern Territory Child Adolescence Male Child: 6-12 years Adolescent: 13-18 years Male ab: Background: Paediatric Cryptococcus gattii disease is rare, with only two previous cases recorded in the Northern Territory (NT) over the last 54 years. Immune reconstitution inflammatory syndrome (IRIS) is a recognised complication of C. gattii infection, even in the absence of an identified immunodeficiency syndrome; however, limited paediatric data exist. We present a series of three paediatric patients treated for C. gattii infection in the NT during 2016/2017.Case Discussions: All three cases were males aged 8-13 years at the time of presentation. Two were Aboriginal Australians from remote NT communities, and the third was a Timorese child from a remote district in Timor-Leste. All cases had evidence of brain cryptococcomas, and two had associated pulmonary lesions. Each child was treated with a 6-week induction phase of intravenous liposomal amphotericin and flucytosine and then continued on a 2-year course of eradication oral fluconazole. Persistent high intracranial pressure (ICP) complicated each case, requiring serial lumbar punctures and, in two cases, insertion of ventriculoperitoneal shunts. All three cases were diagnosed with IRIS between 5 and 10 weeks after commencement of antifungal treatment and were managed with high-dose corticosteroids, which were weaned slowly (6-20 months post-commencement).Conclusions: Paediatric C. gattii disease is rare, although three recent cases in the NT highlight some of the challenges involved in managing the infection, including persistent raised ICP and complications such as IRIS. There is a need for further collaborative research into paediatric C. gattii disease. pubtype: Academic Journal doctype: case study Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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