摘要
目的:探讨新型隐球菌性脑膜炎(CM)合并肺隐球菌病(CP)的临床及影像学特点。方法:对10例经病原学检查证实的CM合并CP的临床资料进行回顾性分析。结果:(1)8例男性,2例女性,年龄4~62岁,平均(31.3±23.2)岁。病程14~120天,平均(40.0±39.7)天。(2)首发症状发热8例、头痛6例、咳嗽咯痰2例、胸痛1例。(3)有基础疾病者8例,其中慢性乙型病毒性肝炎6例、矽肺并肺结核2例、营养不良1例、鼻窦炎1例。(4)9例均被误诊为结核感染。1例误诊为肺癌。(5)胸片表现为两肺散在分布小片状、小结节阴影,边缘模糊、内见不规则低密度区;CT示两肺广泛分布斑片状和斑点状密度增高影、大小不等的空洞或类圆形边缘光滑高密度结节。(6)应用二性霉素B(AMB)联合氟康唑(FCZ)静滴和AMB鞘内注射治疗,治愈6例,好转4例。结论:CM合并CP临床症状和影像学均缺乏特异性,提高对CP影像学的认识有利于早期诊断。
Objective: To investigate the clinical feature and imaging character of cryptococcal meningitis complicated with pulmonary cryptococcosis. Methods: The clinical dates of ten cases with cryptococcal meningitis complicated with pulmonary cryptococeosis proved by etiology examination were analysed retrospectively. Results: There were eight men and two weman aged from 4-80 (36.0±23.7)years old and with course from 15-120 (38.5±31. 1) days. The first symptoms were febrility (n=8),cough and stechocatharsis (n=2) and chest pain(n=1). There were 8 cases with underlaying diseases including chronicity viral hepatitis B(n = 6 ), pneumonokoniosis and pulmonary tuberculosis(n = 2), dystrophy( n= 1 ) , naso inusitis(n= 1 ). Nine cases were misdiagnosied as pulmonary tuberculosis while one was misdiagnosied as lung cancer. X-ray plain film of lung show diffused distribution of nodule and fragment shadows with unsharpness edge and irregular low density areas in center. CT of lung show diffused distribution of plaque and spottiness with high density, cavity with inequlity of size and ellipse nodus with sharpness edge and high density. Cases received treatment with Amphotercin B combination fluconazol by vein and intrathecal injection of Amphotercin B. Five cases were cured and five were improved. Conclusion: The clinical feature and imaging character of cryptocoecal meningitis complicated with pulmonary cryptococcosis have no specificity. To enhancement the cognition of image feature of pulmonary cryptococcosis would be helpful for early diagnosis.
出处
《中国医药导刊》
2008年第1期34-37,共4页
Chinese Journal of Medicinal Guide
基金
湖南省卫生厅科研基金资助(B2006-199)