肾移植术后隐球菌性脑膜炎的临床分析

目的 分析肾移植术后隐球菌性脑膜炎的临床特点,以期提高临床医生的诊治水平.方法 回顾性分析肾移植术后隐球菌性脑膜炎的临床表现、实验室检查和治疗预后.结果 4例患者中,男2例,女2例,全部为首次同种异体肾移植.所有患者均有发热和头痛症状,多表现为轻度头痛和低热.3例患者隐球菌涂片和培养均为阳性.所有患者分别给予两性霉素B脂质体、伏立康唑、5-氟胞嘧啶等抗真菌治疗,其中1例合并两性霉素B鞘内注射.经2～4个月治疗后,4例隐球菌涂片转阴,临床症状消失,均在我院随访,至今未复发.结论 肾移植术后隐球菌性脑膜炎首发症状隐匿,临床表现不典型,极易误诊漏诊.早期明确诊断、多科室协作、规范足量治疗是提高此病救治成功的关键.     

儿童隐球菌性脑膜炎临床分析

目的分析并讨论儿童隐球菌性脑膜炎的临床特点、诊断及治疗方法等。方法回顾性分析上海长征医院皮肤科在1993年3月至2008年6月间16例经病原学确诊的隐球菌性脑膜炎患儿临床资料。结果患儿平均年龄7．25岁（2～15岁）,男女比例2．2：1,主要症状包括头痛（87．5％）、发热（81．25％）、恶心呕吐（75％）等,10例颅内压升高。确诊依据脑脊液真菌涂片、培养或隐球菌抗原检查。治疗采用两性霉素B和（或）两性霉素B脂质体静滴,5一氟胞嘧啶口服,辅以两性霉素B鞘内注射,联合氟康唑、伊曲康唑等药物治疗。16例患儿痊愈9例,病情明显好转5例,死亡2例。结论儿童隐球菌性脑膜炎起病缓慢,临床症状缺乏特异性,对疑有中枢神经系统感染性疾病时,应及早行脑脊液检查,并反复多次检查、联合检查以确定诊断,减少误诊、漏诊。早期诊断和及时、系统、足量、长程的抗真菌治疗是提高治愈率和患儿生存质量的关键。     

隐球菌性脑膜炎的诊断与治疗

隐球菌性脑膜炎是由隐球菌属,特别是新生隐球菌及格特隐球菌引起的机会性感染,在免疫抑制者及正常人群均可发病。隐球菌性脑膜炎早期诊断困难,即便接受治疗,患者死亡率仍然很高。在过去几年中,快速及时的检测及早期隐球菌抗原检查取得了重大进展。对晚期HIV感染者行血隐球菌荚膜抗原筛查并进行抢先治疗,有望阻止其进展为临床感染。目前抗真菌药物主要包括多烯类、唑类及氟胞嘧啶,未来药物研究的重点是疗效更好、毒性更小的新型口服抗真菌药。本文总结近几年隐球菌性脑膜炎的相关诊断及治疗进展,旨在对隐脑患者诊疗提供帮助。     

52例新型隐球菌脑膜炎临床分析

新型隐球菌脑膜炎（Cryptococal neoformans menimgitis）是新型隐球菌引起的隐球菌病（cryptocaccol）,约占新型隐球菌感染的77％～80％,其临床表现不典型,误诊率高,病死率高,早期诊断,合理联合使用抗真菌药物治疗是提高隐球菌脑膜炎治愈率,降低病死率的关键。现对浙江大学医学院附属第一医院感染科2000年1月至2007年11月收治的52例新型隐球菌脑膜炎临床资料作回顾性分析,报道如下。     

隐球菌性脑膜炎治疗的更新

隐球菌性脑膜炎(cryptococcal meningitis,CM)是一种由新型隐球菌和格特隐球菌引起的机会性真菌感染性疾病。尽管近些年来,随着CM诊断方法与治疗手段的重大进展,患者整体病死率明显下降,但其发病率在世界范围内仍呈升高趋势,在我国尤为明显。虽然CM常发生在有免疫缺陷的人群如HIV患者,但HIV阴性的人群患病率却逐年升高,且二者的治疗方案不尽相同。本文总结了国内外关于HIV阳性与HIV阴性隐球菌性脑膜炎患者治疗的新进展,旨在对HIV阳性和HIV阴性隐球菌性脑膜炎患者的治疗提供依据。     

76例儿童隐球菌性脑膜炎临床分析

目的分析儿童隐球菌性脑膜炎临床特点。方法回顾性分析76例隐球菌性脑膜炎患儿临床资料。结果男47例,女29例,平均年龄(6.34±3.67)岁;主要临床表现为发热(100%)、头痛(78.95%)、呕吐(81.58%);首次脑脊液墨汁染色阳性46例(60.53%),首次脑脊液真菌培养阳性21例(27.63%),两性霉素B联合5-氟胞嘧啶抗真菌治疗好转率(74.19%),两性霉素B联合氟康唑治疗好转率(62.96%),差异无统计学意义(P=0.75)。结论儿童隐球菌性脑膜炎极易误诊、漏诊,反复、多次腰穿有助于早期诊断;两性霉素B联合5-氟胞嘧啶是抗真菌治疗首选方案,早期诊断、积极降颅压是改善预后的关键。     

新型隐球菌脑膜炎17例分析

新型隐球菌脑膜炎１７例分析大连医科大学第一临床医院１１６０１１徐裕海赵丽君大连大学医学院附属医院１１６０２１礼征楠１临床资料１．１性别年龄男性９例,女性８例,年龄１．５－６５岁;１．５－１３岁２例,４７－６５岁３例,平均年龄４３岁。１．２诊断标准经脑...     

隐球菌性脑膜炎的药物治疗近况及进展

隐球菌性脑膜炎的发病率逐年上升,病死率较高。目前对该病的治疗主要依靠抗真菌药物。本文就临床上常用的抗真菌药物及对隐球菌性脑膜炎的治疗进展情况进行综述。     

艾滋病合并隐球菌性脑膜炎的治疗原则初探

随着艾滋病（AIDS）疫情的蔓延,患者人数日益增多,隐球菌性脑膜炎的发生率明显上升,尤其是在东南亚、南部和东部非洲。有研究显示,即使在发达国家AIDS合并隐球菌性脑膜炎的病死率也约为10％～25％,在资源有限地区该比例可高达43％。上海市（复旦大学附属）公共卫生临床中心2004～2006年收治住院的艾滋患者中,11．7％（10／85）患有隐球菌性脑膜炎;37．5％（3／8）死亡病例死于隐球菌性脑膜炎。     

非艾滋病人群隐球菌性脑膜炎治疗进展

隐球菌性脑膜炎（cryptococcal meningitis）是新生隐球菌或其变种侵犯中枢神经系统引起的一种深部真菌感染,临床主要表现为发热、头痛、呕吐等亚急性或慢性脑膜炎、脑膜脑炎的症状,少数患者可表现为颅内占位性病变的临床表现。其病情重,疗程长,预后差,病死率高。     

成人化脓性脑膜炎患者脑脊液变化

分析成人化脓性脑膜炎患者脑脊液细胞、病原菌等的变化及其关系, 为该病的有效诊断、病情监测和针对性治疗提供参考。

对我院32例成人化脓性脑膜炎患者用药前后不同时期的脑脊液分别进行常规、生化与细胞学检测, 对检测结果进行统计分析。

与恢复期比较, 患者急性期时脑压、脑脊液白细胞总数与乳酸脱氢酶水平显著升高(均P < 0.05)。32例患者中, 15例脑脊液细菌培养呈阳性。典型菌与非典型菌感染者急性期脑脊液白细胞总数、小淋巴细胞、单核吞噬细胞和嗜中性粒细胞比例差异均有统计学意义(均P < 0.05)。

成人化脓性脑膜炎患者脑脊液变化显著, 脑脊液细胞学变化与感染类型相关, 可为个性化诊疗提供参考。

     

Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis

AIMS: To determine the level of serum procalcitonin and cerebrospinal fluid cytokines in children with bacterial or viral meningitis and to document the use of these parameters in differential diagnosis. RESULTS: Before the start of antibiotic treatment, serum procalcitonin and tumor necrosis factor alpha levels were found to be higher in acute bacterial meningitis compared with viral meningitis and with the control group. Similarly, cerebrospinal fluid interleukin-6 levels were found to be significantly higher in children with acute bacterial meningitis compared with viral meningitis. However, no significant difference was determined between groups in respect to the cerebrospinal fluid interleukin-8 level. CONCLUSION: Serum procalcitonin and cerebrospinal fluid tumor necrosis factor alpha levels can be used in the early diagnosis of bacterial meningitis. Similarly, they may be useful adjuncts in differential diagnosis of bacterial and viral meningitis.     

Chemotactic activity of cerebrospinal fluid in experimental cryptococcal meningitis

Cerebrospinal fluid from rabbits with chronic cryptococcal meningitis was tested for its chemotactic activity towards polymorphonuclear cells and monocytes. CSF chemotactic activity was present; it peaked 5-8 days after infection, coinciding with the time when the number of inflammatory cells in CSF was greatest. However, little chemotactic activity could be found in the early stages of infection, during the initial ingress of inflammatory cells. The chemotactic activity appeared to be host-derived, with characteristics consistent with lymphokine(s) or C5a. Treatment with cortisone significantly reduced the CSF chemotactic activity for both cell types; this reduction may contribute to the severe CSF leukopenia observed in cortisone-treated animals, which are unable to eradicate this yeast infection. Modulation of CSF chemotactic activity may be important to the success or failure of the host central nervous system response to Cryptococcus neoformans.     

Level of lactoferrin in serum and cerebrospinal fluid of patients with meningitis

Study showed 9-fold increase of concentration of lactoferrin (LF) in serum of patients with bacterial meningitis (BM) compared with normal concentration and 5-fold increase of LF concentration in patients with aseptic meningitis (AM). Level of LF in cerebrospinal fluid (CSF) of patients with BM and AM was 200-fold and 22-fold higher than in control group respectively. In 71% of patients with AM concentration of protein in CSF did not exceed minimal level observed in patients with BM. Level of LF in serum and CSF during treatment statistically significantly decreased. Concentration of LF (the latter is marker of neutrophilic granulocytes activation) can be used as a characteristic of acuteness and intensity of inflammatory process in central nervous system, whereas detection of LF in CSF--as additional criterion in differential diagnostics between bacterial and viral meningitis. Furthermore, repeated measurement of LF level can be useful for monitoring of disease course and assessment of effect of treatment.     

Circulating immune complexes in cerebrospinal fluid of patients with tuberculous meningitis.

Circulating immune complexes (ICs) were isolated from cerebrospinal fluids (CSFs) of patients with tuberculous meningitis (TBM), non-tuberculous neurological diseases by a polyethylene glycol (PEG) precipitation method. Mycobacterium tuberculosis antigen 5 was detected in CICs of 30% patients with TBM, by sandwich ELISA. CIC level decreases during antituberculosis chemotherapy and therefore its detection can provide a method to monitor the therapeutic schedule in patients with TBM.