76例儿童隐球菌性脑膜炎临床分析

中国真菌学杂志　 2021, Vol. 16 　Issue (1): 24-28.

76例儿童隐球菌性脑膜炎临床分析

刘文卉, 陈军华

重庆医科大学附属儿童医院感染科, 儿童发育疾病研究教育部重点实验室, 国家儿童健康与疾病临床医学研究中心, 儿童发育重大疾病国家国际科技合作基地, 儿童感染免疫重庆市重点实验室, 重庆 400014

收稿日期:2020-03-10 发布日期:2021-02-25
通讯作者: 陈军华,E-mail:cjh460@163.com E-mail:cjh460@163.com
作者简介:刘文卉,女(汉族),硕士,住院医师.E-mail:1175343413@qq.com

Clinical analysis of 76 pediatric cases of cryptococcal meningitis

LIU Wenhui, CHEN Junhua

Department of infection, Children's Hospital of Chongqing Medical University;Ministry of Education Key Laboratory of Child Development and Disorders;National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders;Chongqing Key Laboratory of Child Infection and Immunity, Chongqing 400014, China

Received:2020-03-10 Published:2021-02-25

摘要/Abstract

摘要： 目的分析儿童隐球菌性脑膜炎临床特点。方法回顾性分析76例隐球菌性脑膜炎患儿临床资料。结果男47例，女29例，平均年龄（6.34±3.67）岁；主要临床表现为发热（100%）、头痛（78.95%）、呕吐（81.58%）；首次脑脊液墨汁染色阳性46例（60.53%），首次脑脊液真菌培养阳性21例（27.63%），两性霉素B联合5-氟胞嘧啶抗真菌治疗好转率（74.19%），两性霉素B联合氟康唑治疗好转率（62.96%），差异无统计学意义（P=0.75）。结论儿童隐球菌性脑膜炎极易误诊、漏诊，反复、多次腰穿有助于早期诊断；两性霉素B联合5-氟胞嘧啶是抗真菌治疗首选方案，早期诊断、积极降颅压是改善预后的关键。

关键词: 儿童, 隐球菌性脑膜炎, 临床分析

Abstract: Objective To analyze the clinical features of cryptococcal meningitis in children. Methods Clinical date of 76 children with cryptococcal meningitis were analyzed. Results There were 47 males and 29 females, with an average age of (6.34±3.67) years. The main clinical manifestations were fever (100%), headache (78.95%) and vomiting (81.58%). The etiological test turned out that the positive rate of cerebrospinal fluid ink staining accounted for 60.53% (46 cases), the cryptococcal culture positive rate accounted for 27.63%(21 cases) at the first time. There were 74.19% patients cured after receiving the combined treatment of amphotericin B and 5-fluorocytosine, 62.96% patients cured after receiving the treatment of amphotericin B and fluconazole, but the difference was not statistically significant(P=0.75). Conclusions Crypotococcal meningitis in children was easely misdiagnosed, multiple and repeated lumbar punctures were beneficial to the diagnosis. amphotericin B combined with 5-fluorocytosine was the first choice for antifungal therapy.The key to improve the prognosis was early diagnosis and reduce intracranial pressuer effectively.

Key words: children, cryptococcal meningitis, clinical analysis

中图分类号:

R519.4

刘文卉, 陈军华. 76例儿童隐球菌性脑膜炎临床分析[J]. 中国真菌学杂志, 2021, 16(1): 24-28.

LIU Wenhui, CHEN Junhua. Clinical analysis of 76 pediatric cases of cryptococcal meningitis[J]. Chinese Journal of Mycology, 2021, 16(1): 24-28.

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