儿童隐球菌性脑膜炎临床分析

Clinical profile of cryptococcal meningitis in children

目的分析并讨论儿童隐球菌性脑膜炎的临床特点、诊断及治疗方法等。方法回顾性分析上海长征医院皮肤科在1993年3月至2008年6月间16例经病原学确诊的隐球菌性脑膜炎患儿临床资料。结果患儿平均年龄7.25岁(2～15岁),男女比例2.2:1,主要症状包括头痛(87.5%)、发热(81.25%)、恶心呕吐(75%)等,10例颅内压升高。确诊依据脑脊液真菌涂片、培养或隐球菌抗原检查。治疗采用两性霉素B和(或)两性霉素B脂质体静滴,5-氟胞嘧啶口服,辅以两性霉素B鞘内注射,联合氟康唑、伊曲康唑等药物治疗。16例患儿痊愈9例,病情明显好转5例,死亡2例。结论儿童隐球菌性脑膜炎起病缓慢,临床症状缺乏特异性,对疑有中枢神经系统感染性疾病时,应及早行脑脊液检查,并反复多次检查、联合检查以确定诊断,减少误诊、漏诊。早期诊断和及时、系统、足量、长程的抗真菌治疗是提高治愈率和患儿生存质量的关键。

Objective To analyze and review the clinical characteristics, diagnosis and treatment of cryptococcal meningitis in children. Methods Between March 1993 and June 2008, 16 non-HIV-infeeted children were diagnosed as eryptococcal meningitis at Changzheng hospital. A retrospective review of medical records and findings was described. Results The children had a male predominance （2.2： 1 ） and a median age of 7.25 years （range, 2 - 15 yr）. Headache （87.5%） , fever （81.25% ） , and nausea or vomiting （75%） were most common presenting symptoms. Ten of 16 patients had abnormal intracranial pressure. The diagnosis of eryptoeoeeal meningitis was made by the positive results of CSF smear or culture, and/or eryptocoecal latex agglutination test. All the patients who survived received amphoterieine B and/or amphoterieine B liposome with 5-FC as basic medication, combined with amphoterieine B intrathecal injection and oral fluconazole or itraeonazole, except two children who died of cerebral hernia and lupus nephritis induced renal failure, respectively. Conclusion First-time examination of cerebrospinal fluid is suggested for suspected CNS infectious disease in children, because the clinical characteristics of cryptoeeal meningitis are lack of specificity. Early diagno- sis and systematical, full-dosage, long-term antifungal treatment is the key to raise the cure rate and promote the life quality.