PMID- 30536470
OWN - NLM
STAT- MEDLINE
DCOM- 20210129
LR  - 20210129
IS  - 1440-1754 (Electronic)
IS  - 1034-4810 (Linking)
VI  - 55
IP  - 8
DP  - 2019 Aug
TI  - Cryptococcus gattii infection complicated by immune reconstitution inflammatory 
      syndrome in three apparently immunocompetent children.
PG  - 943-947
LID - 10.1111/jpc.14321 [doi]
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.
CI  - (c) 2018 Paediatrics and Child Health Division (The Royal Australasian College of 
      Physicians).
FAU - O'Brien, Matthew P
AU  - O'Brien MP
AD  - Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, 
      Australia.
FAU - Ford, Timothy J
AU  - Ford TJ
AD  - Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, 
      Australia.
FAU - Currie, Bart J
AU  - Currie BJ
AD  - Northern Territory Medical Program, Flinders and Charles Darwin Universities, 
      Darwin, Northern Territory, Australia.
AD  - Global and Tropical Health Division, Menzies School of Health Research, Charles 
      Darwin University, Darwin, Northern Territory, Australia.
AD  - Infectious Disease Department, Division of Medicine, Royal Darwin Hospital, 
      Darwin, Northern Territory, Australia.
FAU - Francis, Joshua R
AU  - Francis JR
AD  - Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, 
      Australia.
AD  - Northern Territory Medical Program, Flinders and Charles Darwin Universities, 
      Darwin, Northern Territory, Australia.
AD  - Global and Tropical Health Division, Menzies School of Health Research, Charles 
      Darwin University, Darwin, Northern Territory, Australia.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20181208
PL  - Australia
TA  - J Paediatr Child Health
JT  - Journal of paediatrics and child health
JID - 9005421
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Cryptococcosis/*physiopathology
MH  - Cryptococcus gattii/*isolation & purification
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications
MH  - *Immunocompromised Host
MH  - Male
MH  - Northern Territory
OTO - NOTNLM
OT  - Cryptococcus gattii
OT  - immune reconstitution inflammatory syndrome
OT  - paediatrics
EDAT- 2018/12/12 06:00
MHDA- 2021/01/30 06:00
CRDT- 2018/12/12 06:00
PHST- 2018/07/31 00:00 [received]
PHST- 2018/11/06 00:00 [revised]
PHST- 2018/11/09 00:00 [accepted]
PHST- 2018/12/12 06:00 [pubmed]
PHST- 2021/01/30 06:00 [medline]
PHST- 2018/12/12 06:00 [entrez]
AID - 10.1111/jpc.14321 [doi]
PST - ppublish
SO  - J Paediatr Child Health. 2019 Aug;55(8):943-947. doi: 10.1111/jpc.14321. Epub 
      2018 Dec 8.