格特隐球菌致非免疫功能低下者多系统感染一例

Multi-system infection caused by Cryptococcus gattii in a non-immunocompromised patient:a case report

隐球菌是一种二型态机会致病真菌。隐球菌感染多发生于感染HIV、器官移植、长期使用糖皮质激素、化学治疗、慢性白血病、淋巴瘤等免疫功能低下患者中,非免疫功能低下患者多系统感染隐球菌则很少。该文报道了一例格特隐球菌性脑膜炎合并格特隐球菌性肺炎的成年男性患者,其免疫功能正常,以脑膜炎为首发表现,呼吸系统同时受累,行鞘内注射+静脉滴注抗真菌治疗及脑室-腹腔分流术(VPS)治疗,治疗后未诉发热、头痛、咳嗽、咳痰等不适,出院后长期口服氟康唑+氟胞嘧啶,并定期随访。该例患者的诊治过程提示,医务工作者在临床工作中要考虑免疫功能正常人群也可感染隐球菌,在神经系统感染的同时要注意呼吸系统也可能受累,在隐球菌性脑膜炎治疗中除了常规静脉滴注抗真菌治疗外,也可考虑鞘内注射抗真菌药物以及VPS。

Cryptococcus is a dimorphic opportunistic pathogenic fungus.Cryptococcal infection mostly occurs in immunocompromised patients infected with HIV,organ transplantation,long-term use of cortisol hormone,chemotherapy,chronic leukemia and lymphoma,etc.Multi-system cryptococcal infection is rare in non-immunocompromised patients.In this article,one male adult case of Cryptococcus gattii meningitis complicated with Cryptococcus gattii pneumonia was reported.He had normal immune function and presented with meningitis as the initial manifestation and the respiratory system was involved.The patient underwent intrathecal injection+antifungal therapy via intravenous drip and ventriculoperitoneal shunt(VPS).After corresponding interventions,he did not complain of fever,headache,cough,sputum and other discomforts.He received long-term oral intake of fluconazole+flucytosine after discharge,and was subject regular follow-up.The diagnosis and treatment of this case prompt that medical practitioners should consider the possibility that the population with normal immune function can also be infected with Cryptococcus in clinical practice.Both the nervous system and respiratory system can be infected.Besides conventional antifungal therapy via intravenous drip,intrathecal injection of antifungal drugs and VPS can also be considered in the treatment of Cryptococcal meningitis.