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1.
Seaton RA; Naraqi S; Wembri JP; Warrell DA 《QJM : monthly journal of the Association of Physicians》1996,89(6):423-428
In Papua New Guinea, <it>Cryptococcus neoformans</it> var.
<it>gattii</it> meningitis has a high fatality rate even in
immunocompetent patients. Our retrospective study attempted to identify
marker of poor prognosis. Of 88 immunocompetent patients, 30 (34.1%) died,
usually soon after admission, and mortality was higher in men
(<it>p</it> = 0.025) and older patients (<it>p</it>
= 0.039). Death was associated with altered consciousness
(<it>p</it><0.001), a history of convulsions prior to
treatment (<it>p</it> = 0.002) and a maximum systolic blood
pressure of >150 mmHg (<it>p</it> = 0.017). These data
suggest that death results from raised intracranial pressure and subsequent
tentorial herniation. However, CSF opening pressure measured on admission
was raised in 29/36 (81%) patients and did not predict outcome. In
survivors, relapse was uncommon and was not predicted by discharge serum
cryptococcal antigen titres, which were frequently raised on completion of
therapy in asymptomatic patients. Mortality may be reduced if efforts are
made to lower intracranial pressure in those patients who present with
markers of poor prognosis.
相似文献
2.
Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis 总被引:1,自引:0,他引:1
Lan SH Chang WN Lu CH Lui CC Chang HW 《QJM : monthly journal of the Association of Physicians》2001,94(5):247-253
Twenty-eight patients with cerebral infarction secondary to chronic meningitis were retrospectively identified at our institution over a period of 5 years. They accounted for 47% (17/36) of tuberculous meningitis (TBM) and 32% (11/34) of cryptococcal meningitis cases. Single infarctions were found in 15 patients and multiple infarctions in 13. The distribution of single infarctions was: basal ganglia 7; internal capsule 3; thalamus 1; cerebellum 1; and cortical infarct 3. Therapeutic outcomes at 3 months were determined using a modified Barthel INDEX: At follow-up of 3 months or more, 10 had good outcomes while the other 18 had poor outcomes. The 18 with poor outcomes included six who died, and 12 who had severe neurological sequelae. TBM and cryptococcal meningitis shared similar clinical features, both being frequently associated with other neurological complications, including hydrocephalus, cranial nerve palsy, and seizures in our patients. However, extracranial involvement, such as spinal and pulmonary involvement, was more commonly found in TBM patients. Cerebral infarction can occur in both the acute stage and later stages of treatment. Mortality and morbidity are high, and early diagnosis and appropriate antimicrobial treatment are essential. If hydrocephalus is demonstrated, early ventricular decompression is needed to prevent further cerebral ischaemia. 相似文献
3.
目的 探讨脑脊液细胞学及特殊染色方法诊断结核性脑膜炎(结脑)、化脓性脑膜炎(化脑)和隐球菌性脑膜炎(隐脑)的临床价值.方法 对三种疾病共179例患者脑脊液细胞学资料进行回顾性分析.所有病例均进行脑脊液细胞学MGG染色、阿立新兰染色和墨汁染色的动态观察,70例结脑同时应用免疫荧光和免疫细胞化学方法进行结核抗原的检测.结果 ①结脑特征性的细胞学表现为混合细胞反应.早期嗜中性粒细胞比例可达80%以上,随治疗逐渐下降,1~2个月后以淋巴样细胞反应为主.免疫荧光法和免疫细胞化学法检测脑脊液单核细胞内结核抗原,敏感性分别为82.9%和85.7%.②化脑急性期脑脊液中以嗜中性粒细胞为主,抗生素治疗后迅速下降.③MGG染色、阿立新兰染色和涂片墨汁染色诊断隐脑的阳性率分别为83.3%、81.8%和76.5%.结论 脑脊液细胞学的动态观察联合应用特殊染色方法,可大大提高颅内感染性疾病的诊断和鉴别诊断,并对治疗及预后判断有指导意义. 相似文献
4.
Early surgery in infective endocarditis 总被引:4,自引:0,他引:4
Olaison L; Hogevik H; Myken P; Oden A; Alestig K 《QJM : monthly journal of the Association of Physicians》1996,89(4):267-278
Optimal timing of surgical intervention in infective endocarditis is
important in reducing mortality. We prospectively studied 126 consecutive
episodes of infective endocarditis treated in one institution over 5 years,
with special emphasis on long-term results and on the effects on outcome of
surgical interventions. Twenty-six patients (21%) underwent acute surgery
on median treatment day 14. Mortality during treatment was 8% for patients
undergoing acute surgery vs. 11% for those not undergoing surgery, and the
adjusted 5-year survival rate of acute surgically treated patients was 91%,
compared with 69% for the medically treated patients. Using univariate
analysis, excess mortality during 5 years follow-up was associated with new
cardiac decompensation at entry (<it>p</it> < 0.01), age
(<it>p</it> < 0.01), no acute surgery
(<it>p</it> < 0.05) and mitral valve involvement
(<it>p</it> < 0.05). Multivariate analysis showed new
cardiac decompensation at entry to be an independent predictor of cardiac
death at 5 years follow-up (relative risk 2.39, CI 1.05-5.45), while no
surgery during active disease implied a relative risk of 3.45, though not
statistically significant. Patients undergoing surgery very early
(⩽ 10 days of treatment) did not have a poorer outcome. Acute valve
replacement, as compared with medical therapy only, might be important to
increase both short-term and long-term survival in infective endocarditis.
相似文献
5.
Sarunyou Chusri Thanaporn Hortiwakul Natthaka Sathaporn Boonsri Charernmak Manthana Phengmak Walailuk Jitpiboon Alan Frederick Geater 《Journal of infection and chemotherapy》2018,24(8):648-653
Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis. The definite diagnosis of this disease is difficult and can result in delayed treatment. Conventional culture yields low sensitivity while high-sensitivity diagnostic techniques are costly and unpractical. Adenosine deaminase (ADA) is used to diagnose several settings of extra-pulmonary tuberculosis but it is limited in TBM especially among HIV-infected patients. We retrospectively reviewed the data of patients with non-suppurative meningitis and compared the patient data with TBM and other causes including carcinomatous, lymphomatous, lymphocytic and fungal meningitis. We found that HIV infection, diabetes mellitus, duration of symptoms <14 days, radiologic findings of hydrocephalus, and CSF ADA level >10 IU were associated with TBM. The scoring system based on these parameters and their coefficients in the final model achieved an area under the receiver operating characteristic curve of 0.95,625. The indices were HIV infection = 5, diabetes mellitus = 3, duration of symptoms <14 days = 5, hydrocephalus = 4, and ADA in CSF >10 IU = 5. Based on the assumed costs of the patients with false negative and false positive, an appropriate cut off value of 10 was selected and the sensitivity was 92% and specificity was 89%. 相似文献
6.
The clinical course and management of thoracic empyema 总被引:3,自引:0,他引:3
Ferguson AD; Prescott RJ; Selkon JB; Watson D; Swinburn CR 《QJM : monthly journal of the Association of Physicians》1996,89(4):285-289
We report a prospective multi-centre study of the clinical course and
hospital management of thoracic empyema in 119 patients (mean age 54.8).
The commonest presenting symptom was malaise (75%), 55% were febrile; 31%
were previously well with no predisposing condition. Initial treatments
were antibiotics alone (5), needle aspirations (46), intercostal tube
drainage (61), rib resection (3) and decortication (4). Overall,
intercostal drainage was used in 77 patients (16 failed aspirations),
surgical rib resection in 24 (1 failed aspirations, 20 failed drainage),
and surgical decortication in 28 (6 failed aspirations, 17 failed
drainage). Only 4 patients received intrapleural fibrinolytic agents.
Aspiration and drainage were likely to fail if the empyema was >40%
of the hemithorax. Median time from treatment start to discharge was:
aspirations, 26 days; drainage, 23 days; resection 11 days; decortication,
12 days. Overall 21 patients died (12 with empyema as the major cause); two
had been surgically treated. Mortality correlated with age, diabetes, heart
failure, and low serum albumin at admission. Infecting organisms,
identified in 109 patients (92%) included anaerobes (37), <it>Str.
melleri</it> (36), and <it>Str. pneumoniae</it> (28). Six
months after discharge, all but six survivors had regained their previous
health.
相似文献
7.
Cerebral malaria versus bacterial meningitis in children with impaired consciousness. 总被引:7,自引:0,他引:7
J A Berkley I Mwangi F Mellington S Mwarumba K Marsh 《QJM : monthly journal of the Association of Physicians》1999,92(3):151-157
Cerebral malaria (CM) and acute bacterial meningitis (ABM) are the two common causes of impaired consciousness in children presenting to hospital in sub-Sahara Africa. Since the clinical features of the two diseases may be very similar, treatment is often guided by the initial laboratory findings. However, no detailed studies have examined the extent to which the laboratory findings in these two diseases may overlap. We reviewed data from 555 children with impaired consciousness admitted to Kilifi District Hospital, Kenya. Strictly defined groups were established based on the malaria slide, cerebrospinal fluid (CSF) leucocyte count and the results of blood and CSF culture and CSF bacterial antigen testing. Our data suggests significant overlap in the initial CSF findings between CM and ABM. The absolute minimum proportions of children with impaired consciousness and malaria parasitaemia who also had definite bacterial meningitis were 4% of all children and 14% of children under 1 year of age. The estimated maximum proportion of all children with impaired consciousness and malaria parasitaemia in whom the diagnosis was dual or unclear was at least 13%. The finding of malaria parasites in the blood of an unconscious child in sub-Saharan Africa is not sufficient to establish a diagnosis of cerebral malaria, and acute bacterial meningitis must be actively excluded in all cases. 相似文献
8.
目的分析常见中枢神经系统感染性疾病在临床表现及脑脊髓液(CSF)特征的异同点。方法回顾性总结296例中枢神经系统感染性疾病的临床表现及CSF表现。结果高热以病毒脑和化脑常见(62%和67%),以头痛为首发症状者隐脑多见(60%);抽搐多见于病毒脑(63%);隐脑出现视力改变(40%)、听力下降(45%)、视神经乳头水肿(74%)及脑疝(41%)的比例明显高于其他组;54%的病毒脑出现肢体瘫痪;化脑外周血白细胞显著升高且以多核细胞为主(64%超过20×10^9/L)。CSF检查结果:隐脑的CSF压力升高最明显(91%大于3.96kPa);化脑白细胞升高明显(76%大于400×10^6/L);化脑(74%)和结脑(82%)氯化钠浓度下降;结脑蛋白质升高最显著(48%大于2g/L)。结论隐脑、结脑在临床及CSF变化上相似,CSF压力及蛋白质含量是鉴别的重要指标。化脑、病毒脑的临床诊断相对容易。 相似文献
9.
目的探讨各类中枢神经系统感染的临床特点及治疗方法。方法对我院收治的中枢神经系统感染160例的临床资料进行回顾性分析。结果本组诊断为病毒性脑炎(病脑)80例,化脓性脑膜炎(化脑)37例,结核性脑膜炎(结脑)35例,隐球菌性脑膜炎(隐脑)8例。全部予甘露醇、甘油果糖脱水降颅压及对症治疗,其中148例治疗有效,复查脑脊液示化脑、病脑患者脑脊液均恢复正常;结脑患者脑脊液明显好转,糖基本恢复正常;隐脑患者脑脊液3次墨汁涂片检查(-),糖、氯化物基本正常,脑脊液真菌培养(-),乳胶凝集试验效价明显下降(1∶8~1∶320)。148例病情好转出院,其中10例遗留颅神经损害和脑积水;12例死亡,病死率7.5%。结论中枢神经系统感染需结合临床表现、脑脊液检查和治疗效果综合进行诊断,对疑似中枢神经系统感染但不能确诊者,可予诊断性治疗,以免延误最佳治疗时机。 相似文献
10.
Genetic analysis of thermolabile methylenetetrahydrofolate reductase as a risk factor for myocardial infarction 总被引:3,自引:0,他引:3
Adams M; Smith PD; Martin D; Thompson JR; Lodwick D; Samani NJ 《QJM : monthly journal of the Association of Physicians》1996,89(6):437-444
Hyperhomocyst(e)inemia is associated with an increased risk of coronary
artery disease and myocardial infarction. Both genetic and environmental
factors influence the plasma level of homocysteine. One of the metabolic
pathways for homocysteine involves the enzyme methylenetetrahydrofolate
reductase (MTHFR), which regulates the conversion of homocysteine to
methionine. A thermolabile variant of MTHFR is associated with reduced
enzyme activity and increased plasma homocysteine levels. Recently, the
cause of this variant of MTHFR has been identified as a single base change
altering an alanine to a valine residue in the protein. Using a PCR-based
assay to distinguish the normal and thermolabile variants of MTHFR in this
study, we investigated whether the thermolabile variant is a genetic risk
factor for myocardial infarction. In a study of 532 subjects (310
myocardial infarction patients and 222 population-based controls), we found
no difference in either MTHFR genotype distribution (<it>p</it>
= 0.57) or allele frequencies (<it>p</it> = 0.68) between cases
and controls. The allele frequencies of the thermolabile variant were 0.34
and 0.35 in cases and controls, respectively. The age- and sex-stratified
odds ratio for risk of myocardial infarction associated with homozygosity
for the thermolabile variant was 0.85 (95% CI 0.50-1.50,
<it>p</it> = 0.57) and that with carriage of the thermolabile
allele was 1.06 (95% CI 0.73-1.52, <it>p</it> = 0.76). The odds
ratio remained non-significant when restricted to young subjects
(<60 years) or males, and were not influenced by several other risk
factors for myocardial infarction considered either singly or in
combination. Interestingly, in both cases and controls, there was a trend
toward a higher prevalence of hypertension in subjects carrying the normal
allele, although as this is a <it>post-hoc</it> finding it
needs to be interpreted with caution. The thermolabile variant of MTHFR is
not a major risk factor for myocardial infarction and is unlikely to
explain a significant proportion of the reported association of
hyperhomocyst(e)inemia with coronary artery disease.
相似文献
11.
Autoantibodies against bactericidal/permeability-increasing protein in patients with cystic fibrosis 总被引:5,自引:0,他引:5
Zhao MH; Jayne DR; Ardiles LG; Culley F; Hodson ME; Lockwood CM 《QJM : monthly journal of the Association of Physicians》1996,89(4):259-265
Cystic fibrosis (CF), a genetic disorder, is characterized by chronic
pulmonary infection/inflammation which leads to respiratory failure. The
presence of anti-neutrophil cytoplasmic autoantibodies (ANCA) has
previously been observed in the sera of patients with CF. In view of the
known relationship of ANCA with primary vasculitis and of their putative
pathogenetic role in these disorders, we studied the presence, specificity
and isotype of ANCA and their clinical associations in 66 adult CF
patients. None of the 66 CF samples had autoantibodies to the major ANCA
antigens, proteinase 3 or myeloperoxidase. However, 60/66 (91%) CF samples
contained IgG and 55/66 (83%) IgA, autoantibodies to
bactericidal/permeability increasing protein (BPI), a recently
characterized ANCA specificity. All the IgA anti-BPI-positive samples were
also IgG anti-BPI-positive. The autoantibody specificity was confirmed by
inhibition assay and immunoblotting of CF sera against a neutrophil granule
preparation. Furthermore, in this cross-sectional study, anti-BPI levels
were inversely correlated with the observed reductions in FEV1 and FVC (IgA
anti-BPI and FEV1: r = 0.508, <it>p</it> < 0.0001), and
both IgG and IgA anti-BPI levels were higher in CF patients with secondary
vasculitis (<it>n</it> = 6) than in those without
(<it>p</it> < 0.05). ANCA with specificity for BPI were
present in the majority of CF sera in this study and autoimmune processes
may be associated with the development of pulmonary injury in CF.
相似文献
12.
Silpapojakul K; Mitarnun W; Ovartlarnporn B; Chamroonkul N; Khow-Ean U 《QJM : monthly journal of the Association of Physicians》1996,89(8):623-629
Liver involvement was retrospectively evaluated in 137 patients with murine
typhus. Fifteen (10.9%) were jaundiced. One patient had been subjected to
cholecystectomy after misdiagnosis of acute cholecystitis. Serum
aminotransferase levels were abnormal in 48/52 measurements, and there were
elevations of >5-fold in 14 patients. Liver biopsies and/or
necropsies from four jaundiced patients showed portal tract and sinusoidal
infiltrates, cloudy swelling/and necrosis of the hepatocytes and occasional
pseudogranuloma formation. There were striking mitoses even in the early
stage, suggesting rapid hepatocellular regeneration. Haemolytic diseases
(G7PD deficiency or haemoglobinopathies), alcoholism, and a second
infection probably also contributed to the pathogenesis of jaundice in
murine typhus. This rickettsiosis should be included among differential
diagnoses of acute hepatitis in patients exposed to areas endemic for
<it>Rickettsia typhi</it>.
相似文献
13.
Cryptococcal meningitis (CM), a fungal disease caused by Cryptococcus spp., is the most common form of meningitis and a leading cause of death among persons with HIV/AIDS in sub-Saharan Africa. Detection of cryptococcal antigen, which is present several weeks before overt signs of meningitis develop, provides an opportunity to detect infection early. Screening persons with HIV for cryptococcal infection when they access healthcare can identify asymptomatic infected patients allowing for prompt treatment and prevention of death. A newly developed point-of-care assay for cryptococcal antigen, as well as growing evidence supporting the utility and cost-effectiveness of screening, are further reasons to consider broad implementation of cryptococcal screening in countries with a high burden of cryptococcal disease. 相似文献
14.
Warrell DA; Hudson BJ; Lalloo DG; Trevett AJ; Whitehead P; Bamler PR; Ranaivoson M; Wiyono A; Richie TL; Fryauff DJ; O'Shea MT; Richards AM; Theakston RD 《QJM : monthly journal of the Association of Physicians》1996,89(7):523-530
The New Guinea small-eyed or Ikaheka snake, <it>Micropechis
ikaheka</it>, which occurs throughout New Guinea and some adjacent
islands, is feared by the indigenes. The first proven human fatality was in
the 1950s and this species has since been implicated in many other cases of
severe and fatal envenoming. Reliable attribution of envenoming to this
species in victims unable to capture or kill the snake recently became
possible by the use of enzyme immunoassay. Eleven cases of proven
envenoming by <it>M. ikaheka</it>, with two fatalities, were
identified in Papua New Guinea and Irian Jaya. Five patients showed no
clinical signs of envenoming by other Australasian elapids: mild local
swelling, local lymphadenopathy, neurotoxicity, general myalgia,
spontaneous systemic bleeding, incoagulable blood and passage of dark urine
(haemoglobinuria or myoglobinuria). Two patients developed hypotension and
two died of respiratory paralysis 19 and 38 h after being bitten.
<it>In vitro</it> studies indicate that the venom is rich in
phospholipase A2, is indirectly haemolytic, anticoagulant and inhibits
platelets, but is not procoagulant or fibrinolytic. It shows predominantly
post-synaptic neurotoxic and myotoxic activity. Anecdotally, Commonwealth
Serum Laboratories' (CSL) death adder antivenom has proved ineffective
whereas CSL polyvalent antivenom may be beneficial. Anticholinesterase
drugs might prove effective in improving neuromuscular transmission and
should be tested in patients with neurotoxic envenoming.
相似文献
15.
Cryptococcal meningitis in non-HIV-infected patients 总被引:5,自引:0,他引:5
Shih CC Chen YC Chang SC Luh KT Hsieh WC 《QJM : monthly journal of the Association of Physicians》2000,93(4):245-251
There are few reports on cryptococcal meningitis in non-HIV-infected patients in subtropical areas. We reviewed 94 non-HIV-infected patients microbiologically diagnosed with cryptococcal meningitis and hospitalized at National Taiwan University Hospital, 1977-1996. Forty-two patients (44.7%) had underlying diseases. The main initial manifestations were headache (86.2%), vomiting (72.3%) and fever (69. 1%). The 30 patients with T-cell suppression had more acute illnesses (median duration of symptoms: 14 days vs. 29 days), less typical presentations of meningitis, and reduced inflammatory responses compared with the 64 without T cell suppression. There was no statistical difference between patients who received amphotericin B treatment for 10 weeks and those received amphotericin B with subsequent fluconazole treatment, in terms of mortality rate and recurrence rate. Seventy-five patients (79.8%) had satisfactory clinical responses, and two relapsed. Eighteen patients died (19.1%) and 10 of these died within 2 weeks of hospitalization. Patients in this series had outcomes comparable with those from temperate and even tropical countries with high percentages of immunocompetent hosts. Factors significantly associated with death were lymphoma, semicoma, leukocytosis, and initial high titres of cryptococcal antigen in cerebral spinal fluid (especially >/=1 : 512). On multivariate analysis, lymphoma and initial high cryptococcal antigen titres were independent predictors of mortality. 相似文献
16.
脑脊液sIL-2R、IL-8检测在小儿中枢神经系统感染鉴别诊断中的意义 总被引:2,自引:0,他引:2
目的探讨可溶性白细胞介素-2受体(sIL-2R)和白细胞介素-8(IL-8)在小儿不同病因中枢神经系统(CNS)感染急性期脑脊液(CSF)中的变化规律.方法采用双抗体夹心ELISA法检测了21例结核性脑膜炎结脑、15例化脓性脑膜炎(化脑)和20例病毒性脑膜炎患儿急性期CSF中sIL-2R和IL-8.结果结脑、化脑及病毒性脑膜炎急性期CSF中sIL-2R水平分别为(350±81.2)U/ml,(174.5±50.1)U/ml和(80.1±21.77)U/ml,均明显高于正常对照组(27.37±12.19)U/ml(P<0.001);IL-8水平分别为(218.81±32.52)pg/ml、(360.8±69.38)pg/ml及(106.75±37.16)pg/ml,明显高于正常对照组(42.37±14.92)pg/ml(P<0.01);结脑、化脑及病毒性脑膜炎急性期CSF中.结论sIL-2R在结脑的发病机制中起重要作用,其在CSF显著增高有助于结脑与病毒性脑膜炎、化脑的鉴别诊断;IL-8在化脑的发生发展中起重要作用,CSF中IL-8检测有助于化脑与病毒性脑膜炎、结脑的鉴别诊断. 相似文献
17.
目的探讨隐球菌荚膜抗原胶体金免疫层析法在非HIV患者隐球菌脑膜炎中的诊断价值。方法回顾性分析2013-2018年复旦大学附属华山医院3627例疑似中枢神经系统感染的住院患者的临床资料,收集符合隐球菌脑膜炎初诊的患者214例,分析各检验结果对隐球菌脑膜炎的诊断价值。结果隐球菌脑膜炎患者多数表现为脑脊液糖和氯化物水平显著下降,蛋白含量增高,白细胞增多且以单核细胞为主,脑脊液真菌镜检和培养的阳性率分别为75.23%和78.04%,脑脊液隐球菌胶体金免疫层析法检测阳性率高达100%。隐球菌脑膜炎患者随治疗时间的推移,脑脊液和血的隐球菌荚膜抗原滴度逐渐下降。结论胶体金免疫层析法适用于非HIV患者隐球菌脑膜炎的快速诊断,灵敏度高、特异性强,对隐球菌肺炎的患者能提前筛查是否有中枢神经系统感染,对荚膜抗原的动态监测有助于隐球菌病治疗疗效的观察。 相似文献
18.
19.
《Journal of critical care》2016,31(6):1365-1369
PurposeThere is paucity of information about the outcome of tuberculous meningitis (TBM) patients on mechanical ventilation (MV). In this communication, we report the clinical characteristics, predictors of MV, and outcome of TBM patients requiring MV.MethodThirty-eight (18%) of 205 patients with TBM requiring MV were included; and their demographic, clinical, cerebrospinal fluid, and magnetic resonance imaging finding at admission and follow-up were noted. The ventilator-related and systemic complications, hospital death, and 3-month functional outcome were noted. The predictors of need of MV were derived by multivariate regression analysis.ResultsThere were 38 MV and 36 non-MV TBM patients who were matched for age, sex, and stage of meningitis on admission. The requirement of MV was independently related to leukocytosis, seizure, and cerebrospinal fluid pleocytosis on admission. Patients on MV had higher frequency of septicemia (9 vs 2), bedsores (6 vs 0), and gastric hemorrhage (4 vs 0) compared with non-MV patients. Only 29% of MV patients survived and had poor outcome at 3 months; but in the non-MV group, all the patients survived, and only 11% had poor outcome.ConclusionMechanical ventilation was needed in 18% TBM patients because of TBM-related or systemic complications. Those requiring MV had high mortality and may be categorized separately. 相似文献
20.
目的 探讨如何提高隐球菌性脑膜炎的诊断水平与治疗效果。方法 分析了21例隐球菌性脑膜炎的诊断与治疗。结果 本组病例脑脊液涂片找隐球的阳性率为48.8 %。治疗中A组10例 ,单用二性霉素B ,3例治愈 ,3例好转 ,4例死亡 ,治愈率为30 % ,有效率为60 % ;B组6例 ,用二性霉素B联合5 -氟胞嘧啶治疗 ,4例治愈 ,2例好转 ,治愈率为66.7 % ,好转率100 % ;C组5例 ,单用氟康唑 ,1例治愈 ,1例好转 ,2例死亡 ,治愈率20 % ,有效率为60 %。经统计学处理后 ,B组与A、C组相比 ,治愈率、有效率有显著差异 p<0.01。结论 隐球菌抗原及聚合酶链反应检测 ,有助于提高隐球菌性脑膜炎的诊断水平;抗真菌药物的联合应用 ,有助于提高隐球菌性脑膜炎的治疗效果。 相似文献