30例儿童隐球菌性脑膜炎的临床分析

Cryptococcal meningitis in children: a retrospective study of 30 cases

目的探讨儿童隐球菌性脑膜炎的临床特点及治疗,提高对儿童隐球菌性脑膜炎的认识。方法回顾性分析30例隐球菌性脑膜炎患儿的临床资料。结果男性21例,女性9例,平均年龄(7.25±3.75)岁。临床表现主要为发热(96.67%)、呕吐(86.67%)、头痛(76.67%)和颈强直(73.33%)。30例患儿均行脑脊液检查,其中墨汁染色涂片、培养阳性率分别为90.00%和76.67%。10例行两性霉素B药敏试验,3例耐药;9例氟康唑药敏试验,8例耐药。21例予两性霉素B或锋克松治疗>7 d,2007年至2011年收治患儿的两性霉素B或锋克松总用量、平均用量和疗程明显高于2001年至2006年,差异有统计学意义(P<0.05)。结论儿童隐球菌性脑膜炎多见于学龄前和学龄期儿童,男性多见,以发热、头痛、呕吐、颈项强直为常见临床表现,墨汁染色涂片及真菌培养阳性率高。近年隐球菌性脑膜炎治疗较前困难,可能是因隐球菌对氟康唑耐药现象严重,而且对两性霉素B也有耐药株产生。

Objective To explore the characteristics of cryptococcal meningitis in children to improve diagnosis and treatment. Methods A retrospective study was performed on the clinical data of 30 children with cryptococcal meningitis. Results Twenty-one males and 9 females were enrolled in this study with mean age of （7.25±3.75） years. The main clinical manifestations included fever （96.67%% vomiting （86.67%）, headache （76.67%） and neck rigidity （73.33%）. All cases underwent lumbar puncture and the positive rates of India ink smear and culture were 90.00% and 76.67% respectively. Ten cases under- went drug sensitivity tests. Three of 10 showed amphotericin B resistance and 8 of 9 showed fluconazole resistance. Twenty-one cases were treated with amphotericin B or amphotericin B liposome over 7 days. Data analysis showed that the total dosage of amphotericin B or amphotericin B liposome, the average dose and course of treatment during the period of 2007 to 2011 were higher than those of 2001 to 2006 （P〈0.05）. Conclusions Cryptococcal meningitis in children mainly occurs in preschool and school age children and is common in males. The main clinical manifestations included fever, headache, vomit and neck rigidity. India ink smear and fungi culture are usually used for the diagnosis. It becomes more difficult to treat cryptococcal meningitis than before due to increased incidence of fluconazole-resistance and the occurrence of new isolates of amphotericin B.