新型隐球菌脑膜炎38例  

Clinical analysis of 38 cases of cryptococcus meningitis

作　　者：江磊[1] 张伦理[1] 

机构地区：[1]南昌大学第一附属医院感染科,330006

出　　处：《中华传染病杂志》2007年第4期203-205,共3页Chinese Journal of Infectious Diseases

摘　　要：目的分析新型隐球菌脑膜炎(隐脑)的临床特点和疗效。方法对38例隐脑进行回顾性分析,所有患者均经病原学检查确诊。结果36例隐脑呈慢性或亚急性起病,初次脑脊液涂片确诊24例,经反复脑脊液涂片及培养确诊14例。38例中有8例未用药,其中2例自动出院,其余6例均死亡。30例行抗真菌治疗,治愈11例,好转7例,转院治疗8例,未愈出院2例,死亡2例。其中两性霉素B联合5-氟胞嘧啶治疗9例,6例治愈,3例好转。结论隐脑常易误诊、漏诊,反复行脑脊液涂片以及同时行真菌培养可提高诊断率。两性霉素B联合5-氟胞嘧啶治疗效果较好。Objective To investigate the clinical features and treatment response of cryptococcus meningitis （CM）. Methods Thirty-eight cases of CM diagnosed by etiological examination were analyzed retrospectively. Results Thirty-six cases showed acute or subacute onset. CM was misdiagnosed for tubercular meningitis most frequently, Twenty-four cases were diagnosed by the first smear of cerebrospinal fluid. The other 14 cases were diagnosed by repeated smear or fungal culture of cerebrospinal fluid. Eight cases were not treated, among whom two cases departed from hospital and the other 6 died. Thirty cases were treated with antifungal drugs, among whom eleven were cured, 7 were improved, 8 were transferred to other hospitals for further therapy, 2 were still ill when leaving our hospital but not for other hospitals, the other 2 died. Nine patients were treated with combination of amphotericin B and 5-flurocytosine. Among them, six were cured, the other three were improved. Conclusions CM tends to be misdiagnosed and missed diagnosed. Repeated smear and simultaneous fungal culture of cerebrospinal fluid can improve the diagnosisrate. The combination treatment of amphotericin B and 5-flurocytosine is efficient.

关 键 词：隐球菌 新型 脑膜炎 隐球菌性 两性霉素B 氟胞嘧啶 脂质体 

分 类 号：R519[医药卫生—内科学]