儿童隐球菌感染的治疗和预后分析

Analysis on the Treatment and Prognosis of Children with Cryptococcal Infection

目的 分析儿童隐球菌感染的治疗及预后。方法 8例隐球菌感染患儿均经临床和真菌学检查确诊。其中7例隐球菌性脑膜炎,1例隐球菌皮肤淋巴结感染;前者治疗采用二性霉素B或二性霉素脂质体静注及自身脑脊液(CSF)稀释的二性霉素B鞘内注射,后者给予伊曲康唑口服。治疗前后检测肝肾功能、血常规、尿常规,墨汁涂片菌体计数,并密切观察病情变化。结果 8例患儿经治疗后治愈5例、显效2例、有效1例,有效率为87.5％。所有患儿治疗后均未见肝肾功能、血尿常规的明显变化。隐球菌性脑膜炎患儿中,4例出现颅内压增高、视力下降、听力障碍,1例临床治愈患儿的CSF仍有新生隐球菌菌落生长。伊曲康唑治疗患儿未见明显不良反应。结论 儿童隐球菌感染药物治疗有效。儿童隐球菌脑膜炎颅内压增高导致的视力和听力下降等后遗症较为严重;临床治愈患者CSF中仍可能有菌体存活。

Objective To analyse the treatment and prognosis of children with cryptococcal infection. Methods 8 children was diagnosed as the cryptococcal infection according to the clinical and fungus examination. 7 of them had cryptococcal meningitis treated with amphotericin B or AmBisome con-tinous intravenous injection and intrathecal injection of amphotericin B diluted with autologous cerebral spinal fluid (CSF). While one child suffered from cutaneous and lymphonode cryptococcal infection and received oral intraconazole treatment. Liver and renal function test, blood and urine routine examination as well as the thick - capsule - spherales in CSF stained with the India ink were examined before and after treatment with clinical observation closely. Results The results showed 5 of 8 these children have been cared with 2 having significant response and 1 getting response. The total effective rate was 87. 5% . No one had liver and renal function abnormality as well as abnormal blood urine reactive examination. Results In 7 children with cryptococcal meningitis, 4 presented with intracranial hypertension blurring of vision and addition disturbance. Crytococcus neoformans colony still could be found in CSF culture in one child, even he was considered as clinical care. Whereas, no significant adverse effect could be discovered in the children treated with intraconazole. Conclusion Amphotericin B or AmBisome could be used effectively to treat the children with cryptococcal infection. Blurring of vision and audition disturbance were the most severe sequela resulting from the intracranial hypertension in children with cryptococcal meningitis. Crypto-coccus neoforman could still survive in CSF, even in the children who was considered as cured in clinical point of view.