肾移植术后隐球菌性脑膜炎的临床分析

A clinical analysis of renal transplant patients with cryptococcal meningitis

目的分析肾移植术后隐球菌性脑膜炎的临床特点,以期提高临床医生的诊治水平。方法回顾性分析肾移植术后隐球菌性脑膜炎的临床表现、实验室检查和治疗预后。结果 4例患者中,男2例,女2例,全部为首次同种异体肾移植。所有患者均有发热和头痛症状,多表现为轻度头痛和低热。3例患者隐球菌涂片和培养均为阳性。所有患者分别给予两性霉素B脂质体、伏立康唑、5-氟胞嘧啶等抗真菌治疗,其中1例合并两性霉素B鞘内注射。经2～4个月治疗后,4例隐球菌涂片转阴,临床症状消失,均在我院随访,至今未复发。结论肾移植术后隐球菌性脑膜炎首发症状隐匿,临床表现不典型,极易误诊漏诊。早期明确诊断、多科室协作、规范足量治疗是提高此病救治成功的关键。

Objective To analysis the clinical features of renal transplant patients with cryptococcal meningitis, and the difficulties of the diagnosis and treatment.Methods Four patients with cryptococcal meningitis after renal transplantation were involved in this study.The clinical manifestations,laboratory data,treatment and prognosis were analyzed.Results Four patients,2 male and 2 female, were underwent renal transplantation for the first time.The clinical manifestations included headache and fever.Three patients were confirmed cryptococcal meningitis by CSF culture and means of India ink. All patients were given antifungal treatment of amphotericin B liposome, voriconazole, and 5-flucytosine, while 1 patient was given amphotericin B intrathecal injection. After 2-4 months treatment, the results of cryptococcus smear turned negative, and clinical symptoms disappeared in 4 patients. Now all the 4 patients are still in follow-up, and there are no relapse.Conclusions Renal transplant patients with cryptococcal meningitis presented atypical clinical manifestations, which made it extremely difficult to diagnosis. Early diagnosis,timely treatment,and cooperation between different departments are the key to improve outcomes.