格特隐球菌肺炎合并脑膜炎1例

A case of Cryptococcus gattii pneumonia complicated with meningitis

对人类致病的隐球菌主要是新型隐球菌和格特隐球菌,其中新型隐球菌感染要远高于格特隐球菌。格特隐球菌存在VGⅠ、VGⅡ、VGⅢ和VGⅣ四种类型,我国的患者主要感染的VGⅠ型,这例病例为格特隐球菌VGⅢ型感染,实属罕见。本病例因头痛入院,行颅脑增强核磁及胸部CT后,考虑为肺癌合并脑转移,后通过脑脊液检查确诊为格特隐球菌VGⅢ型感染,经抗真菌治疗后病情好转。通过本病例总结了以下经验教训:病原学培养或者病理是诊断隐球菌感染的金标准,不能单纯依靠影像学诊断或排除隐球菌。并且涂片镜检和荚膜抗原、普通培养不能很好地区分新型隐球菌和格特隐球菌,新一代高通量测序(NGS)是区分这两种不同类型的隐球菌的比较可靠的方法之一。

Cryptococcus neoformans and Cryptococcus gattii are the main pathogenic cryptococcus to humans,and Cryptococcus neoformans infection is much higher than Cryptococcus gattii.There were four types of Cryptococcus gattii,including VGⅠ,VGⅡ,VGⅢand VGⅣ.VGⅠwas the main type of Cryptococcus gattii infection in Chinese patients,and this case was infected with VGⅢ,which was rare.The patient was admitted to the hospital due to headache.After brain enhanced magnetic resonance imaging and chest CT,the patient was considered to be lung cancer with brain metastasis,and then Cryptococcus gattii VGⅢinfection was diagnosed by cerebrospinal fluid examination.This case summarizes the following lessons:Pathogen culture or pathology is the gold standard for the diagnosis of cryptococcus infection,and imaging diagnosis or exclusion of cryptococcus cannot be relied on alone.Smear microscopy,capsular antigen and common culture cannot distinguish Cryptococcus neoformans from Cryptococcus gattii.Next generation sequencing(NGS)is one of the more reliable methods to distinguish these two different types of Cryptococcus.