新型隐球菌脑炎/脑膜炎4例临床分析并文献复习

Clinical Analysis of 4 Cases of Cryptococcus Neoformans Meningoencephalitis or Meningitis:Report and Literature Review

目的:报告新型隐球菌脑炎/脑膜炎4例,并结合文献检索探讨其临床特点及可能的发病机制。方法:回顾分析4例病原学诊断明确的新型隐球菌脑炎/脑膜炎的临床资料,结合文献检索探讨其发病特点及可能发病机制。结果:患者主要表现为头痛、发热、恶心、呕吐及意识障碍;4例均在脑脊液培养中发现新型隐球菌,其中2例墨汁染色发现新型隐球菌;免疫力低下患者易感;脑脊液压力高;主要与结核性脑炎/脑膜炎鉴别;常用的临床治疗方案是两性霉素B联合氟胞嘧啶诱导治疗,氟康唑维持及巩固治疗。结论:中枢神经系统隐球菌病临床表现无特异性,脑脊液墨汁染色阳性率低,在临床诊断过程中对疑似患者,需要反复多次行脑脊液墨汁涂片及培养,减少患者误诊和漏诊。

Objective： To report clinical data of 4 patients with cryptococcus neoformans meningoencephalitis or meningitis （CM） and to employ literature retrieval in determining clinical features and potential pathogenesis. Methods： Clinical data of 4 cases of CM with a confirmed etiological diagnosis were analyzed retrospectively, and literature retrieval was used to investigate clinical features and possible pathogenesis. Results： The main clinical manifestation consisted of headache, fever, nausea, vomiting, and disruption of consciousness.Cryptococcus neoformans was found in the cerebrospinal fluid （CSF） culture of all 4 patients, and the ink stain of the CSF of 2 of these patients were positive for cryptococcus neoformans. Immunocompromized individuals are susceptible. CSF pressure is heightened. Differential diagnosis includes tuberculous encephalitis/meningitis. The current clinically recommended treatment is amphotericin B with flucytosine in induction treatment and fluconazole in consolidation and maintenance treatment. Conclusion： Clinical presentation of CM varies greatly and shows low positive rate in the ink stain of CSF. During the clinical diagnosis process, repeated ink stain examination and culturing of CSF can help reduce misdiagnosis and missed diagnosis.