隐球菌脑炎和(或)脑膜炎三例及文献复习

Three cases of cryptococcal encephalitis and(or)meningitis and a review of the literature

回顾性分析3例经病原学确诊为隐球菌脑炎和(或)脑膜炎患者的临床及影像资料。3例患者临床症状均以头痛为主,其中1例患者表现为孤立性头痛,查体无颈强直、无神经系统局灶性定位体征,既往糖尿病史;其他2例患者表现为头痛伴颅高压。经脑脊液培养均确诊为隐球菌脑炎和(或)脑膜炎。对于孤立性头痛的患者,临床医师很少把隐球菌脑炎和(或)脑膜炎作为首要考虑。然而,头痛是隐球菌脑炎和(或)脑膜炎最典型的临床表现,并且隐球菌感染越来越多见于免疫功能正常的非艾滋病人群,可导致急性脑梗死。因此,本文作者总结分析3例隐球菌脑炎和(或)脑膜炎患者的诊疗过程,旨在提高临床医师对该病的早期识别和诊疗。

A retrospective analysis of the clinical and imaging data of three patients diagnosed with cryptococcal encephalitis and(or)meningitis through pathogen identification was conducted.All three patients presented with headaches as their main symptom.One patient exhibited isolated headaches without neck stiffness or focal neurological signs and had a history of diabetes.The other two patients presented with headaches accompanied by increased intracranial pressure.Cerebrospinal fluid cultures confirmed cryptococcal encephalitis and(or)meningitis in all cases.Clinicians rarely consider cryptococcal encephalitis and(or)meningitis as a primary diagnosis for patients with isolated headaches.However,headache is the most typical clinical manifestation of cryptococcal encephalitis and(or)meningitis,which is increasingly seen in immunocompetent,non-HIV-infected individuals and can lead to acute cerebral infarction.The authors of this paper summarizes and analyzes the diagnosis and treatment processes of three cases of cryptococcal encephalitis and(or)meningitis to enhance early recognition and management of this condition by clinicians.