影响隐球菌性脑膜炎确诊的因素分析

Analysis of the factors of affecting diagnosis of cryptococcal meningitis

目的分析影响隐球菌性脑膜炎确诊的因素方法回顾性分析9例经病原学证实的隐球菌性脑膜炎的临床表现及误诊情况,结果9例患者中男性5例,女性4例首发症状表观为口角歪斜1例,咳嗽、咳痰1例,头昏、双下肢震颤1例,其余6例均表现有头痛,其中2例出现呕吐,3例出现发热9例患者中7例误诊(77.8%),3例误诊为结核性脑膜炎,2例误诊为病毒性脑膜炎,1例误诊为面神经炎、脑干肿瘤,1例误诊为枕神经痛结论隐球菌性脑膜炎临床表现复杂多样,颅脑CT和MRI无特异性,早期易误诊,提高对该病的认识及多次脑脊液查找隐球菌是防止漏诊、误诊的关键。

Objective To investigate the factors of affecting diagnosis of cryptococcal meningitis. Methods The clinical manifestations and misdiagnosis state in 9 patients (5 male and 4 female)with cryptococcal meningitis who were diagnosed by etiological examination were retrospectively analyzed. Results The first symptoms were different among 9 patients, one case was distortion of commissura of lips, one case was cough and expectoration, one case was dizziness and both lower extremities thrilling. The other 6 patients presented with headache, among these patients 2 patients appeared vomiting,3 patients appeared fever.7 of 9 patients were misdiagnosed (77.8%),3 patients were misdiagnosed as tubereulous meningitis,2 patients were misdiagnosed as viral meningitis,one patient was misdiagnosed as facial neuritis and brain stem tumor, the other one was misdiagnosed as occipital neuralgia. Conclusion The clinical manifestations of crvptococcal meningitis are diverse,head CT and MRI are short of specialty and are liable to mis-diagnosis.The kevs of preventing misdiagnosis are to enhance the recognition lor the disease and to search repeatedly cryptococcus in cerebrospinal fluid.