Extrapulmonary cryptococcosis in immunocompromised infants and children

The ubiquitous soil fungus Cryptococcus neoformans causes pulmonary and extrapulmonary infections in immunocompromised as well as normal hosts. Infection is acquired predominantly through airborne transmission to the respiratory tract and cell-mediated immunity is important in host defense against this organism. Extrapulmonary cryptococcosis (EC) is a major opportunistic infection in adults who have the acquired immunodeficiency syndrome (AIDS),1 although it has been infrequently reported in pediatric patients infected with human immunodeficiency virus, the etiologic agent of AIDS.2 Information on EC in other populations of immunocompromised infants and children is limited to case reports or series comprised primarily of adults. Emmanuel et al.3 reviewed the pediatric literature on cryptococcal meningitis in 1961 and Siewers and Cramblett4 discussed disseminated cryptococcal infection in children in 1964. In addition to reporting cryptococcal infection in normal hosts, these papers either reviewed or referenced single case reports of children with EC and Hodgkin's disease, sarcoidosis, pancytopenia and undefined immunodeficiency.3, 4 To update information on EC in immunocompromised infants and children, we reviewed the experience with this infection at two pediatric institutions in Memphis as well as the literature since the papers of Emmanuel et al.3 and Siewers and Cramblett.4