儿童新型隐球菌感染的临床特点分析  

Clinical features analysis of cryptococcus neoformans infection in children

作　　者：陈文娟 曹清 罗丽娟 王薇[1] 李璧如[2] Chen Wenjuan;Cao Qing;Luo Lijuan;Wang Wei;Li Biru(Department of Infectious Diseases,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Critical Care Medicine,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心感染科,200127 [2]上海交通大学医学院附属上海儿童医学中心重症医学科,200127

出　　处：《中国小儿急救医学》2020年第6期452-457,共6页Chinese Pediatric Emergency Medicine

基　　金：上海交通大学转化医学协同创新中心合作研究项目(TM201820、TM201927)。

摘　　要：目的分析儿童新型隐球菌感染的临床特点及诊治策略,并探讨PCR及高通量基因分析在新型隐球菌感染诊疗中的应用价值。方法回顾性分析1998年7月至2018年12月于上海儿童医学中心住院治疗的新型隐球菌感染患儿的临床资料(发病年龄、性别、基础疾病、接触史等流行病学特点)、临床表现、实验室检查、影像学检查、病原学检测方法、治疗及预后。结果共计10例患儿入选本次调查,其中男女各5例,中位年龄6.28(4.08,12.02)岁;4例患儿有家禽/土壤/腐物接触史;7例患儿诊断为新型隐球菌脑膜炎,3例诊断为播散性新型隐球菌病;5例患儿存在基础疾病,其中2例通过高通量基因分析发现存在原发性免疫缺陷;头痛伴发热为新型隐球菌脑膜炎最常见的临床症状;3例播散性新型隐球菌病患儿均存在原发性或继发性免疫缺陷。治疗均采用5-氟胞嘧啶+两性霉素B/两性霉素B脂质体联合诱导治疗,氟康唑巩固治疗;其中2例患儿诱导治疗期间出现低钾;1例患儿巩固治疗期间出现轻度肾功能损害。治愈5例,放弃3例,复发1例,死亡1例。结论既往被认为免疫功能正常的新型隐球菌病患儿可能存在基因微突变所致的原发性免疫缺陷;PCR检测可提高新型隐球菌的检出率并缩短检测时间;嗜酸性粒细胞显著增高可能提示感染播散;水化及常规补钾可能减轻两性霉素B的毒性;控制颅内高压是提高治疗成功率的关键。Objective To analyze the clinical characteristics,diagnosis and treatment strategies of cryptococcus neoformans infection in children,and to explore the application value of PCR and high-throughput gene analysis in the diagnosis and treatment of cryptococcus neoformans infection.Methods The clinical data of children with cryptococcus neoformans infection were retrospectively analyzed,who were hospitalized in Shanghai Children′s Medical Center from July 1998 to December 2018,including epidemiological characteristics(age,gender,underlying disease,and contact history,etc.),clinical manifestations,laboratory tests,imaging studies,pathogen detection methods,and treatment and prognosis.Results A total of ten children were enrolled in the survey,including five males and five females,and the median age was 6.28(4.08,12.02)years;four cases had a history of poultry/soil/corrosion exposure;seven cases were diagnosed as cryptococcus neoformans meningitis,three cases were diagnosed as disseminated cryptococcal disease;five cases had underlying disease,including two cases of which were found to have primary immunodeficiency through high-throughput genetic analysis;headache with fever was the most common clinical symptom of cryptococcus neoformans meningitis.All three cases of disseminated cryptococcosis had primary or secondary immunodeficiency.All children were treated with 5-fluorocytosine+amphotericin B/amphotericin B liposome in induction therapy,and fluconazole in consolidation therapy.Notably,two cases showed hypokalemia during induction therapy,and one case showed mild renal dysfunction during consolidation treatment;five cases were cured,three cases were abandoned,one case was relapsed,and one case died.Conclusion Children with cryptococcosis neoformans infection who are considered to have normal immune function may have primary immunodeficiency caused by gene mutation.PCR can improve the detection rate of cryptococcus neoformans and shorten the detection time.A significant increase in eosinophils may indicate the sp

关 键 词：新型隐球菌脑膜炎 播散性新型隐球菌病 原发性免疫缺陷 继发性免疫缺陷 

分 类 号：R725.1[医药卫生—儿科]