新型隐球菌脑膜炎53例临床分析

Clinical analysis of 53 patients with Cryptococcus neoformans meningitis

目的总结分析新型隐球菌性脑膜炎的临床特征。方法分析53例新型隐球菌脑膜炎患者的临床表现、实验室检查、治疗及转归。结果新型隐球菌脑膜炎的临床表现以颅内压增高、脑膜刺激征为主。有基础性疾病者30例(占56．6%)。发病前有鸽子、禽类接触史者30例。脑脊液压力升高51例,其中49例超过200 mmH_2O。30例患者应用两性霉素B与氟康唑联合治疗。53例患者治愈4例,好转27例,死亡5例,自动出院17例。结论新型隐球菌性脑膜炎的主要临床表现是进行性颅内压增高。对进行性颅内压增高、脑膜刺激征阳性的患者反复进行脑脊液墨汁染色查新型隐球菌,有助于减少该病的误诊和误治。两性霉素B联合氟康唑静滴治疗隐球菌脑膜炎仍然安全、有效。

Objective To analyze the clinical characteristics of Cryptococcus neoformans meningitis and provide evidence for clinical therapy. Methods Clinical manifestations, data of laboratory examination, features of CT and MRI findings, therapy and prognosis of Cryptococcus meningitis were analyzed retrospectively for 53 patients. Results The main clinical manifestations included intracranial hypertension and signs of meningeal irritation. Thirty patients （56. 6%） had underlying diseases. Thirty （56.6%） had the history of contact with pigeons or poultries. The intracranial pressure increased in 51 cases. The intracranial pressure was higher than 200 mm H2O in 49 cases. Thirty of the fifty-three patients received intravenous amphotericin B and fluconazole combination therapy. In general, 4 of the 53 cases were cured, 27 were improved, 5 died and 17 gave up any further treatment. Conclusions The clinical manifestations of Cryptococcus meningitis are mainly progressive intracranial hypertension. When progressive intracranial hypertension and meningeal irritation syndrome are identified, cerebral spinal fluid should be examined repeatedly by India ink staining in order to prevent misdiagnosis and mistreatment. The analysis indicates that amphotericin B and fluconazole combination therapy remains effective and well tolerated in treatment of Cryptococcus meningitis.