Title：Clinical analysis of 41 cases of Cryptococcus neoformans meningitis
作者：唐圣桃
关键词：新型隐球菌脑膜炎,诊断,治疗,预后
论文类型：期刊论文
论文来源：湘南学院学报(医学版) 2019
摘要：目的分析新型隐球菌性脑膜炎的临床特点，为提高诊断和治疗水平提供参考。方法回顾性分析2014年1月至2018年11月收治的41例新型隐球菌脑膜炎患者的临床资料，包括年龄、性别、基础疾病、鸟类接触史、临床表现、脑脊液及实验室检查、治疗过程、治疗方案及预后。结果41例患者，男26例，女15例，年龄15～70岁，12例（29.26%）有明确的鸟类接触史，4例（9.75%）有艾滋病，23例有基础疾病。所有患者均有头痛，发热35例（85.36%），高热12例（29.26%），脑膜刺激阳性35例（85.36%），复视和视力减退15例（36.58%），听力减退5例（12.19%），精神症状4例（9.75%），意识障碍4例（18.29%）。10例被误诊为其他脑膜炎。38例患者颅内压升高（92.68%），脑脊液蛋白升高37例（90.24%），墨汁染色阳性40例（97.6%），隐球菌培养阳性18例（43.9%）。41例患者中17例接受AMB（或AMB脂质体）+5-FC+氟康唑联合治疗，15例接受AMB+氟康唑（剂量400mg），6例接受AMB（或脂质体AMB）+5-FC联合治疗，3例单独接受AMB脂质体治疗。14例侧脑室引流，10例同时注射AMB。总有效率为73.17%。结论免疫功能正常、无流行病学史的患者可发生新型隐球菌性脑膜炎。该病误诊率高，阳性率高。。。
Abstract：Objective to analyze the clinical characteristics of Cryptococcus neoformans meningitis and provide reference for improving the diagnosis and treatment level. Methods the clinical data of 41 patients with Cryptococcus neoformans meningitis from January 2014 to November 2018 were analyzed retrospectively, including age, gender, basic diseases, contact history of birds, clinical manifestations, CSF and laboratory tests, treatment process, treatment plan and prognosis. Results 41 patients, including 26 males and 15 females, aged 15-70 years old, 12 patients (29.26%) with a clear history of bird contact, 4 patients (9.75%) with AIDS and 23 patients with underlying diseases. All the patients had headache, fever in 35 cases (85.36%), high fever in 12 cases (29.26%), positive meningeal irritation in 35 cases (85.36%), diplopia and vision loss in 15 cases (36.58%), hearing loss in 5 cases (12.19%), mental symptoms in 4 cases (9.75%), and consciousness disorder in 4 cases (18.29%). Ten patients were misdiagnosed as other meningitis. In 38 patients, intracranial pressure was increased (92.68%), CSF protein was increased in 37 (90.24%), ink staining was positive in 40 (97.6%), Cryptococcus culture was positive in 18 (43.9%). Among the 41 patients, 17 received AMB (or AMB liposome) + 5-FC + fluconazole combination therapy, 15 received AMB + fluconazole (dose 400 mg), 6 received AMB (or liposome AMB) + 5-FC combination therapy, and 3 received AMB liposome alone. 14 patients received drainage of lateral ventricle, 10 of them received AMB injection at the same time. The total effective rate was 73.17%. Conclusion Cryptococcus neoformans meningitis can occur in patients with normal immunity and no epidemiological history. The misdiagnosis rate of the disease is high, and the positive rate of culture of Cryptococcus in CSF is low. The combination of amphotericin B, 5-fluorocytosine and fluconazole is safe and effective. Early detection, early treatment, sufficient quantity, sufficient treatment and reduction of intracranial pressure are the key points of treatment.
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标签：新型隐球菌脑膜炎论文; 诊断论文; 治疗论文; 预后论文;