Cryptococcal meningitis(CM)is a central nervous system infectious disease caused by Cryptococcus.It is the most common fungal infection in the central nervous system,accounting for about 48%of fungal infection.The dis...Cryptococcal meningitis(CM)is a central nervous system infectious disease caused by Cryptococcus.It is the most common fungal infection in the central nervous system,accounting for about 48%of fungal infection.The disease occurs mainly in acquired immunodeficiency syndrome(AIDS)patients and concentrates in the immunocompromised people without AIDS.There are nearly one million new cases of CM each year,and about 70%of them died.In China,CM occurs mainly in people without AIDS and there is an increasing trend in recent years.Early diagnosis and treatment is the key to reducing morbidity and mortality associated with CM.The diagnosis mainly depends on laboratory examination such as morphological examination,fungal culture and antigen detection.History,clinical manifestation and imaging examination are the important parts of auxiliary examination.The initial combined antifungal treatment is emphasized,and the principle of fractional treatment including induction,consolidation and maintenance therapy should be followed.The high intracranial pressure must be reduced actively at the same time.In addition,it is proved that the novel immunotherapy combined with antifungal agents can improve the curative effect and limit the chance of antimicrobial resistance.Large-scale clinical trials are needed for further study.展开更多
Meningeal carcinomatosis (MC) is a disease that malignant tumor cells cultivate in the cerebrospinal fluid or meninges. With the development of therapy methods and new techniques, survival time of patients with tumor ...Meningeal carcinomatosis (MC) is a disease that malignant tumor cells cultivate in the cerebrospinal fluid or meninges. With the development of therapy methods and new techniques, survival time of patients with tumor is prolonged, and the incidence of MC is increasing. Diagnosis is based on the evaluation of clinical manifestations, cerebrospinal fluid and neuroimaging findings. Furthermore, in recent years, the diagnostic value of the tumor-derived cell-free DNA in the cerebrospinal fluid (CSF) is promising and may improve the diagnostic yield of CSF analysis. Traditional treatments of MC include surgery, radiation therapy, systemic therapy, and intrathecal therapy. Recently, molecular targeted therapy and immunotherapy have received more and more attention. The authors review the epidemiology, pathogenesis, clinical manifestation, diagnosis and treatment of MC in solid cancer, and discuss the diagnosis and treatment options currently available as well as those under investigation.展开更多
BACKGROUND Listeria meningitis is an infectious disease of the central nervous system caused by Listeria monocytogenes.This bacterium is widely present in the natural environment and can be transmitted through channel...BACKGROUND Listeria meningitis is an infectious disease of the central nervous system caused by Listeria monocytogenes.This bacterium is widely present in the natural environment and can be transmitted through channels such as food and water.Patients usually show symptoms such as fever,headache,and neck stiffness.In severe cases,coma,convulsions,or even death may occur.Traditional diagnostic methods,such as cerebrospinal fluid(CSF)culture and serological tests,have certain limitations.Although CSF culture is the“gold standard”for diagnosis,it is time-consuming and has a relatively low positivity rate.Serological detection may also result in false positive or false negative results.The emergence of metagenomic sequencing(mNGS)technology has led to a significant break-through in diagnosing Listeria meningitis,allowing quick and accurate detection of various pathogens in samples.CASE SUMMARY Here,we present the case of a previously healthy 64-year-old woman diagnosed with Listeria meningitis using mNGS.She was successfully treated with intravenous ampicillin and meropenem,without any complications.CONCLUSION Listeria meningitis must be considered,especially in patients who fail to show improvement with first-line antibiotic treatments.mNGS significantly reduces the diagnosis time,supporting timely treatment of patients.展开更多
目的分析隐球菌脑膜炎患者的临床特点及诊疗策略,进一步提高该病的临床诊治水平。方法回顾性总结并分析2000年1月至2016年12月间北京协和医院感染内科隐球菌性脑膜炎住院患者的临床资料(包括发病年龄、性别、基础疾病、鸟类接触史等流...目的分析隐球菌脑膜炎患者的临床特点及诊疗策略,进一步提高该病的临床诊治水平。方法回顾性总结并分析2000年1月至2016年12月间北京协和医院感染内科隐球菌性脑膜炎住院患者的临床资料(包括发病年龄、性别、基础疾病、鸟类接触史等流行病学特点)、临床表现、实验室检查、头颅影像学检查、治疗方案及预后。结果共62例患者入选本研究,其中男41例,女21例,中位年龄39岁(16~68岁);有基础疾病者37例(59.7%,37/62),有鸽子等流行病学接触史者23例(37.1%,23/62);入院前误诊为结核性脑膜炎或病毒性脑膜炎者分别为20例(32.3%,20/62)和9例(14.5%,9/62);头痛为最常见临床症状(98.4%,61/62),其次为发热(82.3%,51/62);19例(30.6%,19/62)伴眼部症状,13例(21.0%,13/62)出现中枢神经系统以外器官受累。55例(88.7%,55/62)患者出现颅内压增高,其中34例(61.8%,34/55)颅内压大于330 mm H2O(1 mm H2O=0.0098 k Pa)。脑脊液常规检查示白细胞中位计数[71×106/L(0~408×106/L)],55例(88.7%,55/62)患者表现为以单核细胞为主的脑脊液细胞学异常;62例患者均行脑脊液墨汁染色检测,其中53例(85.5%,53/62)阳性;55例患者接受脑脊液隐球菌抗原检测,其中51例(92.7%,51/55)阳性;57例患者接受脑脊液培养检测,其中28例(49.1%,28/57)阳性。25例患者因出现药物难以控制的颅内高压行侧脑室引流术。治疗方案分4种,包括氟康唑单药治疗(4例)、两性霉素B+5-氟胞嘧啶联合治疗(7例)、两性霉素B+氟康唑联合治疗(16例)、两性霉素B+5-氟胞嘧啶+氟康唑联合治疗(35例),两性霉素B中位疗程19.6周(2~42周),平均用量4139 mg;治愈10例,好转44例,无效6例,死亡2例,总有效率为87.1%(54/62)。结论隐球菌脑膜炎可发生于免疫功能正常人群,临床误诊率高。脑脊液隐球菌抗原乳胶凝集试验及墨汁染色是早期诊断的敏感指标,并可用于疗效评估。两性霉素B、5-氟胞嘧啶和氟康唑联合治疗是治疗隐球菌脑膜炎的有效方法,早期行侧脑室引流术缓解颅内高压是提高治疗成功率的关键。展开更多
文摘Cryptococcal meningitis(CM)is a central nervous system infectious disease caused by Cryptococcus.It is the most common fungal infection in the central nervous system,accounting for about 48%of fungal infection.The disease occurs mainly in acquired immunodeficiency syndrome(AIDS)patients and concentrates in the immunocompromised people without AIDS.There are nearly one million new cases of CM each year,and about 70%of them died.In China,CM occurs mainly in people without AIDS and there is an increasing trend in recent years.Early diagnosis and treatment is the key to reducing morbidity and mortality associated with CM.The diagnosis mainly depends on laboratory examination such as morphological examination,fungal culture and antigen detection.History,clinical manifestation and imaging examination are the important parts of auxiliary examination.The initial combined antifungal treatment is emphasized,and the principle of fractional treatment including induction,consolidation and maintenance therapy should be followed.The high intracranial pressure must be reduced actively at the same time.In addition,it is proved that the novel immunotherapy combined with antifungal agents can improve the curative effect and limit the chance of antimicrobial resistance.Large-scale clinical trials are needed for further study.
文摘Meningeal carcinomatosis (MC) is a disease that malignant tumor cells cultivate in the cerebrospinal fluid or meninges. With the development of therapy methods and new techniques, survival time of patients with tumor is prolonged, and the incidence of MC is increasing. Diagnosis is based on the evaluation of clinical manifestations, cerebrospinal fluid and neuroimaging findings. Furthermore, in recent years, the diagnostic value of the tumor-derived cell-free DNA in the cerebrospinal fluid (CSF) is promising and may improve the diagnostic yield of CSF analysis. Traditional treatments of MC include surgery, radiation therapy, systemic therapy, and intrathecal therapy. Recently, molecular targeted therapy and immunotherapy have received more and more attention. The authors review the epidemiology, pathogenesis, clinical manifestation, diagnosis and treatment of MC in solid cancer, and discuss the diagnosis and treatment options currently available as well as those under investigation.
基金Supported by National Natural Science Foundation of China,No.82100631.
文摘BACKGROUND Listeria meningitis is an infectious disease of the central nervous system caused by Listeria monocytogenes.This bacterium is widely present in the natural environment and can be transmitted through channels such as food and water.Patients usually show symptoms such as fever,headache,and neck stiffness.In severe cases,coma,convulsions,or even death may occur.Traditional diagnostic methods,such as cerebrospinal fluid(CSF)culture and serological tests,have certain limitations.Although CSF culture is the“gold standard”for diagnosis,it is time-consuming and has a relatively low positivity rate.Serological detection may also result in false positive or false negative results.The emergence of metagenomic sequencing(mNGS)technology has led to a significant break-through in diagnosing Listeria meningitis,allowing quick and accurate detection of various pathogens in samples.CASE SUMMARY Here,we present the case of a previously healthy 64-year-old woman diagnosed with Listeria meningitis using mNGS.She was successfully treated with intravenous ampicillin and meropenem,without any complications.CONCLUSION Listeria meningitis must be considered,especially in patients who fail to show improvement with first-line antibiotic treatments.mNGS significantly reduces the diagnosis time,supporting timely treatment of patients.
文摘目的分析隐球菌脑膜炎患者的临床特点及诊疗策略,进一步提高该病的临床诊治水平。方法回顾性总结并分析2000年1月至2016年12月间北京协和医院感染内科隐球菌性脑膜炎住院患者的临床资料(包括发病年龄、性别、基础疾病、鸟类接触史等流行病学特点)、临床表现、实验室检查、头颅影像学检查、治疗方案及预后。结果共62例患者入选本研究,其中男41例,女21例,中位年龄39岁(16~68岁);有基础疾病者37例(59.7%,37/62),有鸽子等流行病学接触史者23例(37.1%,23/62);入院前误诊为结核性脑膜炎或病毒性脑膜炎者分别为20例(32.3%,20/62)和9例(14.5%,9/62);头痛为最常见临床症状(98.4%,61/62),其次为发热(82.3%,51/62);19例(30.6%,19/62)伴眼部症状,13例(21.0%,13/62)出现中枢神经系统以外器官受累。55例(88.7%,55/62)患者出现颅内压增高,其中34例(61.8%,34/55)颅内压大于330 mm H2O(1 mm H2O=0.0098 k Pa)。脑脊液常规检查示白细胞中位计数[71×106/L(0~408×106/L)],55例(88.7%,55/62)患者表现为以单核细胞为主的脑脊液细胞学异常;62例患者均行脑脊液墨汁染色检测,其中53例(85.5%,53/62)阳性;55例患者接受脑脊液隐球菌抗原检测,其中51例(92.7%,51/55)阳性;57例患者接受脑脊液培养检测,其中28例(49.1%,28/57)阳性。25例患者因出现药物难以控制的颅内高压行侧脑室引流术。治疗方案分4种,包括氟康唑单药治疗(4例)、两性霉素B+5-氟胞嘧啶联合治疗(7例)、两性霉素B+氟康唑联合治疗(16例)、两性霉素B+5-氟胞嘧啶+氟康唑联合治疗(35例),两性霉素B中位疗程19.6周(2~42周),平均用量4139 mg;治愈10例,好转44例,无效6例,死亡2例,总有效率为87.1%(54/62)。结论隐球菌脑膜炎可发生于免疫功能正常人群,临床误诊率高。脑脊液隐球菌抗原乳胶凝集试验及墨汁染色是早期诊断的敏感指标,并可用于疗效评估。两性霉素B、5-氟胞嘧啶和氟康唑联合治疗是治疗隐球菌脑膜炎的有效方法,早期行侧脑室引流术缓解颅内高压是提高治疗成功率的关键。
