以梗阻性黄疸、抽搐为表现的播散性隐球菌感染1例报告

目的探讨同时累及胆道系统及中枢神经系统的播散性隐球菌病的诊断和治疗。方法回顾性分析1例同时累及胆道系统及中枢神经系统的播散性隐球菌病患儿的临床资料,同时复习相关文献。结果患儿,男,6岁。临床表现为黄疸、肝功能受损、抽搐。行手术治疗,病理活检提示隐球菌感染,血清及脑脊液隐球菌荚膜多糖抗原乳胶凝集试验阳性,脑脊液墨汁染色阳性。经抗真菌治疗后症状缓解,随访无后遗症。结论患儿为罕见的同时累积胆道、中枢系统的播散性隐球菌病。     

隐球菌病9例临床特征及治疗分析

目的了解儿童隐球菌病的临床特征,探讨其诊治方法。 方法回顾分析2004—2006北京儿童医院收治的9例隐球菌病患儿的临床资料。 结果急性起病2例,亚急性或慢性起病7例。发热8例,头痛、呕吐5例,咳嗽4例,皮肤黄疸3例。脑膜刺激征阳性5例,肝大、脾大各4例,淋巴 结肿大5例。视乳头水肿3例。白细胞、C反应蛋白均增高,脑脊液异常5例。 肺CT异常8例。血清隐球菌抗原均阳性。1例放弃治疗;8例出院时 临床症状消失,病原学检查阴性。 结论儿童隐球菌病临床表现多样,无特异性体征,误诊率高。对于中枢神经系统感染或多脏器损害且经抗结核、抗感染治疗无效者,应考虑该病可 能。确诊依赖于脑脊液墨汁染色、血清或脑脊液乳胶凝集试验,组织病理及病原培养。     

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目的了解儿童隐球菌病的临床特征,探讨其诊治方法。方法回顾分析2004—2006北京儿童医院收治的9例隐球菌病患儿的临床资料。结果急性起病2例,亚急性或慢性起病7例。发热8例,头痛、呕吐5例,咳嗽4例,皮肤黄疸3例。脑膜刺激征阳性5例,肝大、脾大各4例,淋巴结肿大5例。视乳头水肿3例。白细胞、C反应蛋白均增高,脑脊液异常5例。肺CT异常8例。血清隐球菌抗原均阳性。1例放弃治疗;8例出院时临床症状消失,病原学检查阴性。结论儿童隐球菌病临床表现多样,无特异性体征,误诊率高。对于中枢神经系统感染或多脏器损害且经抗结核、抗感染治疗无效者,应考虑该病可能。确诊依赖于脑脊液墨汁染色、血清或脑脊液乳胶凝集试验,组织病理及病原培养。     

新型隐球菌性脑膜炎38例

目的 分析隐球菌性脑膜炎误诊的原因。探讨早期诊断方法。方法 采用回顾性方法对38例新型隐球菌性脑膜炎临床进行分析。并对其中25例误诊者原因进行探讨。结果 38例隐球菌性脑膜炎有25例误诊，结论 隐球菌性脑膜炎早期易误诊。多次脑脊液离心涂片墨汁染色镜检是防止漏诊，误诊的关键。     

儿童肺隐球菌病6例诊断和治疗分析

目的　探讨儿童肺隐球菌病的诊断与治疗。方法　回顾性分析北京儿童医院 2 0 0 0～ 2 0 0 2年收治的 6例肺隐球菌病患儿的临床资料、影像学表现、免疫状态、诊断方法、治疗和转归。结果　 6例均起病缓慢、病史长 ,症状为发热、咳嗽。肺部查体 5例正常 ,1例闻及干性音和中水泡音。 4例体液和细胞免疫功能检查正常 ,1例人类免疫缺陷病毒阳性 ,1例为X 连锁低丙种球蛋白血症。 6例患儿均发生血行播散 ,其中 5例合并脑膜炎。 2例应用二性霉素B和氟康唑治疗后 ,肺隐球菌病控制 ,脑膜炎好转 ;3例放弃治疗 ;1例合并肝脾和淋巴结隐球菌病 ,应用氟康唑治愈。结论　儿童肺隐球菌病可发生于免疫功能正常的儿童 ,其临床和影像学表现无特异性 ,诊断依赖于对该病的警惕和认识及隐球菌检查。儿童肺隐球菌病易发生血行播散应及时予抗真菌治疗。     

儿童播散性隐球菌病8例临床特征和预后

目的 探讨儿童播散性隐球菌病的临床特征和预后。方法 回顾性分析2009年5月至2013年11月复旦大学附属儿科医院感染科收治的播散性隐球菌病患儿的临床资料,总结临床特征和预后。结果 8例播散性隐球菌病连续病例进入分析,男5例,女3例,平均年龄6.1岁。血清HIV抗体均阴性,流式细胞仪检测CD4细胞计数正常。2例起病前曾口服糖皮质激素,余6例否认免疫抑制剂服用史及基础疾病史。8例患儿家长均否认鸽子或其他禽类接触史。8例患儿起病均表现为持续发热,7例有明显的肝脾肿大,4例有黄疸,2例有咳嗽等呼吸道症状,2例服用糖皮质激素患儿有皮肤损害,8例均无头痛、呕吐或意识改变等神经系统症状。8例血清隐球菌抗原滴度均>1:640,6例血培养结果示新型隐球菌阳性,4例CSF隐球菌抗原升高,5例外周血嗜酸性粒细胞计数升高。8例血清IgE均升高,平均3 896.5 KuA·L-1。3例影像学检查提示累及胆道,肝内胆管扩张,胸部CT示7例累及肺部。8例起病至确诊2～7周,均接受全身性抗真菌治疗（两性霉素B联合5-氟胞嘧啶或氟康唑）,其中1例治疗后出现隐球菌相关性免疫重建炎症综合征,8例治疗反应良好。8例诱导治疗结束后外周血嗜酸性粒细胞计数和血清IgE水平均恢复正常,停药后随访3~6个月,均无复发。结论 播散性隐球菌病可发生于无HIV感染的儿童,可累及多系统脏器,以单核-巨噬细胞系统和肺部受累多见。外周血嗜酸性粒细胞计数升高和血清IgE水平升高是本病实验室检查的显著特点。     

小儿隐球菌病8例临床分析

我院于 1990～ 1999年共收治 8例隐球菌病患儿 ,均经脑脊液墨汁染色或(和 )真菌培养 ,皮疹印片及淋巴结活检找到新型隐球菌确诊。现报告分析如下。一般资料 :本组 8例 ,男性 6例 ,女性 2例 ,年龄 1岁 9个月至 12岁 ,亚急性起病 5例 ,慢性起病 3例 ,有基础疾病 5例 (白血病化疗后、结核病、肾病综合征长期服激素、化脓性感染大剂量抗生素治疗后、中度营养不良各 1例 )。临床表现 :病程 2周至 8个月 ,首发症状 :发热、头痛 6例 ;皮疹、淋巴结肿大、肝脾大 2例。累及中枢神经系统6例 ,累及肺、肝、脾、淋巴结、皮肤、胸膜 2例。临床诊断单纯隐…     

疑难病研究——全身性播散性隐球菌病

该文通过 1例全身性播散性隐球菌病的疑难病例分析以期提高临床医师对隐球菌病的认识。隐球菌病是由新型隐球菌引起的深部真菌病 ,起病隐袭 ,临床表现无特异性 ,易漏诊 ,误诊。诱因有长期使用广谱抗生素、激素、抗代谢药物、免疫抑制剂、抗肿瘤药物、慢性疾病和长期静脉插管、留置导尿管等。临床表现包括发热、肝脾淋巴结肿大及肝功能损害、皮肤、肺、骨骼和中枢神经系统的病变 ,取病灶组织或渗液作墨汁染色 ,可见特有形态的隐球菌 ,亦可作真菌培养或淋巴结活检找到隐球菌确诊 ;鉴别诊断主要与结核性脑膜炎、败血症和淋巴瘤等鉴别 ;治疗主要是在使用 2～ 3种抗真菌药物的同时加强支持治疗。     

隐球菌性脑膜炎预后的相关因素

目的探讨影响隐球菌性脑膜炎预后的相关因素。方法对1986~2004年确诊为隐球菌性脑膜炎13例患儿进行回顾性分析。结果在疗效成功的8例中,两性霉素B(Amp B)联用氟胞嘧啶(5-FC)和(或)氟康唑治疗效果肯定,其中6例联合鞘内注射给药,1例经Ommaya囊侧脑室放液给药术。5例死亡,影响预后的因素主要有诊断延误,病情进展快,早期未合理使用抗真菌药物,未及时鞘注和施行Ommaya囊侧脑室放液给药术。结论早期诊断,早期合理使用抗真菌药物,早期采用鞘内注射给药和经Ommaya囊侧脑室放液给药,可显著改善本病预后。     

儿童颅内新型隐球菌肉芽肿临床分析

目的探讨儿童颅内新型隐球菌肉芽肿的临床表现、影像学特征及诊治方法。方法回顾性分析3例经手术后病理证实为新型隐球菌肉芽肿患儿的临床资料。结果 3例患儿均为女性,起病年龄4～12个月,均有癫发作。CT检查发现颅内异常占位病变伴钙化,头颅磁共振成像(MRI)示T1WI、T2WI均呈混杂异常信号。3例患儿切除病灶病理检查均可见特征性的新型隐球菌,部分钙化。手术切除病灶联合抗真菌治疗及对症抗癫治疗有效,长期随访预后良好。结论儿童颅内新型隐球菌肉芽肿罕见,尤其是婴幼儿起病者;对于临床癫反复发作难以控制,伴或不伴局灶神经系统损害症状,结合影像学颅内有异常病灶者,应怀疑该病。病理诊断为确诊方法。手术切除病灶联合抗真菌治疗及对症抗癫的综合治疗方法有效。     

Latex agglutination: an appropriate technology for the diagnosis of bacterial meningitis in developing countries

We evaluated prospectively the utility of a latex agglutination technique for the diagnosis of Haemophilus influenzae type b meningitis in a paediatric ward in India. Eight of 44 children had H. influenzae grown from cerebrospinal fluid. These proven cases plus four additional cases of H. influenzae meningitis were detected by the latex agglutination test. There were no cross reactions with other organisms. The high degree of sensitivity and specificity, combined with the speed and simplicity of this technique make it an appropriate method for developing countries.     

Etiology of acute bacterial meningitis in hospitalized children in western Uttar Pradesh

We retrospectively studied clinical and etiological profile of acute bacterial meningitis in hospitalized children for two consecutive years at a pediatric hospital in western Uttar Pradesh. Etiological diagnosis could be made in 30 (44.8%) out of 67 cases with either culture or latex agglutination test. Pneumococcus was the commonest pathogen found in 17 (25.4%) cases. The overall mortality was 10.5%.     

Cerebrospinal latex agglutination fails to contribute to the microbiologic diagnosis of pretreated children with meningitis

We conducted a 10-year retrospective study of all children who had cerebrospinal fluid latex agglutination testing for bacterial antigens performed at 1 tertiary care urban children's hospital. Of the 176 patients with culture-negative meningitis who were pretreated with antibiotics before lumbar puncture, none had a positive latex agglutination study (0 of 176; 95% confidence interval, 0-2%). Latex agglutination studies identified no additional cases of bacterial meningitis beyond those identified by culture in pretreated patients. Clinical decision-making algorithms for the management of pretreated patients at risk for bacterial meningitis should not include latex agglutination testing.     

Rapid diagnosis of hemophilus influenzae meningitis by a latex agglutination technique

A latex agglutination test for the rapid diagnosis of H. influenzae meningitis was evaluated by testing 122 CSF samples. All ten CSFs from culture-proven cases of H. influenzae meningitis were positive by the latex agglutination test, which detected an additional two cases of meningitis. There were no cross reactions in 27 CSF samples bacteriologically positive for other organisms. This latex agglutination test is rapid, simple, specific and more sensitive than routine culture. As H. influenzae is the most common cause of childhood bacterial mentingitis in many parts of India, this simple test has a high utility in hospitals and health centres. An erratum to this article is available at .     

Cerebrospinal fluid C-reactive protein in the diagnosis of meningitis in children

The mortality rate of bacterial meningitis in infants and children is still high (40-50%). Such a mortality rate can be reduced by establishing a prompt and accurate diagnosis. Until now the diagnosis of meningitis is still an important clinical problem. The examination of cerebrospinal fluid C-reactive protein had been done in 44 clinical meningitis patients in the Paediatrics Department, Dr. Sardjito General Hospital qualitatively by means of latex agglutination slide test. Cerebrospinal fluid C-reactive protein was positive in 90% (18/20) of bacterial meningitis patients compared to 8.3% (2/24) of non bacterial meningitis patients. The sensitivity and specificity of cerebrospinal fluid C-reactive protein were 90% and 91.7% respectively and these values were more sensitive and specific than those of white cell count, absolute polymorphonuclear, glucose and protein levels and the cerebrospinal fluid smear (50-80% and 80-91% respectively) which had been performed in the diagnosis of meningitis. It can be concluded that the examination of cerebrospinal fluid C-reactive protein can be used as a diagnostic tool of bacterial meningitis.     

Detection of pathogens in bacterial meningitis. Comparison of Gram staining, culture, latex agglutination test and counterimmunoelectrophoresis

To look for the etiologic agent in cerebrospinal fluids of 44 children with meningitis, Gram stain, traditional culture, latex agglutination and counterimmunoelectrophoresis were simultaneously performed. The sensitivity of all four methods was roughly equal. The outstanding importance of the Gram technique has to be emphasized, however. Differences with regard to antigen detection could be observed in patients previously treated with antibiotics, where etiologic agents could still be detected by latex agglutination and counterimmunoelectrophoresis, but not by traditional cultures. A further advantage of the two methods is that they provide results rapidly. The use of all four methods simultaneously allows for optimal results in the detection of causative organisms in cerebrospinal fluid in meningitis.     

Sub acute and chronic meningitis in children—An immunological study of cerebrospinal fluid

Cerebrospinal fluid (CSF) from 274 cases of subacute to ohronic meningitis in age groups from 3 months to 12 years were analysed for the presence of antibody response to mycobacterial and cysticercal antigens by enzyme linked immunosorbent assay (ELI8A). Simultaneously other correlative parameters such as CSF cell cytology by cytospin studies, mycobacterial antigens of Lipoarabinomannan (LAM) type (a polysaccharide antigen) by reverse passive haemagglutination assay (RPHA) CSF C-reactive protein (CRP) by latex agglutination and microbial cultures for mycobacterium tuberculosis and fungi were carried out Antimycobacterial antibody was present in 35.4% of the cases. In 57.66% of the oases there was no demonstrable immune response to either mycobacterial or cysticercal antigens. However, it was interesting to note that 5.47% of the cases revealed the presence of anticysticercal antibody in the CSF. The mycobacterial antigen (LAM poiysaccharide antigen) was found in 72.6% of the cases. There was no evidence of carcinomatous or cryptococcal meningitis. This study stresses the role of multimodal diagnostic tests on CSF for investigating cases of chronic and subacute meningitis irrespective of leading dues such as tuberculosis.     

Evaluation of polymerase chain reaction (PCR) for diagnosing Haemophilus influenzae b meningitis

A polymerase chain reaction (PCR) for detecting Hib in cerebrospinal fluid (CSF) was evaluated and compared with culture and a latex agglutination test (LAT) in a hospital-based prospective surveillance. We studied 107 children aged from 1 month to 12 years with a clinical and CSF profile suggestive of acute bacterial meningitis. CSF culture was performed on blood-chocolate agar by standard technique, LAT by a commercially available kit (Wellcogen) and PCR using total DNA extracted from CSF samples. Of 107 children, 79% had received one or more doses of injectable antibiotics. Hib was detected by culture in 14 cases, by LAT in 23 and by PCR in 37. All CSF samples that reveal Hib by culture or LAT had a PCR positive for Hib (sensitivity 100%). PCR also detected 14 additional cases of Hib meningitis which were not detected by culture or LAT. We conclude that PCR is a sensitive and specific diagnostic tool that may be valuable in a population with high pre-hospital antibiotic usage.     

Blood culture results as determinants in the organism identification of bacterial meningitis.

The diagnosis of bacterial meningitis depends on a lumbar puncture (LP). Sometimes, antibiotics are administered before a LP that is delayed owing to prior need for computerized tomography (CT) scan, technical problems, inability to obtain consent, or an unstable patient. We examined the accuracy of blood culture, cerebrospinal fluid (CSF) Gram's stain, and antigen detection by latex for organism identification of meningitis. All patients admitted to the Children's Hospital of Buffalo between January 1, 1984 and December 31, 1989 and having a CSF culture diagnosis of bacterial meningitis had their charts retrospectively reviewed. Patients excluded from the study were those with neural tube defects or CSF catheters, those admitted directly to the Intensive Care Nursery (ICN), those whose positive CSF cultures were determined to be a contaminant, those whose medical records were not found, or those older than 16 years. We analyzed a total of 178 patients with positive CSF cultures and the confirmed diagnosis of bacterial meningitis. Of 169 patients who had a blood culture performed, 86% had the organism responsible for meningitis recovered by this test, with the highest yield of 91% occurring in the 2.5-month to 24-month age group. Blood culture identified the bacteria in 94% of those patients with Haemophilus influenzae meningitis, and this yield increased to 100% when patients who had been pretreated with antibiotics were excluded. The combination of blood culture, CSF Gram's stain, and/or latex agglutination identified the causative bacteria in 92% of patients with meningitis. Blood culture, CSF Gram's stain, and latex agglutination are useful in identifying the organism causing pediatric meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Latex agglutination testing in bacterial meningitis.

The value of the latex agglutination test in meningitis was assessed. This was positive in 60% cases of Streptococcus pneumoniae, 93% of Haemophilus influenzae type b, and 39% of Neisseria meningitidis infections. We cannot support the view that this test was more valuable than Gram staining in partially treated meningitis and cannot recommend its routine use. It may, however, be valuable if Gram staining does not identify an organism or if it suggests meningococcal infection.