36例新型隐球菌性脑膜炎的临床分析

目的探讨36例新型隐球菌性脑膜炎的临床特征,以提高对该病的认识。方法分析36例新型隐球菌感染患者的临床资料。结果新型隐球菌感染的患者临床表现均有不同程度的头痛、颅内压增高表现,葡萄糖降低尤为显著,IgG、IgM、IgA及微量总蛋白升高明显。治疗后脑脊液和血清标本中隐球菌荚膜多糖抗原滴度下降明显。新型隐球菌对两性霉素B(100%)、氟康唑(94.4%)和5-氟胞嘧啶(94.4%)抗真菌药敏感性较高。结论对颅内压增高、脑膜刺激征阳性的患者反复多次进行脑脊液培养、墨汁染色和隐球菌荚膜多糖抗原检测,有助于新型隐球菌性脑膜炎的早期诊断和早期治疗;隐球菌荚膜多糖抗原滴度随着患者病情的好转而下降。两性霉素B联合氟康唑或5-氟胞嘧啶治疗新型隐球菌性脑膜炎仍然安全有效;早期控制感染和降低颅内压是治疗的关键。

Clinical analysis of 36 cases of Cryptococcus neoformans meningitis

Objective To explore the clinical features of 36 cases of cryptococcal meningitis and to raise awareness of the disease. Methods Clinical data of 36 patients with Cryptococcus neoformans infections were analyzed. Results The clinical manifestations of Cryptococcus neoformans infections showed different levels of headache and increases intracranial pressure, significantly decreased glucose, significantly increased in IgG, IgM, IgA, and micrototal protein. After treatment, serum and cerebrospinal fluid specimens in Staphylococcus aureus capsular antigen titer decreased significantly. The Cryptococcus neoformans was highly sensitive to amphotericin B (100%), fluconazole (94.4%) and 5-fluorocytosine (94.4%). Conclusion Repeatedly cerebrospinal fluid (CSF) cultures, india ink staining and cryptococcal capsular polysaccharide antigen detections were conducted in patients with increased intracranial pressure and meningeal irritatation signs, which could help in the early diagnosis of Cryptococcus neoformans meningitis and early treatment. The titer of the capsular polysaccharide antigen of Cryptococcus neoformans decreased with the improvement of the patient's conditions. Amphotericin B combined with fluconazole or 5-fluorocytosine in the treatment of cryptococcal meningitis is still safe and effective. Early control of infections and reduction of intracranial pressure are key to the treatment.