Fatores prognósticos de letalidade na meningoencefalite criptocócica em crianças e adolescentes no estado do Pará

Abstract

Introduction: Cryptococcosis is a systemic fungal infection that often affects adults, especially those who have an alteration in their cellular immunity. Its frequency in children is low. Objective: to describe the clinical, epidemiological, radiological and laboratorial profile of children with meningitis cryptococcal, and to evaluate what are the circumstances that affect the evolution of these patients and increase the fatality rates of the disease. Materials and methods: we performed a retrospective review of medical records in which we evaluated the prognostic factors of 62 children less than 16 years old, diagnosed with cryptococcal meningoencephalitis, admitted in the at João de Barros Barreto Hospital, reference for patients with infectious diseases in Belém-PA, from 1999-2013. Results: Ages ranged from less than 4 to 15 years. The average age was 10 and 66% were male. The Para state microregions, presented by order of decreasing frequency, showed: Cametá (29%), Guamá (12,9%), Belém (12,9%), Tomé-Açu (11,3%), Bragantina (9,7%) and others (39%). The predominant clinical presentation was the subacute form, represented by 50% of the cases. The most frequent clinical manifestations were headache (98,4%), fever (91,9%) and vomiting (88,7%). A skull tomography was performed in 54 patients, and abnormalities were reported in 43 (79,6%). Hydrocephalus was described in 27 cases. Cryptococcus gattii was the main agent involved, identified in 35 children (71,4%). In total, 91,9% of the patients were treated with amphotecicin B (AmB) alone. Conclusions: Rate of lethality from 19,3%; Seizure was a prognostic factor of lethality. In the State of Pará, where cryptococcosis by Cryptococcus gattii is endemic, the disease in children is relatively frequent. However, studies in this population are still scarce and there are no own management guides. New studies are needed to improve the management of children by this fungal infection.