免疫正常人群隐球菌性脑膜炎临床分析

The clinical characteristics of cryptococcal meningitis in apparently immunocompetent patients

目的分析近似免疫正常患者发生隐球菌性脑膜炎的临床表现及特点。方法回顾分析我院近16a来相关隐球菌性脑膜炎患者的临床表现、实验室检查及诊治情况。结果 44例患者中,平均年龄为(35.9±17.2)岁,男女性别比例为1.2∶1。临床表现不典型,以头痛(93.2%)、恶心(70.5%)、呕吐(68.2%)等最为常见。脑脊液压力偏高,平均为(339.3±75.0)mmH2O。42例首次腰穿后脑脊液行隐球菌墨汁染色的患者中,有41例(97.6%)真菌镜检阳性;查到34例患者的脑脊液乳胶凝集试验信息,其中33例(97.1%)阳性;有培养记录的患者有11例,阳性率为100%。44例患者抗真菌治疗诱导期以两性霉素B联合氟胞嘧啶(6例,13.6%)为主。所有患者经抗真菌治疗之后,治愈14例,好转14例,视力听力受累15人,1例女性患者出现轻瘫,所有患者到随访时间为止无死亡病例。结论新生隐球菌也可累及近似免疫正常患者人群,导致隐球菌性脑膜炎,且早期临床表现不典型,极易误诊漏诊,临床医师对此应提高警惕。对疑似病例及早送脑脊液标本行相关真菌学检查是明确诊断的关键。

Objective To analyze the clinical features of cryptococcal meningitis（CM）in apparently immunocompetent patients.Methods Clinical data of 44 CM cases in immunocompetent patients were collected and analyzed in Shanghai Changzheng Hospital from 2000 to 2015.Results Headache,nausea,and fever were the most common leading symptoms of the patients whose mean age was 35.9years old.The difference in the male-to-female gender ratio of immunocompetent patients was not significant in this survey.And the mean pressure of CSF was（339.3±75.0）mmH2O.Cryptococcus neoformans was positively detected using Indian ink stain in 41patients（97.6%,41/42）,followed by CSF cryptococcal antigen latex agglutination test 33 patients,CSF culture was positive in 11 patients.Six patients were given AmB and flucytosine,which was the most common induction therapy.The prognosis was somewhat optimistic of our study,resulting only one patient with mild paralysis.Conclusions Cryptococcal meningitis also can occur in immunocompetent hosts without any apparent underling disease,and the clinical manifestations may be not so typical at early stage,which can lead to misdiagnosis and missed diagnosis.To achieve higher survival and lower mortality rate,relevant CSF examinations are recommended for those suspected patients.