肺隐球菌病合并隐球菌陛脑膜炎临床分析

新型隐球菌是一种带厚荚膜的酵母菌，它的致病机制尚未完全清楚，多认为与鸽子及其它鸟类的排泄物接触有关。肺隐球菌病合并隐球菌性脑膜炎临床上较少见。我院新近诊治1例和国内报道15例总结如下。     

结核性脑膜炎合并新型隐球菌脑膜炎一例

结核性脑膜炎合并新型隐球菌脑膜炎一例彭江红伍崇旭钟亮（江西省赣州地区人民医院儿科３４１０００）１临床资料患儿，女，７岁，因发热、头痛、食欲差、消瘦１５天入院，患儿入院前１５天出现午后低热、头痛、烦躁与嗜睡交替，食欲差、盗汗，有时恶心、呕吐，身体日渐消...     

隐球菌性脑膜炎28例临床分析

目的 分析28例隐球菌性脑膜炎的临床资料，以期提高对隐球菌性脑膜炎的认识。方法 回顾性总结近年28例隐球菌性脑膜炎的临床表现、辅助检查、误诊情况及治疗。结果 隐球菌性脑膜炎误诊率高，采用二性酶素B(AMB)、氟康唑和(或)5-氟胞嘧啶联合治疗，总有效率为64．3％。10例无效患者中7例死于脑疝。结论 减少病死率的关键在于提高警惕，早期诊断，合理使用抗真菌药物。     

新型隐球菌性脑膜炎合并肺隐球菌病10例临床分析

目的:探讨新型隐球菌性脑膜炎(CM)合并肺隐球菌病(CP)的临床及影像学特点。方法:对10例经病原学检查证实的CM合并CP的临床资料进行回顾性分析。结果:(1)8例男性,2例女性,年龄4～62岁,平均(31.3±23.2)岁。病程14～120天,平均(40.0±39.7)天。(2)首发症状发热8例、头痛6例、咳嗽咯痰2例、胸痛1例。(3)有基础疾病者8例,其中慢性乙型病毒性肝炎6例、矽肺并肺结核2例、营养不良1例、鼻窦炎1例。(4)9例均被误诊为结核感染。1例误诊为肺癌。(5)胸片表现为两肺散在分布小片状、小结节阴影,边缘模糊、内见不规则低密度区;CT示两肺广泛分布斑片状和斑点状密度增高影、大小不等的空洞或类圆形边缘光滑高密度结节。(6)应用二性霉素B(AMB)联合氟康唑(FCZ)静滴和AMB鞘内注射治疗,治愈6例,好转4例。结论:CM合并CP临床症状和影像学均缺乏特异性,提高对CP影像学的认识有利于早期诊断。     

Clinical manifestations of AIDS with cryptococcal meningitis

Objective To increase the awareness of AIDS with cryptococcal meningitis. Methods Eighteen cases of confirmed AIDS with cryptococcal meningitis in the Bata Region al Hospital, Equatorial Guinea from January 1997 to November 1999 were analyzed . Results The clinical manifestations of the 18 cases were: insidious onset, fever, severe headache, generalized pain, nausea and vomiting, weight loss and dehydration, a nd enlarged cervical lymph nodes. Boa’s and Cullen’s signs were positiv e. The positive rates of cerebrospinal fluid (CSF) India ink stain and the poly saccharide capsule antigen (ELISA) were 77. 8% and 99. 4%, respectively. The po sitive rate of CSF culture of cryptococcus was 100%. The mortality rate was 83 . 3%. Conclusion Cryptococcal meningitis is the most common opportunistic infection and one of th e major causes of deaths in AIDS patients. The misdiagnosis and mortality rates were very high and could be explained by a lack of awareness for the occurrence of AIDS with cryptococcal meningitis, late presentation, serious illness and se vere complications, and delayed and inadequate therapy.     

Antifungal therapy for treatment of cryptococcal meningitis

Objective To compare the curative effects of three different antifungal regimens in the treatment of cryptococcal meningitis.Methods Twenty-two patients were divided into 3 groups: Group Ⅰ was given intravenous amphotericin B alone or combination with flucytosine therapy. Group Ⅱ received intravenous fluconazole alone or combination with flucytosine. The treatment of Group Ⅲ was divided into two steps, where the patients received intrathecal amphotericin B plus intravenous amphotericin B with or without intravenous fluconazole until the mycological culture of cerebrospinal fluid (CSF) turned negative, followed by oral fluconazole or itraconazole as maintenance therapy until direct microscopic examination of CSF showed negative once a week for three consecutive weeks. Results Of the twenty-two patients, 17 (77.3%) were cured, 2 (9.1%) improved, 3 (13.6%) died, and one (4.5%) relapsed. Of the 8 patients in Group Ⅰ, 5 were cured, 2 improved, one died and one relapsed; Of the 4 patients in Group Ⅱ, 2 were cured, and 2 died; All the 10 patients in Group Ⅲ were cured without any recurrence.Conclusion The two-step therapeutic regimen may be suited to the treatment of cryptococcal meningitis.     

Voriconazole in an infant with cryptococcal meningitis

Cryptococcus neoformans （C. neoformans） is the most common cause of fungal meningitis worldwide.1 Cryptococcal meningitis is an opportunistic infection commonly found in immunocompromised hosts, especially HIV-infected adults. It also occurs in apparently immunocompetent individuals. Rarely has it been reported in children, and it is almost nonexistent in infants. Voriconazole is a member of a second generation of antifungal triazoles with broad spectrum antifungal activity, oral and parenteral bioavailability and a favorable safety profile in adults.3 This patient shows improved in vitro activity against C. neoformans when compared to fluconazole and it has been used successfully in about half the patients with refractory cryptococcosis.4 However, the efficacy and safety of voriconazole as a antifungal agent in children with cryptococcal meningitis have not been well assessed, This report described cryptococcal meningitis in a 13-day-old premature neonate who recovered without overt toxicity after voriconazole was added to an antifungal regimen that included amphotericin B and flucytosine. We focused on the response of this child with cryptococcal meningitis to voriconazole.     

结缔组织病合并膝关节骨梗死三例报道

结缔组织病患者因为长期大量应用激素,骨梗死并不少见,但多发生于髋关节,发生在膝关节较少见。由于结缔组织病常表现有关节疼或关节炎,发生在膝关节的骨梗死容易被误诊;同样,骨梗死的诊断也可能掩盖结缔组织病的病情活动。作者回顾性分析了3例结缔组织病合并膝关节骨梗死患者的临床表现、免疫学特征以及诊疗过程。患者均为年轻女性,其中2例为系统性红斑狼疮,1例为干燥综合征;均有长期应用激素和免疫抑制剂史,均有雷诺现象,骨梗死为多发或单发,抗骨质疏松和活血、改善骨代谢有一定的疗效,磁共振成像具有较高的诊断价值。临床上应结合其症状以及实验室和影像学检查结果进行综合分析,避免误诊。     

两性霉素B脂质体治疗隐球菌性脑膜炎疗效观察

目的：探讨两性霉素Ｂ（ＡＭＢ）脂质体治疗隐球菌性脑膜炎的疗效与安全性。方法：对４例隐球菌性脑膜炎患者早期采用ＡＭＢ脂质体静脉滴注，同时间断鞘内注射治疗，后期采用氟康唑口服维持。结果：４例患者均治愈。治疗期间未发生明显毒性作用和不良反应。结论：ＡＭＢ脂质体是一种治疗隐球菌性脑膜炎安全有效的抗真菌药物     

儿童新型隐球菌脑膜炎15例临床特征分析

目的探讨儿童新型隐球菌脑膜炎的临床特点、早期诊断方法和误诊原因.方法回顾性分析15例经病原学检查确诊的新型隐球菌脑膜炎临床资料.结果 15例新型隐球菌脑膜炎有14例院外误诊;脑脊液改变与结核性脑膜炎相似.结论儿童新型隐球菌脑膜炎是以发热和颅内高压为主要特点,发病年龄有小龄化趋势,误诊率极高,反复脑脊液检查有助于早期诊断,防止误诊.     

结缔组织病相关间质性肺疾病呈进展性纤维化表型的临床特征及危险因素分析

目的 探讨结缔组织病相关间质性肺疾病（CTD-ILD）患者呈进展性肺纤维化表型的临床特点及危险因素,以期为疾病的早期诊断提供理论依据。方法 回顾性分析2015年11月—2019年3月桂林医学院附属医院诊断为CTD-ILD的127例患者的临床资料。其中,呈进展性肺纤维化表型41例为PF-ILD组,非进展性纤维化表型86例为non-PF-ILD组。比较两组患者的人口学特征及病种构成、临床表现、实验室指标和肺部高分辨率CT影像特征;影响因素的分析采用多因素Logistic回归模型;绘制受试者工作特征（ROC）曲线评估Logistic回归模型的准确性。结果 CTD-ILD患者中呈进展性肺纤维化表型的发生率为32.3%,疾病构成主要包括多发性肌炎/皮肌炎、类风湿性关节炎、系统性硬化症、干燥综合征。与non-PF-ILD组患者比较,PF-ILD组患者病程缩短（P <0.05）,咳嗽、气促占比增加（P <0.05）,白细胞计数、中性粒细胞比值、红细胞沉降率、C反应蛋白升高（P <0.05）,血清白蛋白水平降低（P <0.05）。同时,PF-ILD组患者IgA水平升高（P &l...     

71例结缔组织病患者肺功能临床意义的探讨

目的 探讨结缔组织病(CTD)患者肺功能尤其是肺弥散功能的损伤情况及其与病程时间的关系;分析肺功能检测对于CTD肺部疾病的临床意义.方法 对我院风湿免疫科已确诊CTD的71例患者进行肺通气功能及弥散功能检测,并与正常组比较.结果 80.00％CTD患者存在肺功能的异常,主要以弥散功能下降为主,其次为肺容积的减少、气道阻塞等.肺功能各项指标的异常率(DLCO)为71.83％,DLCO/肺泡通气量(VA)为31.00％,用力肺活量(FVC)为36.62％,慢肺活量(SVC)为31.00％,1秒用力呼气容积(FEV1)为29.58％,FEV1/FVC为5.60％,VA为69.01％,最大呼气流速(FEFmax)为12.68％,小气道功能(FEF) 25％～75％为35.21％.结论 CTD患者肺功能损害主要以肺弥散功能为主,并伴有肺容量的减低等.肺功能检查较肺部CT更早出现异常,对CTD患者肺部疾病的早期发现、治疗及预防有很好的临床意义.     

法舒地尔治疗结缔组织病相关肺间质病变疗效观察

目的:观察法舒地尔对结缔组织病相关肺间质病变的治疗效果。方法:将62例结缔组织病肺间质病变患者随机分为对照组32例和治疗组30例。对照组行常规治疗,治疗组在常规治疗的基础上加用法舒地尔30 mg加入250 mL 0.9%氯化钠注射液静脉滴注,疗程14 d。对治疗前后行6 min步行实验、超声心动图测肺动脉压力、高分辨率胸部CT、血气分析及红细胞沉降率、C反应蛋白等进行对比。结果:用药后治疗组6 min步行距离增加,肺动脉压降低,高分辨率胸部CT评分降低,疾病活动度减轻,与用药前及对照组用药后差异均有统计学意义（P < 0.01）。结论:法舒地尔治疗结缔组织病相关肺间质病变有效。     

结缔组织病相关动脉性肺动脉高压临床特点分析

目的:分析结缔组织病相关动脉性肺动脉高压（CTD-PAH）患者的临床特点,提高对疾病的认识。方法:回顾性总结经右心导管（RHC）确诊的70例CTD-PAH患者的临床资料,分析其特征。结果:患者均为女性,平均年龄（43.8±13.9）岁,最常见的PAH症状为活动后气短、乏力。33例（47.1%）有雷诺现象。常见的基础疾病为系统性红斑狼疮（SLE,48.6%）及原发性干燥综合征（pSS,20%）。抗SSA抗体阳性率（54.9%）较高。69例（98.6%）超声心动图结果提示可能存在肺动脉高压（PH）,38例（54.9%）有心包积液。患者1年及3年的生存率为96%和93%。结论:多种CTD可继发PAH,以SLE及pSS多见。雷诺现象、抗SSA抗体及心包积液可能是CTD-PAH发病的危险因素。超声心动图是筛查CTD-PAH的有效检查。激素及免抑制剂治疗可能对于改善病情有积极作用。