原发性儿童深部真菌感染的诊断和治疗

目的 分析自1994年至2002年间，13例患儿包括白念珠菌肝脓肿和慢性皮肤粘膜念珠菌病、隐球菌脑膜炎和皮肤淋巴结感染、孢子丝菌病等儿童原发性深部真菌感染，探讨采用二性霉素B、伊曲康唑、氟康唑等治疗的疗效及安全性。方法 13例患儿均为临床和真菌学确诊，真菌镜检和真菌培养阳性并鉴定到种。隐球菌性脑膜炎患儿采用二性霉素B或静脉滴注，结合自身脑脊液稀释的二性霉素B鞘内注射。其他患儿分别给予伊曲康唑口服、10％碘化钾口服、二性霉素B脂质体静滴。治疗前后患者均检查肝肾功、血常规和尿常规。结果 13例患儿经治疗后治愈8例、显效4例、有效1例，有效率为92．3％。所有患儿治疗后均未见肝肾功能、血尿常规的明显变化。二性霉素B和二性霉素脂质体治疗的患儿出现低热、肌肉颤抖、低血钾等。其他治疗的患儿未见明显不良反应。结论 深部真菌感染患儿．可根据年龄和病情、深部真菌感染菌株不同，分别给予二性霉素B、二性霉素脂质体、伊曲康唑等治疗，安全性好，疗效可靠。

Diagnosis and treatment of primary deep mycosis in children

Objective From 1994 to 2002, thirteen children were diagnosed as primary deep mycoses, including heptic Candida abscess , chronie mucocutaneous candidosis , cryptococcal meningitis , cutaneous and lymphatic crypto-coccosis, sporotrichosis, and kerion. They were treated with amphotericin B , itraconazole, et al and their efficacy and safety were observed. Methods Thirteen children with primary deep mycoses were diagnosed clinically and myco-logically. Fungi hyphae or spherule were found in specimens of children by microscope and positive in culture. Their positive strains in culture were then defined into fungi species. Among 7 chidren with cryptococcal meningitis 5 were treated with intravenous amphotericin B and 2 intravenous AmBisome (amphotericin B packed in lipide ) for 2 to 6 months. All 7cases received intrathecal injection of amphotericin diluted by their CSF 1 to 2 times per week. The other children were given oral itraconazole, potassium iodide or AmBisome. Results Among 13 children 8 were cured , 4 markedly improved and 1 fair. The efficacy rate was 92. 3% . There was no significant change of hepatic and renal function, blood and urine routine test in all children. Among 8 children treated with amphotericin or AmBisome some had low fever,tremor and hypopotassiumemia. Conclusion The children with primary deep mycoses,according to age, disease and fungi species, would be treated respectively with amphotericin B , AmBisome , itraconazole , et al . They might get reliable effect with safety.