回顾性分析新型隐球菌性脑膜炎的诊断与治疗

目的 分析隐球菌性脑膜炎临床资料并探讨隐球菌性脑膜炎的诊断与治疗。方法 总结近8年来本院隐球菌性脑膜炎的诊断、治疗和预后情况。结果 23例患者中有6，3，2，2例分别误诊为结核性脑膜炎、病毒性脑膜炎、血管炎、系统性红斑狼疮脑病。比较氟康唑和两性霉素B联用与两性霉素B和氟胞嘧啶联用，其治疗痊愈率无明显差别。结论 隐球菌脑膜炎误诊率较高，建议对可疑病例做反复腰穿、墨汁涂片和霉菌培养。

Retrospective analysis of diagnose and treatment on cryptococcal meningitis

Objective To analyze the antifungal efficacy of different antifungal drugs on the cryptococcal meningitis retrospectively. Methods The cli- nical features, antifungal treatment and prognosis of 23 cases of cryptoco- ccal meningitis diagnosized at Xiamen First Hospital from January 1995 to October 2003 were analyzed. Results Some patients were misdiagnosed as tuberculous meningitis, viral meningitis, vasculitis and encephalopathy of systematic lupus erythematosus etc. All the patients were diagnosised comfirmedly with fungal identification by the methods of ink-stain or culture of cerebrospinal fluid,and the antifungal treatment efficacy of several regimens of single fluconazole, amphotericin B combining with flucytosin or fluconazole did not show any difference. Conclusion Cryptococcal meningitis was more likely to be misdiagnosed as other diseases, so early and repetitive cerebrospinal fungal detect from suspected patients was a key way to confirm the diagnosis. Controlled randomized antifungal study should be conducted for getting better therapeutic regimen.