两性霉素B鞘内注射治疗隐球菌性脑膜炎

Intrathecal injection of amphotericin B in treatment of patients with cryptococcal meningitis

目的探讨隐球菌性脑膜炎的临床特征、治疗方法及其效果。方法对2010年9月至2012年6月郑州大学第一附属医院儿科收治的3例隐球菌性脑膜炎患儿的临床特征及治疗方法等进行回顾，无菌抽取患儿脑脊液进行墨汁染色，均为阳性。结果3例患儿临床表现多为发热、头痛、呕吐，其中1例出现复视、嗜睡、昏迷、抽搐，3例均通过脑脊液墨汁染色发现有隐球菌，1例脑脊液培养出新型隐球菌，2例脑实质有异常信号改变，2例前期静脉应用氟康唑、两性霉素B，口服5-氟胞嘧啶，出现病情加重或静脉炎后，改为鞘内注射两性霉素B，口服氟康唑、5-氟胞嘧啶，1例确诊后即鞘内注射两性霉素B，现3例已痊愈。结论隐球菌脑膜炎患儿的临床症状多样且不典型，由于年龄限制，部分患儿不能准确表达症状，故易误诊、延误治疗，在静脉应用“两性霉素B”病情渐加重或出现静脉炎的情况下改用鞘内注射，患儿病情明显得以控制，治疗时间较长．最终治愈。

Objective To investigate the clinical characterizes, effect and treatment of patients with cryptococcal meningitis. Methods Three patients with cryptococcal meningitis from September 2010 to May 2012 were selected, and their clinical characteristics and therapy were reviewed. The cerebrospinal fluids samples were collected from these patients. Ink stain in CSF was positive in all patients. Results The clinical manifestation of 3 patients showed to be complication, including fever, headache and vomiting. One patient had diplopia, drowsiness, coma, spasm. Ink stain in CSF was positive in three patients. The Cryptococcus neoformans was detected from the CSF of 1 patient, 2 patients had abnormal signals in cerebral parenchyma, 2 patients were inserted intravenous drips with amphotercin B and fluconazole, took 5-flucytosine. When these 2 patients got worse or phlebitis, amphotercin B was used through intrathecal injection, 1 patient after diagnose was treated with intrathecal injection, now 3 patients had been cured. Conclusions The clinical symptoms of patients with cryptococcal meningitis or cryptococcal vaccination are various and atypical, some patients can not express symptoms exactly due to little age, so it is easy to miss diagnose and delay treatment, when it gets worse with intravenous injection, intrathecal injection can control and cure this disease though treatment costs too long time.