新型隐球菌脑炎/脑膜炎4例临床分析并文献复习

目的:报告新型隐球菌脑炎/脑膜炎4例,并结合文献检索探讨其临床特点及可能的发病机制。方法:回顾分析4例病原学诊断明确的新型隐球菌脑炎/脑膜炎的临床资料,结合文献检索探讨其发病特点及可能发病机制。结果:患者主要表现为头痛、发热、恶心、呕吐及意识障碍;4例均在脑脊液培养中发现新型隐球菌,其中2例墨汁染色发现新型隐球菌;免疫力低下患者易感;脑脊液压力高;主要与结核性脑炎/脑膜炎鉴别;常用的临床治疗方案是两性霉素B联合氟胞嘧啶诱导治疗,氟康唑维持及巩固治疗。结论:中枢神经系统隐球菌病临床表现无特异性,脑脊液墨汁染色阳性率低,在临床诊断过程中对疑似患者,需要反复多次行脑脊液墨汁涂片及培养,减少患者误诊和漏诊。     

原发性肺隐球菌病的临床特点及外科治疗

目的探讨原发性肺隐球菌病的临床特点与手术治疗。方法回顾性分析1996~2013年解放军总医院胸外科收治的27例原发性肺隐球菌病患者的临床资料与随访结果结果 48%(13/27)的患者有全身或呼吸道症状。全部患者胸片及胸部CT误诊为肺癌、肺炎或结核。7例行FDG-PET检查,均表现为高代谢病灶。全部患者抗炎与抗痨治疗后病变无变化。3例穿刺确诊患者抗真菌治疗无法治愈。所有患者病变均手术切除。病灶切除术后16例未行抗真菌治疗,其中1例发生隐球菌性胸膜炎,经过抗真菌治疗后痊愈。全部病例随访无复发。结论原发性肺部隐球菌病的临床症状、化验检查、影像学表现均无特异性,容易误诊为肺癌或肺结核等疾病。除非病理确诊,均应手术切除,术式以局部切除为宜。     

肺隐球菌病的临床分析

目的了解肺隐球菌病的发病特点。方法报告1例肺隐球菌病患者的临床资料,复习了74篇相关文献,总结其临床表现、影像学特点、诊断方法及治疗手段。结果肺隐球菌病的临床表现无特异,诊断依赖病理学,易并发隐球菌性脑膜炎。治疗包括抗真菌药物治疗和手术切除。结论提高对该病的认识可提高确诊率。抗真菌药物治疗,尤其术前术后应用,可减少隐球菌的播散和隐球菌性脑膜炎的发生。     

Antigen detection, serology, and molecular diagnosis of invasive mycoses in the immunocompromised host

Understanding the uses and limitations of methods for rapid diagnosis of fungal disease is essential in order to diagnose and treat these infections early in their course. Antigen detection methods are useful for diagnosis of aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, paracoccidioidomycosis, and penicilliosis marneffei. The accuracy of the beta-glucan assay for diagnosis of aspergillosis and candidiasis and its role in fungal diagnosis remains unclear, in part because the few published studies report widely varying specificity. Serologic tests for antibodies are also useful for diagnosis of histoplasmosis and coccidioidomycosis, but their sensitivity may be reduced by immunosuppression. While molecular diagnostic methods have been described and are available at some reference and university laboratories, their role in patient care remains uncertain, largely because of the lack of well-characterized assays and studies establishing their accuracy. Culture methods, although essential for establishing the diagnosis in some cases, have limitations for rapid diagnosis, namely insensitivity, need for invasive procedures, and delayed growth.     

Cryptococcal infection of the femoral bone similar with pathologic features of vascular tumors: a case report and review of literature

A rare case is presented of a 62-year-old man with primary isolated cryptococcal femoral osteomyelitis. Magnetic resonance imaging (MRI) revealed osteolytic destruction of his left femur. Biopsy was performed firstly. Under microscope, the lesion was compose of numerous large mononuclear cells, scattered multinucleated giant cells, a few lymphocytes and neutrophils, necrosis with serious artificial deformation. By immunohistochemistry (IHC), only CD31 and CD68 were positive, while CK, CK8/18, EMA, P63, CK7, CK20, PSAP, PSA, CD34 negative. It was considered a low grade vascularsarcoma, but not confirmed. Then the operation was done. Surgical specimen showed a lot of red-sphere materials in most cells cytoplasm. The Gomorra methenamine silver staining and PAS revealed the mucopolysaccharide-containing capsule of the Cryptococcus. Laboratory culture of lesion liquid grew a kind of yeast at 37°C. Cryptococcal femoral osteomyelitis was diagnosed at last. The patient is good now after the thorough debridement and anti-fungal treatment.     

29例非免疫缺陷肺隐球菌病临床分析

目的 探讨非免疫缺陷肺隐球菌病的临床特征.方法 分析我院确诊的非免疫缺陷肺隐球菌病患者的临床资料.结果 29例肺隐球菌病患者多为中年男性,咳嗽(48.3％)、咳痰(27.6％)是最常见的临床症状,胸部影像学以孤立的单发结节影最多见,治愈18例(62.1％),好转6例(20.7％),恶化2例(6.9％),死亡1例(3.4％).结论 非免疫缺陷肺隐球菌病多发于中年男性,临床与影像学表现缺乏特异性,确诊需依靠病理组织学检查.     

Examination of a Chinese-made cryptococcal glucuronoxylomannan antigen test in serum and bronchoalveolar lavage fluid for diagnosing pulmonary cryptococcosis in HIV-negative patients

BackgroundWe presented the performance of a Chinese-made cryptococcal glucuronoxylomannan (GXM) antigen test using serum and bronchoalveolar lavage fluid (BALF) samples in the HIV-negative Chinese population.MethodsBetween February 2017 and January 2019, HIV-negative patients with pulmonary cryptococcosis were recruited and followed-up every three months, including completion of a chest CT examination and collection of serum and BALF samples.ResultsHere, thirty-seven confirmed and ten clinically diagnosed patients were recruited. Furthermore, samples from 174 noncryptococcosis patients that may cause false positives were also collected. The sensitivity of a lateral flow assay (LFA) for detecting cryptococcal GXM antigen in serum and BALF samples from confirmed cases was 97% and 95%, respectively, and the specificity was 98.2% and 93%, respectively, and the differences in these values between the BALF and serum samples were not significant. The serum cryptococcal GXM antigen value showed a positive correlation (r: 0.581, p < 0.001) with pulmonary lesion size, while the BALF value showed no correlation (r: 0.253, p: 0.13). The positivity rate of BALF was higher than that of serum when the diameter of the pulmonary lesion was small (diameter less than 20 mm). Moreover, the serum cryptococcal GXM antigen levels showed an overall decreasing trend with the decrease in pulmonary lesion size after antifungal therapy in patient follow-up.ConclusionsThe Chinese-made cryptococcal GXM antigen test has better sensitivity and specificity for diagnosing pulmonary cryptococcosis in the HIV-negative Chinese population, and it could be used to diagnose and to monitor this disease.     

皮肤隐球菌病1例

报告1例皮肤隐球菌病。患儿男，12岁。因肾病综合征给予大剂量甲泼尼龙及环磷酰胺冲击治疗，面部及前臂出现多发性传染性软疣样皮疹，真菌学和组织病理检查证实为皮肤隐球菌病，给予氟康唑治疗无效，患者9d后死于急性肾功能衰竭。     

以胆道梗阻伴胆管炎为首发表现的播散性隐球菌病1例

播散性隐球菌病主要是由隐球菌引起的全身不连续的两个及以上部位感染的疾病,其临床表现多样,常诊断困难。某院收治1例因“腹胀、间断低热2个月,身目黄染1个月,高热伴头痛11 d”入院的34岁女性患者,该患者无免疫力低下情况,病程中患者最先表现为腹胀、身目黄染、间断低热,继而出现高热、头痛,辅助检查发现胆管壁增厚并胆道梗阻,肺部渗出性病变,心内膜赘生物,纵膈、肝门、腹膜后多发淋巴结肿大,腰穿脑脊液压力>400 mmH₂O,脑脊液感染病原体宏基因组二代测序及培养均发现新生隐球菌,腹膜后淋巴结及肝脏病理检查均提示隐球菌感染,患者最终诊断为播散性隐球菌病。本文就该例病例进行分析,旨在提高临床对播散性隐球菌感染的认识。