免疫正常人群隐球菌性脑膜炎临床分析

中国真菌学杂志　 2016, Vol. 11 　Issue (2): 99-102.

免疫正常人群隐球菌性脑膜炎临床分析

刘加, 方文捷, 洪南, 李娟, 陈敏, 潘炜华, 廖万清

上海市医学真菌分子生物学重点实验室上海长征医院皮肤病与真菌病研究所全军皮肤病重点实验室第二军医大学附属长征医院皮肤科, 上海 200433

收稿日期:2015-12-21 出版日期:2016-04-28 发布日期:2016-04-28
通讯作者: 廖万清,E-mail:liaowanqing@sohu.com;潘炜华,E-mail:panweihua@medmail.com.cn E-mail:liaowanqing@sohu.com;panweihua@medmail.com.cn
作者简介:刘加,女(满族),硕士研究生在读.E-mail:liuzhenxiang67@163.com
基金资助:
国家973项目(2013CB531601,2013CB531606);重大传染病防治科技重大专项(2013ZX10004612);国家自然科学基金(81201269);上海市科委专项(14DZ2272900)

The clinical characteristics of cryptococcal meningitis in apparently immunocompetent patients

LIU Jia, FANG Wen-jie, HONG Nan, LI Juan, CHEN Min, PAN Wei-hua, LIAO Wan-qing

Shanghai Key Laboratory of Molecular Medical Mycology, Institute of dermatology and fungal diseases, PLA Key laboratory of the fungal diseases, Department of dermatology, Changzheng hospital, Shanghai 200433

Received:2015-12-21 Online:2016-04-28 Published:2016-04-28

摘要/Abstract

摘要：

目的分析近似免疫正常患者发生隐球菌性脑膜炎的临床表现及特点。方法回顾分析我院近16 a来相关隐球菌性脑膜炎患者的临床表现、实验室检查及诊治情况。结果 44例患者中,平均年龄为(35.9±17.2)岁,男女性别比例为1.2:1。临床表现不典型,以头痛(93.2%)、恶心(70.5%)、呕吐(68.2%)等最为常见。脑脊液压力偏高,平均为(339.3±75.0) mmH₂O。42例首次腰穿后脑脊液行隐球菌墨汁染色的患者中,有41例(97.6%)真菌镜检阳性;查到34例患者的脑脊液乳胶凝集试验信息,其中33例(97.1%)阳性;有培养记录的患者有11例,阳性率为100%。44例患者抗真菌治疗诱导期以两性霉素B联合氟胞嘧啶(6例,13.6%)为主。所有患者经抗真菌治疗之后,治愈14例,好转14例,视力听力受累15人,1例女性患者出现轻瘫,所有患者到随访时间为止无死亡病例。结论新生隐球菌也可累及近似免疫正常患者人群,导致隐球菌性脑膜炎,且早期临床表现不典型,极易误诊漏诊,临床医师对此应提高警惕。对疑似病例及早送脑脊液标本行相关真菌学检查是明确诊断的关键。

关键词: 隐球菌性脑膜炎, 近似免疫正常患者, 临床分析

Abstract:

Objective To analyze the clinical features of cryptococcal meningitis (CM) in apparently immunocompetent patients.Methods Clinical data of 44 CM cases in immunocompetent patients were collected and analyzed in Shanghai Changzheng Hospital from 2000 to 2015.Results Headache, nausea, and fever were the most common leading symptoms of the patients whose mean age was 35.9 years old.The difference in the male-to-female gender ratio of immunocompetent patients was not significant in this survey.And the mean pressure of CSF was (339.3±75.0) mmH₂O.Cryptococcus neoformans was positively detected using Indian ink stain in 41 patients (97.6%, 41/42), followed by CSF cryptococcal antigen latex agglutination test 33 patients, CSF culture was positive in 11 patients.Six patients were given AmB and flucytosine, which was the most common induction therapy.The prognosis was somewhat optimistic of our study, resulting only one patient with mild paralysis.Conclusions Cryptococcal meningitis also can occur in immunocompetent hosts without any apparent underling disease, and the clinical manifestations may be not so typical at early stage, which can lead to misdiagnosis and missed diagnosis.To achieve higher survival and lower mortality rate, relevant CSF examinations are recommended for those suspected patients.

Key words: cryptococcal meningitis, immunocompetent hosts, clinical analysis

中图分类号:

R519.4

刘加, 方文捷, 洪南, 李娟, 陈敏, 潘炜华, 廖万清. 免疫正常人群隐球菌性脑膜炎临床分析[J]. 中国真菌学杂志, 2016, 11(2): 99-102.

LIU Jia, FANG Wen-jie, HONG Nan, LI Juan, CHEN Min, PAN Wei-hua, LIAO Wan-qing. The clinical characteristics of cryptococcal meningitis in apparently immunocompetent patients[J]. Chinese Journal of Mycology, 2016, 11(2): 99-102.

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