难治性真菌性脑膜炎3例并文献复习  

Refractory fungal meningitis:report of three cases and literature review

作　　者：齐雪姣[1] 卜晖[1] 邹月丽[1] 杨建凯[2] 赵银龙[2] 何俊瑛[1] Qi Xuejiao;Bu Hui;Zou Yueli;Yang Jiankai;Zhao Yinlong;He Junying(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Neurosurgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,河北石家庄050000 [2]河北医科大学第二医院神经外科,河北石家庄050000

出　　处：《临床荟萃》2019年第2期154-157,共4页Clinical Focus

摘　　要：目的分析难治性真菌性脑膜炎的诊治经过,进一步提高该病的诊治水平。方法回顾性分析3例难治性真菌性脑膜炎的诊治过程并文献复习。结果例1患者头痛、肢体无力,抗结核、抗病毒后效果不明显,通过多次腰椎穿刺,最终发现少见类型真菌,给予抗真菌药物后好转。例2患者头痛,脑脊液发现隐球菌,肺部CT示肺结核,联合给予抗真菌、抗结核后,临床症状有所缓解。例3患者头痛,脑脊液发现隐球菌,颅压高给予Ommaya囊植入,静脉窦血栓给予抗凝,联合抗真菌药物治疗后临床症状好转。结论难治性真菌性脑膜炎是一类预后差,病死率高的脑膜炎。早期诊断、积极治疗原发病、控制颅高压等是改善该病预后的关键。Objective To analyze the diagnosis and treatment of refractory fungal meningitis, so as to further improve the diagnosis and treatment of the disease.Methods Retrospective study was used to analyze the process of diagnosis and treatment of three cases refractory fungal meningitis, and relative literature was reviewed.Results Case one patient admitted with headache and limb weakness. The patient did not get well via antitubercular and antiviral treatment. Rare type of fungi was found in CSF through repeated lumbar puncture. The patient improved via antifungal treatment. Case two patient admitted with headache, and cryptococcus was found in CSF. The lung CT showed pulmonary tuberculosis, and the patient recovered via antifungal and antitubercular treatment. Case three patient admitted with headache, and cryptococcus was found in CSF. Because of Intracranial hypertension treated with Ommaya implantation, venous sinus thrombosis treated with anticoagulation combined with antifungal drugs, the patient’s clinical symptoms improved.Conclusion Refractory fungal meningitis is a kind of meningitis with poor prognosis and high mortality. Early diagnosis, active treatment of protopathy and control of intracranial hypertension are the key to improve the prognosis of this disease.

关 键 词：脑膜炎 真菌性 颅内高压 早期诊断 

分 类 号：R515.2[医药卫生—内科学]