艾滋病合并隐球菌性脑膜炎19例临床分析

Clinical analysis of 19 AIDS patients coinfected with cryptococcus meningitis

目的探讨艾滋病合并新型隐球菌性脑膜炎的临床特征。方法对19例艾滋病合并新型隐球菌性脑膜炎患者的临床资料进行回顾性分析。结果 19例患者临床表现以头痛(100%)、恶心/呕吐(94.7%)、发热(78.9%)、颈强直(84.2%)为主。7例CSF蛋白升高,10例CSF葡萄糖下降及11例CSF压力升高。CD4+细胞计数平均值为(58.9±27.8)/mm3。影像学检查显示多为脑积水、脑梗死、脑萎缩和脑疝。两性霉素B、两性霉素B脂质体、氟康唑和氟胞嘧啶的使用率为31.6%、21.1%、47.4%和47.4%,仅2例接受抗逆转录病毒治疗。19例患者误诊率为31.6%,死亡率为21.1%。结论艾滋病合并新型隐球菌性脑膜炎起病隐匿,临床表现不典型,误诊率较高,及早诊断并早期使用抗真菌/抗逆转录病毒治疗有助于控制其发展。

Objective To observe the clinical features of AIDS coinfected with cryptococcus meningitis. Methods The clinical data of 19 AIDS patients coinfected with cryptococcus meningitis were retrospectively analyzed.Results Among 19 patients, the main clinical manifestation including headache （100.0%）, nausea/vomiting （94.7%）, fever （78.9%） and neck stiffness （84.2%）.Seven cases revealed increased CSF protein, 10 cases showed depressed CSF glucose levels and 11 patients revealed elevated CSF pressures.The mean CD4＋cell count was （58.9 ±27.8）/mm3.Imaging examination showed the neurological complications were hydrocephalus, cerebral infarction, cerebral atrophy and cerebral hernia.The usage rate of amphotericin B, amphotericin B liposome, fluconazole and fluorine cytosine was 31.6%, 21.1%, 47.4% and 47.4%, respectively.Only 2 cases received antiretroviral therapy.The misdiagnosis rate was 31.6%, and mortality rate was 21.1%.Conclusions AIDS coinfected with cryptococcus meningitis onsets hidden, with the clinical manifestation is atypical, and the misdiagnosis rate is higher.Early diagnosis and early usage of appropriate antifungal therapy/antiretroviral therapy can help to prevent the development of it.