22例隐球菌脑膜炎患儿的临床特征和抗生素敏感性分析  

Clinical characteristic and antibiotic sensitivity of 22 patients with cryptococcal meningitis

作　　者：游洋伟 YOU Yang-wei(Laboratory of Medicine Department,The First People’s Hospital of Shuangliu District,Chengdu 610200,China)

机构地区：[1]成都市双流区第一人民医院检验科

出　　处：《中国人兽共患病学报》2019年第9期870-874,共5页Chinese Journal of Zoonoses

摘　　要：目的探讨隐球菌性脑膜炎患儿的临床特征,以提高该病的诊治水平及预后。方法回顾性分析成都市双流区第一人民医院收治的22例诊断为隐球菌性脑膜炎儿童的临床资料。结果81.8%(18例)隐球菌性脑膜炎患者有头痛症状,22例(100.0%)患儿有发热症状;脑脊液糖(2.70±0.93mmol/L)降低尤为显著;所有患者均有不同程度的颅内压增高,病原学脑脊液墨汁染色阳性患者15例(占68.2%),隐球菌培养阳性患者22例(占100.00%),两性霉素B(AmpB)联合5-氟胞嘧啶(5-FC)治愈好转率100%(22/22),两性霉素B(AmpB)+5-氟胞嘧啶(5-FC)+氟康唑治疗的2例患者后期均调整为两性霉素B(AmpB)联合5-氟胞嘧啶(5-FC)。结论隐球菌性脑膜炎早期误诊率较高,脑脊液墨汁染色、脑脊液培养试验有助于确诊;两性霉素B联合5-氟胞嘧啶仍是目前经典的抗真菌治疗方案,早期控制真菌及颅高压是改善预后关键。To improve the diagnosis,treatment and prognosis,we analyzed the clinical data of 27 cases with CM in The First People’s Hospital of Shuangliu District.Retrospectively and the treatment experience were summarized.The clinical information showed there were 18 cases (81.8%) had headache,all patients had increased intracranial pressure for certain degrees.The laboratory data showed that CSF glucose (2.70±0.93 mmol/L) reduced significantly.The etiological test turned out that the positive rate of cerebrospinal fluid ink staining accounted for 68.2%(15cases),the rate of cryptococcal culture positive accounted for 100.00%(22 cases).At last,100%(22/22) patients were cured or better after receiving the combined treatment of amphotericin B (AmpB) and 5-fluorocytosine (5-FC),2 patients treated by fluconazole were changed to amphotericin B (AmpB) and 5-fluorocytosine (5-FC) later.In conclusion,Cryptococcal meningitis could prone to be misdiagnosed at early stage,cerebrospinal fluid ink stain,fungi culture are beneficial to the diagnosis.The combination of AmpB and 5-FC is still the classic anti-fungal treatment options.Effective control of fungal and intracranial hypertension is crucial to improve the prognosis in early stage.

关 键 词：脑膜炎 隐球菌性 诊断 治疗 

分 类 号：R379.5[医药卫生—病原生物学]