疑难病研究——全身性播散性隐球菌病

A difficult and complicated case study: Systemic disseminated cryptococcosis

该文通过 1例全身性播散性隐球菌病的疑难病例分析以期提高临床医师对隐球菌病的认识。隐球菌病是由新型隐球菌引起的深部真菌病 ,起病隐袭 ,临床表现无特异性 ,易漏诊 ,误诊。诱因有长期使用广谱抗生素、激素、抗代谢药物、免疫抑制剂、抗肿瘤药物、慢性疾病和长期静脉插管、留置导尿管等。临床表现包括发热、肝脾淋巴结肿大及肝功能损害、皮肤、肺、骨骼和中枢神经系统的病变 ,取病灶组织或渗液作墨汁染色 ,可见特有形态的隐球菌 ,亦可作真菌培养或淋巴结活检找到隐球菌确诊 ;鉴别诊断主要与结核性脑膜炎、败血症和淋巴瘤等鉴别 ;治疗主要是在使用 2～ 3种抗真菌药物的同时加强支持治疗。

The aim of this article is to improve the clinician's cognition to the cryptococcosis through a case of analysis of disseminated cryptococcosis. Cryptococcosis is a kind of deep mycosis caused by cryptococcus neoformans. Because the clinical manifestion of this disease has no specificity and it is easy to be misdiagnosed. The disease starts insidiously and often occurrs in patients who are in low resistance or have been treated with either broad spectrum antibiotics, hormone, antimetabolites, immuno-suppressive agents and anti-tumor drugs for a long time and have been on venous cannulation or indwelling urinary catheter for a long time. The clinical manifestions of the disorder include fever, swelling of liver, spleen and lymph nodes, lesions of liver function, skin, lung, skeleton and central nervous system. The final diagnosis depends on the finding of cryptococcus in lesion tissues or fluid by Chinese ink staining or biopsy. The differential diagnosis should be made with tubercular meningitis, sepsis and lymphoma. The disease should be treated with at least two to three antifungal medicines.