糖皮质激素在隐球菌性脑膜炎治疗中的应用研究

目的：探讨糖皮质激素在隐球菌性脑膜炎治疗中的应用。方法：对45例隐球菌性脑膜炎患者进行回顾性分析，前期治疗用两性霉素B加氟康唑或氟胞嘧啶，后期治疗用氟康唑或伊曲康唑维持，配合使用糖皮质激素。结果：40例患者治愈。糖皮质激素在隐球菌性脑膜炎的治疗中不仅可以减轻两性霉素B的不良反应及改善症状，对颅内高压及后期治疗中各种不明原因的症状都有较好的控制作用。结论：糖皮质激素在隐球菌性脑膜炎的治疗中有其特有的作用，如能准确用药将对治疗有很大帮助。     

隐球菌性脑膜炎患者临床免疫指标分析

目的：研究隐球菌性脑膜炎（隐脑）患者细胞和体液免疫功能，方法：用液式细胞仪和免疫扩散法检测了12例隐脑患者外周T细胞亚群、NK细胞百分率及体液免疫指标。结果：与正常对照组相比，隐脑患者CD4^ 细胞百分率、CD4^ ／CD8^ 及C3均显著下降（P＜0.01），血清中IgG下降（P＜0.05）。结论：在非获得性免疫缺陷综合症（AIDS）隐脑患者同样存在着细胞免疫低下情况。     

Cryptococcal cellulitis: A rare entity histologically mimicking a neutrophilic dermatosis

Cutaneous Cryptococcus infection presents classically with granulomatous and gelatinous reactive patterns. Cases mimicking neutrophilic dermatoses have not been described. Conversely, neutrophilic dermatoses with degrading cells mimicking cryptococcal organisms have been reported. We report a case of cryptococcal cellulitis in an immunocompromised male with a robust neutrophilic infiltrate raising histologic consideration for a neutrophilic dermatosis.     

Necrotizing fasciitis caused by Cryptococcus neoformans in a patient with pemphigus vegetans

Cryptococcosis occurs most often in immunocompromised people. The cutaneous features of cryptococcosis include papules, pustules, nodules, subcutaneous swelling, abscesses, molluscum contagiosum‐like or tumour‐like lesions, cellulitis, blisters, ulcers and very rarely, necrotizing fasciitis (NF). NF is a destructive soft‐tissue infection that is most typically caused by group A streptococci or by a combination of facultative and anaerobic bacteria. We present the case of a 55‐year‐old woman with pemphigus vegetans, who developed cryptococcal NF in the legs. She had been treated with immunosuppressants including plasmapheresis and pulse therapy with steroid and cyclophosphamide. Cryptococcal NF localized to the legs is very rare. Because diagnosis and treatment of cryptococcal infection is often delayed, clinicians should be aware of the possibility of cryptococcal infection when antibacterial therapy is not effective in an immunocompromised patient.     

Cryptococcal Cellulitis in Congenital Lymphedema

A 27-year-old woman with intestinal lymphangiectasia and congenital lymphedema developed cryptococcal cellulitis as a result of her underlying depressed cell-mediated immune responsiveness. Prompt therapy with amphotericin B and 5-fluorocytosine resulted in an excellent outcome. The authors believe that the increasing population of patients with depression of cell-mediated immune response will lead to an increase in the frequency with which cryptococcal cellulitis is seen and emphasize that proper evaluation of a patient with presumptive cellulitis includes consideration of fungal, as well as bacterial, etiology.     

Cryptococcal cellulitis in a patient on prednisone monotherapy for myasthenia gravis

The development of cutaneous cryptococcosis is extremely rare in the human immunodeficiency virus-negative population. The cutaneous manifestations vary greatly, with the rarest presenting as cellulitis. We report a unique case of a 64-year-old woman who had been on prednisone monotherapy for the treatment of myasthenia gravis and subsequently developed cryptococcal cellulitis. This case provides an opportunity to discuss the importance of including cryptococcal cellulitis in the differential diagnosis of cellulitis in a patient on low-dose prednisone who is not responding to empiric antibiotic therapy. Early recognition is crucial as cutaneous manifestations are usually the first sign of disseminated cryptococcosis.     

Cryptococcal cellulitis in renal transplant recipients

We report three cases of cryptococcal cellulitis in renal transplant recipients and review five other cases in the literature. Seven cases of cryptococcal cellulitis occurring in other immunocompromised states are also reviewed and compared with the renal transplant group. Cryptococcal cellulitis in renal transplant recipients affects the skin of the extremities and is seen along with erythema, induration, tenderness, and superficial ulcerations of varying extent. Histopathologic examination shows either a variable lymphohistiocytic infiltration of the reticular dermis and subcutaneous fat or an acute panniculitis. Organisms may be difficult to find on routine sections, and special stains are recommended. Culture of tissue aspirate is an excellent method of diagnosis.     

Disseminated cellulitic cryptococcosis in the setting of prednisone monotherapy for pemphigus vulgaris

Cryptococcal infections are seen mainly in immunocompromised hosts. The cutaneous manifestations of infection can include papules, plaques, nodules, vesicles, ulcers, ecchymosis, and, rarely, cellulitis. Cryptococcal meningitis is a life-threatening complication of this disease. Pemphigus vulgaris is a rare auto-immune blistering disease that can also be life-threatening. Treatment of pemphigus commonly entails both corticosteroids and steroid-sparing agents. We present a case of disseminated cryptococcal infection in a patient with pemphigus vulgaris treated with high dose corticosteroids as monotherapy. This case provides an opportunity to discuss the difficulty of managing two potentially mortal conditions in which the treatment of pemphigus vulgaris may exacerbate the disseminated cryptococcal infection.     

A case of cutaneous localized cryptococcosis

A 65-year-old Japanese male with cutaneous localized cryptococcosis, which was developed as an erythematous infiltrated plaque on the right side of the face, was reported. The biopsy specimen taken from the lesion showed a granulomatous change with many spores in the dermis. Culture of the biopsy specimen gave Cryptococcus neoformans serotype D. There were no cryptococcal infections in the other organs. The skin lesion was improved by a systemic administration of miconazole. This patient was unusual since the cryptococcal lesion was limited to the skin, nevertheless he was under a severe cellular immunity deficiency. The reason for this may be that the infected C. neoformans strain belonged to serotype D.     

Primary cutaneous cryptococcal cellulitis secondary to insect bite in an immunosupressed patient after liver transplantation

Cutaneous cryptococcosis is usually a manifestation of disseminated disease, especially in immunosuppressed patients. Primary cutaneous cryptococcosis has also been described in some patients without evidence of systemic disease. Distinguishing between primary and secondary cutaneous cryptococcosis may be difficult as patients can be asymptomatic or cutaneous lesions may precede systemic involvement by some months. Features supporting primary disease are a history of cutaneous inoculation, and solitary superficial lesions on uncovered parts of the body. We present a liver transplant patient with cutaneous cryptococcal cellulitis subsequent to an insect bite, without systemic involvement and with excellent response to treatment with amphotericin B for 15 days and surgical debridement plus oral fluconazole for 3 months. In immunosupressed patients with cellulitis a cryptococcal infection must be excluded. If cutaneous cryptococcosis is diagnosed, systemic evaluation and prompt lengthy treatment are required.     

CRYPTOCOCCAL INFECTION SIMULATING VARICELLA

A case of systemic cryptococcal infection which presented with cutaneous lesions including facial papules and vesicles was initially diagnosed as varicella. The diverse cutaneous manifestations of cryptococcosis are discussed and the need for precise microbiological diagnosis of skin lesions in immunosuppressed patients is highlighted.     

Formation of palisading granulomas in a patient with chronic cutaneous cryptococcosis

We describe a unique case of a 57-year-old man who developed a chronic cryptococcal infection with cutaneous lesions that showed palisading granulomas. To our knowledge, this is the first report of this entity in the skin. We also discuss the differential diagnosis of palisading granulomas.     

C57BL/6小鼠感染新生隐球菌对大脑皮质BDNF和bFGF表达的影响

目的：观察C57BL／6小鼠感染新生隐球菌后对大脑皮质BDNF和bFGF表达的影响，并探讨BDNF和bFGF在新生隐球菌感染过程中的作用及其意义。方法：48只C57BL／6雌性小鼠随机分为对照组、环磷酰胺组和试验组，免疫组化法检测大脑皮质BDNF和bFGF的表达。结果：尾静脉注入新生隐球菌后6h大脑皮质查见新生隐球菌，2h大脑皮质BDNF的表达明显高于对照组和环磷酰胺组（P〈0．01），0.5h大脑皮质bFGF的表达明显高于对照组和环磷酰胺组（P〈0.01）。结论：新生隐球菌感染后大脑皮质BDNF和bFGF表达增高，提示BDNF和bFGF对新生隐球菌性脑膜炎具有修复作用，有望成为潜在的防治新生隐球菌性脑膜炎的药物。     

Primary cutaneous cryptococcosis.

Cryptococcal infections in immuno-compromised patients are of major importance. Current opinion holds that cutaneous cryptococcal infections in these patients indicate disseminated disease. In our renal transplant patient with primary cutaneous cryptococcosis, intravenously administered antifungal chemotherapy resulted in resolution of the disease and appears to have prevented disseminated infection.     

Persistent cellulitis in a patient receiving renal dialysis

Cryptococcus neoformans, an opportunistic fungus, may cause cutaneous disease by dissemination from primary lung infection or, more rarely, by direct cutaneous inoculation. Cellulitis in an immunocompromised host who does not respond to conventional antibacterial therapy should alert the physician to consider other diagnoses, including cryptococcal skin infection.     

Localized Cutaneous Cryptococcosis in an Immunosuppressed Man

Isolated cutaneous cryptococcosis developed in a 62-year-old white man with an idiopathic deficiency of T-lymphocytes. The patient was healthy, except for the cutaneous infection, and displayed no other evidence of an immunodeficiency disorder. An immunologic workup should be conducted in all patients with cryptococcal infection, regardless of their apparent health status.     

Cutaneous cryptococcus resembling molluscum contagiosum in a patient with acquired immunodeficiency syndrome

A hemophiliac man who tested positive for the human immunodeficiency virus presented with facial lesions resembling molluscum contagiosum as the initial manifestation of systemic cryptococcal infection. Widespread molluscum contagiosum is being seen with increasing frequency in patients who have been exposed to the human immunodeficiency virus, and examination of biopsy specimens to rule out atypical fungal infection is mandatory.     

Solitary Giant Molluscum Contagiosum of the Sole

Abstract: Molluscum contagiosum of the sole is extremely rare and only three cases have been reported in the literature. We report a solitary giant molluscum contagiosum on the left sole of a 5-year-old boy, which should be clinically differentiated from plantar wart, eccrine poroma, epidermal cyst, foreign body granuloma, cryptococcal infection, and pyogenic granuloma.     

Generalized Cryptococcus albidus in an immunosuppressed patient with palmopustular psoriasis

Cryptococcal infection is relatively uncommon, except among immunocompromised individuals. The most common human pathogenic species is Cryptococcus neoformans. Virtually all organs can be affected, particularly the central nervous and pulmonary systems. The prototypical manifestations of cutaneous cryptococcal infection include generalized papules, periorificial acneiform pustules, and molluscumlike vesicles on the upper body. We describe an unusual case of Cryptococcus albidus infection presenting atypically with generalized hemorrhagic plaques. Furthermore, we review the literature on diagnostic evaluation and treatment.     

以皮肤损害为首发症状的HIV阴性的播散性隐球菌病1例

患者女,11岁.因"颜面四肢皮疹1个月,咳嗽伴低热1周"入院.皮肤科情况:颜面四肢分布红色结节,中央有脐凹.胸片显示双肺间质性改变.组织病理检查示组织中有多核巨细胞,PAS染色可见孢子.HIV检测(-).诊断:播散性隐球菌病.