肾移植术后新型隐球菌性脑膜炎的临床诊治分析

Single-center clinical study of cryptococcal neoformans meningitis after renal transplantation:a retrospective analysis

目的:分析肾移植患者新型隐球菌性脑膜炎的临床特征及诊治难点。方法:收集2014年6月至2019年9月温州医科大学附属第一医院肾移植术后感染新型隐球菌性脑膜炎患者的临床资料及治疗情况进行回顾性分析。结果:9例感染隐球菌性脑膜炎中首发症状发热7例,头痛4例,咳嗽2例,视物模糊2例,意识障碍1例;肾移植术后感染发病时间1.6~14年,发病至确诊时间8~42 d。脑脊液培养阳性8例。以他克莫司(TAC)+吗替麦考酚酯(MMF)+甲泼尼龙(PRED)为基础的免疫抑制方案,经过5氟胞嘧啶(5FC)5 g/d+两性霉素B脂质体(L-AmB)3 mg/(kg·d)等抗真菌足量治疗5~11.5个月,随访6个月后,完全缓解5例,部分缓解3例,死亡1例。结论:肾移植术后隐球菌性脑膜炎临床表现多样性,潜伏期长,病程久。早发现、早诊断、多科室协作、规范足量治疗是提高该病救治成功的关键。

Objective:To analyze the clinical characteristics and difficulties in the diagnosis and treatment of cryptococcal neoformans meningitis in renal transplant patients.Methods:Clinical data of patients with Cryptococcal meningitis after kidney transplantation in the First Affiliated Hospital of Wenzhou Medical University from June 2014 to September 2019 were collected and analyzed retrospectively.Results:Of 320 cases after kidney transplantation,9 were infected with cryptococcal meningitis,with first symptoms including fever(n=7),headache(n=4),cough(n=2),blurred vision(n=2)and consciousness disorder(n=1).The average time of infection after kidney transplantation was(1.6-14)years and the time from onset to confirmed diagnosis was 8-42 D.CSF culture was positive in 8 cases(88.9%).On the basis of tacrolimus+mortymecofenate+meponyolone(TAC+MMF+PRED)immunosuppressive regimen,antifungal therapy such as 5 fluorocytosine(5FC)5G/D+amphotericin B liposome(L-AmB)3 mg·kg-1D-1 were given for(5-11.5)months.After 6-month follow-up,5 cases had complete remission(n=5),5 partial remission(n=5)and 1 case died(n=1).Conclusion:Cryptococcus infection after kidney transplantation is characterized by a variety of clinical manifestations,long incubation period and long course of disease.Therefore,early detection,early diagnosis,multi-department cooperation and adequate standardized treatment are the key to the successful treatment of cryptococcal meningitis.