中枢神经系统少见真菌感染35例临床分析  

Analysis on the characteristics of 35 patients with uncommon central nervous system fungal infections

作　　者：胡秀平[1] 朱利平[1] 王璇[1] 区雪婷[1] 吴吉芹[1] 徐斌[1] 王睿莹[1] 章强强[1] 翁心华[1] 

机构地区：[1]复旦大学附属华山医院感染科,上海200040

出　　处：《中华传染病杂志》2011年第3期143-147,共5页Chinese Journal of Infectious Diseases

摘　　要：目的了解中枢神经系统少见真菌感染的临床特点。方法收集1997年至2010年复旦大学附属华山医院收治的中枢神经系统少见真菌感染病例，共35例，对其病原菌种类、临床特点、疗效等进行回顾性分析，统计学方法采用秩和检验和Fisher确切概率法。结果35例患者中确诊29例，临床诊断6例。30例患者存在一种或多种易感因素，占86％，致病菌主要有曲霉感染16例，念珠菌感染14例。常见的临床表现有发热22例，头痛19例，脑神经受累12例，脑膜刺激征12例。脑脊液变化为WBC增多、蛋白含量升高及糖含量降低。其中曲霉感染患者多存在免疫力低下的基础疾病，常由邻近部位感染或血流播散所致，以头痛和脑神经受累等脑实质损害为主；而念珠菌感染患者多继发于颅脑手术或外伤后，以发热、脑膜刺激征以及脑脊液异常等脑膜炎表现为主。总有效率为77％（27／35），其中曲霉感染患者以颅内病灶手术清除联合抗真菌药物疗效较佳；念珠菌感染由于多继发于颅脑手术，尤其是脑脊液外引流术，抗真菌药物治疗同时更换或拔除引流管可达到较好疗效。结论近年来曲霉、念珠菌等中枢神经系统少见真菌感染有明显增多趋势，而早期诊断和及时治疗是改善预后的关键。Objective infections in central nervous To analyze the clinical features of patients with uncommon fungal system （CNS）. Methods Thirty-five patients with uncommon CNS fungal infections who were admitted to Huashan Hospital from 1997 to 2010 were retrospectively reviewed. The pathogens, symptoms and signs, treatments of patients were evaluated. The data were analyzed by rank sum test and Fisherrs exact test. Results Twenty-nine of the 35 patients met the definition criteria of prover CNS fungal infections, while the other 6 had probable diagnosis. Predisposing factors were found in 86% of all patients. The most common pathogens were Aspergillus and Candida species. The symptoms and signs commonly occurred including fever （22 cases）, headache （19 cases）, cranial neuropathy （12 cases）, and meningeal irritation sign （12 cases）. High white blood cell count, high protein level, and low glucose level were the main findings of cerebrospinal fluid （CSF） analysis. Patients with cerebral aspergillosis were more frequently accompanied with immunocompromised conditions, and they often got CNS aspergillosis from hematogenous dissemination or direct extension of paranasal sinus infection. Cerebral granuloma and abscess were the common clinical characteristics of CNS aspergillosis. Cerebral candidiasis often arose from neurosurgical surgery or traumatic brain injury, and these patients were usually presented with meningitis. All patients were treated with antifungal drugs and （or） surgical intervention and 77% （27/35） of the patients achieved complete or partial responses. Antifungal agents combined with surgical resection might improve outcome of patients with CNS aspergillosis; while removal or replacement of drainage tubes in combination with antifungal treatment showed satisfactory efficacy in patients with cerebral candidiasis who usually had shunt manipulation. Conclusions The incidence of CNS fungal infection, such as cerebral aspergillosis and candidiasis, is increasing. Early diagnose and

关 键 词：真菌病 中枢神经系统感染 曲霉菌病 念珠菌病 脑膜炎 真菌性 

分 类 号：R741[医药卫生—神经病学与精神病学]