Twelve patients with cryptococcosis, which is a systemic infection caused by Cryptococcus neoformans, admitted to the Pediatric department of Yonsei University College of Medicine over thirteen years were reviewed. The diagnosis was made by either the India ink preparation.. or culture of the. cerebrospinal fluid and tissue sections and their cultures.
The age distribution was from 17 months to 13 years with a sex ratio of 1.4 : 1 of maje predominance. The signs and symptoms of cryptococcosis were fever in seven patients, headache in six patients, vomiting and -abdominal pain in four patients each, anorexia, convulsions and jaundice in two patients each, in that order of frequency. The organ system clinically involved most frequently was the central nervous system (10 patients). The organisms were found in other organs which were lymphncdes and skin (three patients each), liver (two patients), and lung (one patient). The usual therapy upto 1974 was the administration of amphotericin B. Of six patients who died, two died before adequate treatment, and four died despite amphotericin B treatment. Only one patient survived with amphotericin B treatment. Since 1975, 5-fluorocytosine has been available and five.patients who were admitted after 1974, were all alive and well for at least nine to 24 months after discharge. Of six patients who -had meningeal sings with central nervous system involvement, five died, but only one died among four patients with disseminated infection who had no meningeal signs.
With the advantage of oral administration and the fewer side effects of 5-fluorocytosine, it will probably replace amphotericin B as the treatment of choice for cryptococcosis although further trials are needed.
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