22例艾滋病合并隐球菌血流感染患者的临床特征

Clinical features of 22 AIDS patients complicated with cryptococcal bloodstream infection

目的探讨艾滋病合并隐球菌血流感染患者的临床特征。方法回顾性分析22例艾滋病合并隐球菌血流感染的住院患者的临床表现,实验室、脑脊液检查和药敏试验的结果,以及治疗和预后情况等临床资料。结果22例艾滋病患者中,5例合并巨细胞病毒感染,5例合并肺结核,4例合并肺孢子菌肺炎,12例合并隐球菌性脑膜炎;临床表现包括发热、头痛、恶心呕吐、认知障碍、视力下降;22例实验室检查提示CD4+T淋巴细胞计数均<100个/μL;脑脊液检查结果提示9例(75%)患者脑脊液压力≥200 mmHg,3例(25%)患者脑脊液外观浑浊,6例(50%)患者脑脊液葡萄糖含量下降,7例(58%)患者脑脊液氯化物含量下降,7例(58%)患者脑脊液蛋白定量升高;药敏试验提示21例对两性霉素B、伊曲康唑、伏立康唑、氟康唑和氟胞嘧啶敏感,1例对两性霉素B耐药。经治疗,3例(14%)患者病情好转,7例(32%)患者死亡,12例(55%)患者放弃治疗后失访。结论艾滋病合并隐球菌血流感染常发生在CD4+T淋巴细胞计数<100个/μL的患者,通常对两性霉素B、伊曲康唑、伏立康唑、氟康唑和氟胞嘧啶敏感,易并发隐球菌性脑膜炎,治疗效果差,死亡率高。

Objective To investigate the clinical features of AIDS patients complicated with cryptococcal bloodstream infection.Methods The clinical data of 22 hospitalized AIDS patients complicated with cryptococcal bloodstream infection were retrospectively analyzed,including clinical manifestations,laboratory and cerebrospinal fluid examinations and drug susceptible test results,treatment,and prognosis.Results Among the 22 AIDS patients,5 cases were complicated with cytomegalovirus infection,5 cases were complicated with pulmonary tuberculosis,4 cases were complicated with Pneumocystis pneumonia,and 12 cases were complicated with cryptococcal meningitis.Their clinical manifestations included fever,headache,nausea and vomiting,cognitive impairment,and decreased visual acuity.The laboratory examinations results showed that 22 cases had CD4+T lymphocyte counts<100/μL.The cerebrospinal fluid examinations results showed 9 cases(75%)had cerebrospinal fluid pressure≥200 mmHg,3(25%)had turbid cerebrospinal fluid,6(50%)had decreased cerebrospinal fluid glucose levels,7(58%)had decreased cerebrospinal fluid chloride levels,and 7(58%)had increased cerebrospinal fluid protein levels.Results of drug susceptible tests showed that 21 cases were sensitive to amphotericin B,itraconazole,voriconazole,fluconazole,and flucytosine,and 1 case was resistant to amphotericin B.After treatment,3 cases(14%)improved,7 cases(32%)died,and 12 cases(55%)were lost to follow-up after giving up treatment.Conclusion AIDS complicated with cryptococcal bloodstream infection often occurs in patients with a CD4+T lymphocyte count of<100/μL,who are usually sensitive to amphotericin B,itraconazole,voriconazole,fluconazole,and flucytosine,and are prone to cryptococcal meningitis,with poor treatment response and high mortality.