隐球菌性脑膜炎的诊断与治疗

Cryptococcal meningitis:Diagnosis and treatment

隐球菌性脑膜炎是由隐球菌属,特别是新生隐球菌及格特隐球菌引起的机会性感染,在免疫抑制者及正常人群均可发病。隐球菌性脑膜炎早期诊断困难,即便接受治疗,患者死亡率仍然很高。在过去几年中,快速及时的检测及早期隐球菌抗原检查取得了重大进展。对晚期HIV感染者行血隐球菌荚膜抗原筛查并进行抢先治疗,有望阻止其进展为临床感染。目前抗真菌药物主要包括多烯类、唑类及氟胞嘧啶,未来药物研究的重点是疗效更好、毒性更小的新型口服抗真菌药。本文总结近几年隐球菌性脑膜炎的相关诊断及治疗进展,旨在对隐脑患者诊疗提供帮助。

Cryptococcal meningitis is an opportunistic infection caused by Cryptococcus spp. , especially C. neoforrnans and C. gattii. It can occur in both immunosuppressive and apparently immunocompetent pa- tients. The diagnosis of cryptococcal meningitis is difficult in early stage, and the mortality rate remains high despite of treatment. Over the past few years, advances have been made in rapid point-of-care diagnosis and early detection of cryptococcal antigen in the blood. The screening and pre-emptive treatment of cryptococcal antigenemia in patients with late-stage HIV infection is expected to prevent the development of clinical infec- tion. At present, antifungal drugs mainly include polyenes, azoles and flucytosine, and the emphasis of re- search should be put on developing new oral antifungal agents with better efficacy and less toxicity in the fu- ture. The aim of this article is to provide helpful information for the diagnosis and treatment of cryptococcal meningitis.