新型隐球菌脑膜炎临床观察

目的：探讨新型隐球菌脑膜炎患儿的临床特点。方法：对9例新型隐球菌脑膜炎患儿临床症状、辅助检查，愈后进行比较。结果：①头痛、颅高压及脑脊液隐球菌阳性占本组患儿的100％；②合理处理颅高压治愈患儿占本组患儿的77.8％。结论：①对头痛、颅高压患儿应行脑脊液隐球菌检查；②合理处理颅高压的新型隐球菌脑膜炎患儿愈后好。     

儿童深部真菌感染的治疗

目的：探讨儿童深部真菌感染的治疗。方法：回顾性分析14例经病原学检查确诊的儿童深部真菌感染的临床资料。结果：14例患儿中11例为新隐球菌脑膜炎，3例为新隐球茵全身感染；13例给予抗真菌治疗，其中2例单用氟康唑(F1u)，另11例用二性霉素B(AMB)或脂质体二性霉素B(L-AMB)联合氟康唑或5-氟胞嘧啶(5-FC)，3例治愈。7例好转。结论：新隐球菌是儿童深部真菌感染的常见病原，AMB联合5-FC或Flu是治疗儿童深部真菌感染的主要方案。     

艾滋病合并隐球菌脑膜炎18例临床分析

目的探讨艾滋病合并隐球菌脑膜炎的临床认识。方法选自2013年2月至2014年1月我院收治的艾滋病合并隐球菌脑膜炎患者18例,对这18例患者的临床治疗资料进行回顾,总结艾滋病合并隐球菌脑膜炎的临床特征。结果艾滋病合并隐球菌脑膜炎患者的主要临床表现为嗜睡、发热、视力下降、呕吐,其中发热是主要的临床特征。18例患者有淋巴结核、口腔真菌感染、肺结核以及消耗综合征等并发症,其中口腔感染和肺结核是主要的并发症。18例患者中经过头颅CT检查,大部分患者具有不同程度的脑萎缩。结论艾滋病合并隐球菌脑膜炎患者的主要临床特征是临床治疗的有效依据,因此,应该积极的研究艾滋病合并隐球菌脑膜炎患者的临床特征,为临床治疗提供可靠的数据参考。     

新型隐球菌脑膜炎临床观察

目的　探讨新型隐球菌脑膜炎患儿的临床特点。方法　对 9例新型隐球菌脑膜炎患儿临床症状、辅助检查 ,愈后进行比较。结果　①头痛、颅高压及脑脊液隐球菌阳性占本组患儿的 10 0 % ;②合理处理颅高压治愈患儿占本组患儿的 77.8%。结论　①对头痛、颅高压患儿应行脑脊液隐球菌检查 ;②合理处理颅高压的新型隐球菌脑膜炎患儿愈后好     

中枢神经系统损害为主的艾滋病并发隐球菌感染13例报告

目的提高对以中枢神经系统损害为主的全身性获得性免疫缺陷疾病（AIDS）并发新型隐球菌感染脑膜炎的认识。方法对13例以中枢神经系统损害为主的AIDS并发新型隐球菌感染脑膜炎患者进行临床综合分析。结果13例中枢神经系统损害为主的AIDS并发新型隐球菌感染脑膜炎患者均有神经系统症状，脑脊液中均发现新型隐球菌。结论隐球菌脑膜炎为AIDS常见机会性感染及主要致死病因之一。     

儿童隐球菌脑膜炎的诊断与治疗

儿童隐球菌脑膜炎呈隐袭性起病,慢性进展性病程,临床表现无特异性,早期诊断较困难,容易被误诊,其病死率和致残率均较高。目前对本病的治疗主要依靠抗真菌药物。本文从儿童隐球菌脑膜炎的流行病学、诊断及治疗等不同的方面进行综述。     

隐球菌性脑膜炎的治疗

隐球菌性脑膜炎的治疗石尧忠（上海医科大学附属华山医院传染病学教研室，上海２０００４０）关键词脑膜炎，隐球菌病；两性霉素Ｂ；氟胞嘧啶真菌性脑膜炎临床上较为少见，但其中的隐球菌性脑膜炎仍时有报道。由于该病起病缓慢，临床上极易误诊为结核性脑膜炎。因此对中枢...     

新型隐球菌性脑膜炎的实验室诊断

目的 探讨新型隐球菌性脑膜炎的实验室诊断方法 .方法 对脑脊液标本进行墨汁染色镜检,查找新型隐球菌.结果 13例新型隐球菌性脑膜炎患者的脑脊液标本均镜检到新型隐球菌,而对照组未镜检出一例阳性.结论 因新型隐球菌性脑膜炎的临床表现与结核性脑膜炎很相似,实验室几乎均未将墨汁染色镜检新型隐球菌作为脑脊液的常规检测项目,故新型隐球菌性脑膜炎往往不能及时确定而被误诊.对脑脊液标本进行墨汁染色镜检,是诊断新型隐球菌性脑膜炎的非常有效的方法 ,应将墨汁染色镜检新型隐球菌作为脑脊液的常规检测项目而日常开展.     

中枢神经系统感染性疾病的流行特征分析

目的 了解中枢神经系统感染性疾病的临床流行特征。方法 对2012—2016年间安徽医科大学第一附属医院住院诊断为中枢神经系统感染的805例病例进行回顾性资料分析。按照病种构成、年度分布、年龄分布、季节分布、性别差异、城乡分布和病死率等特征进行临床流行病学统计分析。结果 主要病种构成依次为:病毒性脑炎73.4%,化脓性脑膜炎13.2%、结核性脑膜炎8.0%、隐球菌脑膜炎4.2%、脑寄生虫病1.2%。病毒性脑炎发病年龄以10岁以内儿童感染为主,化脓性脑膜炎10岁以内和60岁以上年龄段感染者较多,结核性脑膜炎发病集中在10岁以后且有老龄化趋势,隐球菌脑膜炎以青壮年发病较多。病毒性脑炎和结核性脑膜炎的发病季节主要是春季。5种中枢神经系统感染性疾病中,男女构成比均差异无统计学意义(P>0.05)。除脑寄生虫病10例均发生于农村,其他四种城乡差异无统计学意义(P>0.05)。中枢神经系统感染性疾病的总病死率为8.8%,病死率前3位者为隐球菌脑膜炎、结核性脑膜炎、化脓性脑膜炎。化脓性脑膜炎病原菌以肺炎链球菌、大肠埃希菌、脑膜炎双球菌为主。引起病毒性脑炎的病毒主要为肠道病毒及疱疹病毒。结论 安徽地区中枢神经系统感染的病种构成依次为:病毒性脑炎＞化脓性脑膜炎＞结核性脑膜炎。儿童病毒性脑炎和化脓性脑膜炎多见,老年人化脓性脑膜炎和结核性脑膜炎多见,HIV合并隐球菌脑膜炎有所增加。中枢神经系统感染病死率较高。     

新型隐球菌性脑膜炎的诊治进展

新型隐球菌性脑膜炎,简称隐脑（CM）,是新型隐球菌所致的中枢神经系统的亚急性或慢性感染。临床主要表现为亚急性或慢性脑膜炎、脑膜脑炎,少数可表现为颅脑内占位性病变。隐脑误诊率高,新型隐球菌性脑膜炎临床表现不典型,起病隐袭,病程长,误诊率高,病死率高。     

Cryptococcal meningitis in Auckland 1969-89

Twenty-six patients with cryptococcal meningitis were seen in Auckland between 1969 and 1989. The incidence of cryptococcal meningitis in Auckland residents was 0.12 cases/100,000/year. Ten (38%) of the patients were Maori or Pacific Island Polynesians. Nineteen (73%) had a predisposing cause, including immunosuppressive therapy in nine and the acquired immunodeficiency syndrome (AIDS) in seven. The most common presenting syndrome was a subacute or chronic meningitis. Other clinical syndromes included a slowly progressive ataxia, polyradiculopathy, and headache with vomiting. In two patients, the symptoms of meningitis were overshadowed by those of systemic cryptococcal infection. Delay in making the diagnosis was common. The most sensitive method for diagnosing cryptococcal meningitis was the cerebrospinal fluid cryptococcal antigen test. Antifungal therapy cured 17 of the 25 (68%) treated patients overall, 15 of the 19 (79%) without AIDS and six of the seven with no underlying disease.     

两性霉素B联合抗结核药物治疗结核性脑膜炎合并隐球菌性脑膜炎的疗效观察

目的:观察两性霉素B联合抗结核药物治疗结核性脑膜炎合并隐球菌性脑膜炎的临床疗效。方法:将52例结核性脑膜炎合并隐球菌性脑膜炎患者随机均分为治疗组和对照组。2组患者均采用抗结核、降颅内高压、应用激素、保肝等综合治疗。治疗组在综合治疗的基础上给予两性霉素B注射剂,以1mg·kg-1·d-1为首次剂量逐渐递增治疗;对照组在综合治疗的基础上给予氟康唑注射剂200mg·kg-1·d-1,首次剂量加倍。2组均治疗45d,均于治疗期间每周复查脑脊液蛋白量。结果:治疗后治疗组脑脊液蛋白量下降至正常率为84.6%,对照组为57.7%,2组比较差异有统计学意义(P<0.05)。治疗组有5例(19.2%)、对照组有4例(15.4%)发生不良反应,2组比较差异无统计学意义(P>0.05)。结论:两性霉素B联合抗结核药物治疗结核性脑膜炎合并隐球菌性脑膜炎可明显降低脑脊液蛋白量,且不良反应少。     

Effect of rifampicin on the pharmacokinetics of fluconazole in patients with AIDS

OBJECTIVE: To study the effect of rifampicin on the pharmacokinetics of fluconazole and on clinical outcomes of fluconazole treatment in patients with AIDS-related cryptococcal meningitis. PATIENTS: Forty Thai patients with AIDS and cryptococcal meningitis, of whom 20 had been receiving oral rifampicin for at least 2 weeks to treat tuberculosis. METHODS: Patients were treated for cryptococcal meningitis with amphotericin 0.7 mg/kg/day for 14 days followed by fluconazole 400 mg/day, which was reduced to 200 mg/day once culture of cerebrospinal fluid (CSF) became negative. Patients with tuberculosis received oral rifampicin 600 mg/day at night. Blood samples were collected from the first 12 patients in each group and pharmacokinetic parameters for fluconazole were calculated. CSF samples were collected by lumbar puncture and monitored for eradication of Cryptococcus neoformans. RESULTS: Concomitant administration of rifampicin with fluconazole resulted in significant changes in the pharmacokinetic parameters of fluconazole, including a 39% increase in elimination rate constant, 28% shorter elimination half-life, 22% decrease in area under the concentration-time curve, 17% decrease in maximum concentration and 30% increase in clearance (p < 0.05). Different fluconazole regimens did not affect the extent of change in the elimination rate constant. Although serum concentrations of fluconazole during the time that patients received rifampicin concomitantly with fluconazole 200 mg/day were generally lower than the minimum inhibitory concentration for C. neoformans, there were no significant differences in clinical outcomes between the two groups to date (p = 0.792). CONCLUSIONS: Coadministration of rifampicin with fluconazole caused significant changes in the pharmacokinetic parameters of fluconazole. Long-term monitoring for recurrence rates of cryptococcal meningitis is required to assess the clinical significance of this interaction.     

应用双向电泳分析结核性脑膜炎与隐球菌性脑膜炎脑脊液的蛋白差异

目的 比较分析结核性脑膜炎(TBM)与隐球菌性脑膜炎脑脊液的差异蛋白质,筛选二者的鉴别诊断标志物.方法 采用双向凝胶电泳技术对4例TBM和4例隐球菌性脑膜炎脑脊液蛋白进行电泳分离,以PDQuest8.0软件根据蛋白的等电点PI、分子量、匹配率、灰度值等进行差异蛋白描述性分析.结果 结核性、隐球菌性两组脑脊液分别检测到蛋白点数为111和114,蛋白点分子量均分布为10～130 kDa,等电点PI为4.4～6.7间.两组脑脊液蛋白图谱匹配率为95％,产生24个差异蛋白点,其中3个蛋白点只在TBM中表达,2个蛋白点只在隐球菌性脑膜炎中表达,19个匹配蛋白点存在2倍差异表达.结论 双向电泳技术可得到分辨率和重复率较高的结核性与隐球菌性脑膜炎脑脊液蛋白质凝胶图谱,二者存在差异蛋白点.     

1例脑膜炎隐球菌患者的药学监护

目的 探讨临床药学监护方法,促进药物合理应用.方法 依据隐球菌性脑膜炎治疗指南,对选用的药物、剂量、服药方法、制订个体化给药方案等实行药学全程监护,并进行疗效评价.结果 临床药师深入临床,针对临床脑膜炎隐球菌感染的控制,发挥自身药学专长,进行药学监护,收到了预期效果.结论 临床药师对患脑膜炎隐球菌患者实行全程药学,有效地减少了药物的滥用,对合理、安全地使用药物起到了良好作用.     

艾滋病合并新型隐球菌性脑膜炎100例临床分析

目的 分析艾滋病合并新型隐球菌性脑膜炎的临床特点、治疗及转归,提高对隐球菌性脑膜炎的认识.方法 回顾性总结2008年1月至2012年12月在广州医科大学附属广州市第八人民医院住院治疗的艾滋病合并隐球菌性脑膜炎的临床表现、实验室检查、治疗及转归.结果 100例确诊患者中,男75例,女25例,平均年龄（39.5±10.3）岁,Charlson合并症指数为（6.1±0.7）,所有患者均未接受高效抗逆转录病毒治疗（HAART）.发热和头痛是最常见的临床症状.CD4细胞计数1～ 139/μl（中位数8.5）.98例患者入院初次脑脊液压力升高,平均为（21.2±12.4）mmHg.脑脊液白细胞中位计数2（1 ～ 110）× 10^6/L,中位蛋白质定量为0.41 g/L（0.11 ～1.43 g/L）,葡萄糖含量中位数为0.42 g/L（0.05～ 0.69g/L）.88例患者脑脊液墨汁染色找到隐球菌,81例患者脑脊液培养阳性,88例患者脑脊液隐球菌抗原阳性,99例患者血清隐球菌抗原阳性.中位疗程23天,各治疗组间临床转归差异无统计学意义（Х^2=4.387,P=0.821）.结论 艾滋病并发新型隐球菌性脑膜炎是艾滋病常见机会性感染,临床表现及实验室检查缺乏特异性,减少病死率的关键在于早期诊断,早期合理地使用抗真菌药物.     

氟康唑治疗新型隐球菌性脑膜炎22例临床观察

目的 研究氟康唑治疗新型隐球菌性脑膜炎的疗效。方法 22例患者单独应用氟康唑治疗,重症患者从400mg/d静脉点滴开始,至临床症状明显好转后,改用200mg/d静脉点滴,至达到治愈标准后,改口服200mg/d,3周后停药。轻症患者从200mg/d静脉点滴开始,首剂加倍。对长期口服激素者,停药后给予口服氟康唑200mg,3次/周。结果 22例中13例达治愈标准,4例死亡,3例未愈,2例退出治疗后死亡。结论 早期足量长疗程应用氟康唑可以用于治疗绝大多数新型隐球菌脑膜炎患者。     

Treatment of acute cryptococcal disease

Successful treatment outcome for cryptococcal disease has been available since the introduction of the polyene antifungal, amphotericin B. Over the past 15 - 20 years, treatment of acute cryptococcal disease has dramatically improved. Several therapeutic strategies have been introduced which improve overall outcome of therapy and help decrease the duration of treatment. Not surprisingly, most data now exists on the treatment of AIDS-associated cryptococcal disease, especially cryptococcal meningitis. Currently, amphotericin B with or without flucytosine is regarded as the best initial therapy for patients with meningitis or more severe illness, although, the azoles and other formulations of amphotericin B can considered in other situations. The choice of treatment for cryptococcal disease depends on both the anatomic sites of involvement and the host’s immune status, all of which will be addressed in this article.     

Treatment of acute cryptococcal disease

Successful treatment outcome for cryptococcal disease has been available since the introduction of the polyene antifungal, amphotericin B. Over the past 15-20 years, treatment of acute cryptococcal disease has dramatically improved. Several therapeutic strategies have been introduced which improve overall outcome of therapy and help decrease the duration of treatment. Not surprisingly, most data now exists on the treatment of AIDS-associated cryptococcal disease, especially cryptococcal meningitis. Currently, amphotericin B with or without flucytosine is regarded as the best initial therapy for patients with meningitis or more severe illness, although, the azoles and other formulations of amphotericin B can considered in other situations. The choice of treatment for cryptococcal disease depends on both the anatomic sites of involvement and the host's immune status, all of which will be addressed in this article.