儿童播散性隐球菌病8例临床特征和预后  

Clinical features and prognosis of disseminated cryptococcosis in 8 children

作　　者：谢新宝[1] 朱燕凤[1] 王晓红[1] 俞蕙[1] 曾玫[1] 陆怡[1] 沈军[1] 杨天娇[1,2] 

机构地区：[1]复旦大学附属儿科医院感染科,上海201102 [2]上海和睦家家庭医疗,上海200336

出　　处：《中国循证儿科杂志》2015年第4期281-286,共6页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的探讨儿童播散性隐球菌病的临床特征和预后。方法回顾性分析2009年5月至2013年11月复旦大学附属儿科医院感染科收治的播散性隐球菌病患儿的临床资料,总结临床特征和预后。结果 8例播散性隐球菌病连续病例进入分析,男5例,女3例,平均年龄6.1岁。血清HIV抗体均阴性,流式细胞仪检测CD4细胞计数正常。2例起病前曾口服糖皮质激素,余6例否认免疫抑制剂服用史及基础疾病史。8例患儿家长均否认鸽子或其他禽类接触史。8例患儿起病均表现为持续发热,7例有明显的肝脾肿大,4例有黄疸,2例有咳嗽等呼吸道症状,2例服用糖皮质激素患儿有皮肤损害,8例均无头痛、呕吐或意识改变等神经系统症状。8例血清隐球菌抗原滴度均〉1∶640,6例血培养结果示新型隐球菌阳性,4例CSF隐球菌抗原升高,5例外周血嗜酸性粒细胞计数升高。8例血清Ig E均升高,平均3 896.5 Ku A·L-1。3例影像学检查提示累及胆道,肝内胆管扩张,胸部CT示7例累及肺部。8例起病至确诊2~7周,均接受全身性抗真菌治疗（两性霉素B联合5-氟胞嘧啶或氟康唑）,其中1例治疗后出现隐球菌相关性免疫重建炎症综合征,8例治疗反应良好。8例诱导治疗结束后外周血嗜酸性粒细胞计数和血清Ig E水平均恢复正常,停药后随访3~6个月,均无复发。结论播散性隐球菌病可发生于无HIV感染的儿童,可累及多系统脏器,以单核-巨噬细胞系统和肺部受累多见。外周血嗜酸性粒细胞计数升高和血清Ig E水平升高是本病实验室检查的显著特点。Objective To investigate the clinical characteristics, treatment and outcome of disseminated cryptococcosis in nonhuman immunodeficiency virus-infected children. Methods Retrospective study was performed to review the charts of 8nonhuman immunodeficiency virus-infected children diagnosed as disseminated cryptococcosis in a tertiary care teaching hospital from May 2009 to November 2013. Results Eight children with the average age of 6. 1 years were recruited in the study,including 5boys and 3 girls. Two children receiving corticosteroids were immunocompromised,other 6 children were immunocompetent. All had fever,7 /8 cases had hepatosplenomegaly,4 cases had jaundice,2 cases had cough,and skin lesions were initial and remarkable clinical features of the 2 immunocompromised children. None had symptoms of central nervous system（ CNS）involvement. All had high titers of serum cryptococcal antigen with latex agglutination test at initial of admission,which was 1∶ 640 or higher,6 cases had positive blood culture of Cryptococcus neoformans. Four cases were identified as CNS involved by cerebrospinal fluid examination. Five cases（ 62. 5%） had notably increased eosinophil counts in peripheral blood,the serum levels of Ig E were also elevated at the beginning of admission for all the patients. Three of 8 cases revealed a dilated intrahepatic bile duct by imaging examination,and 7 cases were identified pulmonary involved by chest CT scan. Inductive therapy with combination of amphotericin B（ Am B） or lipid formulation of Am B（ LFAm B） plus flucytosine or fluconazole was given. One case occurred immune reconstitution inflammatory syndrome after steroid withdrawal. All responded well to systemic antifungal therapy,both eosinophil counts and elevated serum Ig E levels decreased after induction therapy. All children were followed up at outpatient clinic to continue consolidation and maintenance therapy with fluconazole. After cessation of therapy,none relapsed. Conclusion The clinical manifestations of dissemina

关 键 词：播散性隐球菌病 儿童 临床特征 预后 

分 类 号：R725.1[医药卫生—儿科]