播散性隐球菌病1例分析  

Disseminated cryptococcosis caused by Cryptococcus neoformans:a case report and review

作　　者：单琨[1] 左惠芬[2] 郑翠影 张泽坤[3] 赵连春[2] 黄印启[3] 王鹏[3] 赵振军[2] 张丽杰[3] SHAN Kun;ZUO Hui-fen;ZHENG Cui-ying;ZHANG Ze-kun;ZHAO Lian-chun;HUANG Yin-qi;WANG Peng;ZHAO Zhen-jun;ZHANG Li-jie(The First Central Hospital of Baoding,Baoding,Hebei 071000,China;Hebei Yi-Ling Hospital,Shijiazhuang,Hebei 050091,China;The Third Hospital of Hebei Medical University,Shijiazhuang,Hebei 050051,China)

机构地区：[1]保定市第一中心医院,河北保定071000 [2]河北以岭医院,河北石家庄050091 [3]河北医科大学第三医院,河北石家庄050051

出　　处：《中国热带医学》2022年第11期1043-1046,共4页China Tropical Medicine

基　　金：河北省卫健委青年医学科学研究课题(No.20190185);河北省卫健委医学科学研究课题(No.20180460)。

摘　　要：分析在1例肝硬化脾切除术后患者被新型隐球菌侵入血流引起播散性隐球菌病的临床表现、治疗措施与实验室检测结果。患者,男性,30岁,于2016年3月因“脾大、脾功能亢进”行“脾切除+贲门周围血管离断术”,术后多次无明显诱因发热,体温最高39℃,相继伴背痛、左下肢脓肿和右髋关节痛。CT和MRI显示患者肺部病变及多处骨质破坏,期间抗生素治疗效果不佳。2017年4月19日对脓液直接革兰染色、墨汁染色,使用API 32C、Vitek 2 Compact、rDNA ITS和IGS序列分析等方法对分离自患者脓液、血液中的菌株进行鉴定,检测患者血清中隐球菌抗原,使用ATB FUNGUS 3进行抗真菌药敏试验。结果在新鲜脓液标本墨汁染色后菌株呈现厚厚的荚膜,从脓液及血液中分离出的菌株经API 32C、Vitek 2 Compact、rDNA ITS和IGS序列分析均鉴定该菌为新型隐球菌,血清新型隐球菌荚膜抗原阳性。该菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑及伏立康唑的最小抑菌浓度分别为:<4 mg/L、<0.5 mg/L、4 mg/L、≤0.25 mg/L和0.125 mg/L。给予“氟康唑联合两性霉素B”抗感染治疗2个月脓肿缩小,6个月患者康复。隐球菌感染起病隐匿且临床症状不典型,缺乏特异性,经血流播散造成血流感染会累及包括皮肤、骨骼等全身多个脏器。临床应尽早采血培养监测,去除原发病灶以切断感染途径并进行有效抗隐球菌治疗。To analyze the clinical,therapeutic and laboratory characteristics of disseminated cryptococcosis caused by Cryptococcus neoformans invading the blood stream in patient with liver cirrhosis and splenectomy.A 30-year-old male underwent splenectomy plus pericardial devascularization due to"splenomegaly and hypersplenism"in March in 2016.The patient had intermittent fever after operation for many times,and successively accompanied with back pain,left lower limb abscess and right hip pain.The highest body temperature was 39℃.CT and MRI revealed the lung lesion and multiple bone destruction.During that period,the effect of antibiotics was not good.On April 19th,2017,Gram’s stain,India ink stain,API32C,Vitek 2 Compact,ribosomal ITS and IGS sequence analysis were performed to identify the strain isolated from the pus and blood stream.The serum of the patient was detected for cryptococcal antigen.Antifungal susceptibility test was used to determine drug sensitivity and minimum inhibitory concentration(MIC).The Cryptococcus neoformans isolated from fresh pus specimen showed a prominent,thick capsule after India ink stain.The colonies isolated from pus and blood stream were identified Cryptococcus neoformans using API 32C,Vitek 2 Compact,and sequence analysis of rDNA ITS and IGS.Cryptococcal capsule antigen was positive.The minimal inhibitory concentrations of 5-Flucytosine,amphotericin B,fluconazole,itriconazole,voriconazole against the isolate were<4μg/mL,<0.5μg/mL,4μg/mL,≤0.25μg/mL,0.125μg/mL respectively.The patient was initially treated with intravenous amphotericin B and flucytosine.After anti-Cryptococcus treatment for two months,the patient clinically improved,and the lesions were reduced on a follow-up CT scan.The patient made a full functional recovery after treatment for six months.Cryptococcosis has hidden onset,atypical clinical symptoms and lack of specificity.Blood stream is the main channel for Cryptococcus to spread and involve many organs of the whole body,including skin,bone and so on.Therefor

关 键 词：新型隐球菌 播散性隐球菌病 肝硬化脾切除术后 血流感染 鉴定 基因序列 真菌药敏试验 

分 类 号：R379.5[医药卫生—病原生物学]