新型隐球菌性脑膜炎109例临床分析  

Cryptococcus neoformans meningitis： a report of 109 cases

作　　者：李莎[1] 宋晓玲[1] 唐早梅 

机构地区：[1]南宁市第四人民医院,内儿科530023

出　　处：《国际流行病学传染病学杂志》2014年第2期86-89,共4页International Journal of Epidemiology and Infectious Disease

基　　金：广西壮族自治区卫生厅自筹经费科研课题（z2012624）

摘　　要：目的了解HIV阴性新型隐球菌性脑膜炎患者的临床特征及其治疗转归。方法回顾性分析109例抗-HIV阴性的新型隐球菌性脑膜炎患者的流行病学资料、临床表现、实验室检查、治疗及预后的情况。结果109例新型隐球菌性脑膜炎患者中，临床表现以剧烈头痛、发热、颅内压升高、脑膜刺激征阳性为主。患者中有基础性疾病者占9．2％。发病前有鸽子接触史者占19-3％，桉树富植区居住史者占61．4％。所有患者颅内压均升高，其中37．6％超过330mmH2O（1mmH2O=0．098kPa）。首次墨汁染色涂片找隐球菌阳性率67．0％，经多次反复查找涂片阳性率100．0％；脑脊液培养隐球菌阳性率89．0％。治疗总有效率为85．3％（93例），病死率14．7％（16例）。结论对发热、剧烈头痛及颅内压升高，且有鸽子接触史或桉树种植区居住史的患者应考虑新型隐球菌性脑膜炎的可能，一旦诊断应积极控制硕内压，同时给予足量、足疗程的抗真菌药物以提高疗效和降低病死率。Objective To analyze the clinical features and prognosis of Cryptococcus neoformans meningitis. Methods Patients （n=109） with anti-HIV negative who were diagnosed as having Cryptococcus neoformans meningitis were enrolled. The epidemiological data, clinical manifestations, laboratory examination, treatments and outcomes were analyzed. Results The main clinical manifestations of patients with Cryptococcus neoformans meningitis were severe headache, fever, increased intracranial pressure, and positive meningeal stimulation. Of 109 patients, 9.2% had basic disease, 19.3% had dove and poultry exposure history, 61.4% lived in eucalyptus- planting area. All patients showed increase in intracranial pressure, with 37.6% higher than 330 mm H2O（lmmH2O=0.098 kPa）. Ink staining smear for Cryptococcus neoformans showed a positive rate of 67.0% for the first time and 100.0% positive after repeated lookup. Cerebrospinal fluid culture detected 89.0% positive of Cryptococcus neoformans. The total therapeutic efficiency was 85.3% （93/109） with a mortality of 14.7%（16/109）. Conclusions Patients with fever, severe headache and intraeranial pressure increased should be considered as having cryptococcal meningitis if they have a dove exposure histol7 or live in eucalyptus-planting area . Once the diagnosis is made, measures like active control of intracranial pressure and administration of full dose and course of antifungal drugs should be taken to improve the cure rate and reduce the fatality rate.

关 键 词：隐球菌 新型 脑膜炎 临床分析 

分 类 号：R742.9[医药卫生—神经病学与精神病学]