中枢神经系统念珠菌感染抗感染治疗案例分析

目的总结4例中枢神经系统念珠菌感染(Central nervous system candidiasis,CNSC)患者的临床表现、实验室检验检查、治疗方案和随访情况,为此类患者的治疗提供参考。方法回顾4例CNSC患者的治疗过程,结合文献分析该类患者的治疗特点。结果①4例患者脑脊液培养结果分别为季也蒙念珠菌、白色念珠菌、热带假丝酵母菌、白色念珠菌。②4例患者实验室检验结果脑脊液生化葡萄糖含量降低,蛋白质含量正常或者偏高,脑脊液常规白细胞计数略高,1,3-β-D-葡聚糖正常或偏高。③治疗方案中,2例患者使用伏立康唑,1例患者首选伏立康唑治疗,由于精神系统不良反应停药,另1例为氟康唑治疗无效换用伏立康唑治疗,治愈后随访未复发。2例首选氟康唑治疗患者1例治愈,另1例治疗无效。结论国内文献关于成人CNSC治疗案例报道较少,本文通过对4例患者进行病例回顾和文献分析,为CNSC的临床治疗提供参考。

Case reports of anti-infective therapy for central nervous system candida infection

Objective To summarize the clinical manifestations,laboratory tests,treatment regimen and follow-up of patients with central nervous system candidiasis infection(CNSC),and provide a reference for clinical treatment.Methods CNSC treatment of four cases was reviewed,and the characteristics of diagnosis and treatment of patients were analyzed in combination with literature review.Results①Cerebrospinal fluid culture results of four patients indicated that there were Candida monticulata,Candida albicans,Candida tropicalis,and Candida albicans.②Laboratory tests of four patients with CNSC showed that the cerebrospinal fluid had reduced sugar content,normal or high protein content,slightly higher white blood cell count and normal or high level of 1,3-β-D-glucan;③In the treatment plan,two patients were treated with voriconazole.One patient was treated with voriconazole first,but withdrew due to psychiatric adverse reactions.The other patient was treated with fluconazole and switched to voriconazole.No case recurred during follow-up.Two patients were treated with fluconazole,one case was cured,the other was ineffective.Conclusion There are few reports about CNSC in domestic literatures.This review of four patients′treatment plans provide experience for clinical diagnosis and treatment of CNSC.