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Aim: To determine the clinical, paraclinical, and prognostic profile of pediatric neuromeningeal cryptococcosis. Methods and Material: This descriptive, retrospective study was conducted in children under 15 years of age hospitalized from March 1st, 2010 to March 31st, 2018 for neuromeningeal cryptococcosis in the infectious diseases department of the Mother and Child Center of the Chantal Biya Foundation in Yaounde. Diagnosis of neuromeningeal cryptococcosis was confirmed by direct examination of the cerebrospinal fluid (CSF) and subsequent staining with India ink and/or culture on Sabouraud medium. Hospital records were assessed for clinical features and laboratory parameters. The univariate logistic regression model was used to identify factors associated with prognosis. The significance level of the comparisons was p <0.05. Results: Total 331 children were hospitalized for infectious meningitis with 12 (3.6%) being confirmed cases of neuromeningeal cryptococcosis. All 12 patients were HIV infected. The mean age at presentation was 11 years with a range of 1-15 years. Clinical manifestations were headache (75%), fever (66.7%), nausea or vomiting (58.3%), convulsions (58.3%), and on clinical examination signs of meningeal irritation (83.5%). All patients had received fluconazole monotherapy. Intra-hospital mortality was 58.3%. Marginally increased cells in the CSF (p=0.04), hypoglycorrhachia (p=0.04), high HIV viral load (p=0.03), and deterioration of consciousness during treatment (p=0.001) were associated with this high mortality. Conclusion: Neuromeningeal cryptococcosis is a severe opportunistic mycosis in HIV-infected children. In our study, it is associated with a high mortality rate, hence the need for early diagnosis and appropriate treatment to improve the prognosis is needed. Introduction Cryptococcosis is a systemic fungus with a subacute or chronic evolution.1,2,3 It is caused by a neurotropic encapsulated yeast, Cryptococcus Neoformans, whose most frequent clinical presentation is meningoencephalitis.2 This is a common infection in immunocompromised patients, and its incidence has increased with the advent of HIV infection.4,5,6 The first cases of neuro-meningeal cryptococcosis (NMC) in children in Africa were described in 1996 involving 3 children in Malawi.7 Although HIV is the leading cause of immunosuppression in Africa and should be routinely investigated, other causes of immunosuppression are possible. These are mainly malnutrition, which is relatively common in sub-Saharan Africa, connective tissue disorders, and visceral or solid tumours. Depending on the region, NMC is present in 2 to 30% of HIV-infected patients, particularly those with less than 100 CD4+/mm3.5,8 It is estimated that the disease is responsible for more than 600,000 deaths per year worldwide.9 In Africa, cryptococcal meningitis is responsible for 13-42% of all deaths in HIV-infected people.8 Sub-Saharan Africa has the highest estimated annual burden with a median incidence in HIV patients of 3.2% and high mortality of 13-40%.5 A study in Cameroon showed that 42.2% of patients with the neuro-meningeal cryptococcal disease died within 21 days of diagnosis, despite being on antifungal treatment with fluconazole.10 Compared to the number of adults, the number of children who acquire cryptococcosis has been inexplicably low, with fewer than 1000 cases of cryptococcosis described in children, including those CONTACT Dr Nguefack Séraphin Email: seraphin_nguefack@yahoo.fr Address for Correspondence: Nguefack Séraphin, BP 4362 YaoundéCameroun. ©2020 Pediatric Oncall ARTICLE HISTORY Received 12 April 2020 Accepted 3 September 2020

Neuromeningeal Cryptococcosis in children: Clinical and prognostic aspects in a Pediatric hospital in Yaoundé - Cameroon