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。

Clinical profile of cryptococcal meningitis in children

Objective To analyze and review the clinical characteristics, diagnosis and treatment of cryptococcal meningitis in children. Methods Between March 1993 and June 2008, 16 non-HIV-infeeted children were diagnosed as eryptococcal meningitis at Changzheng hospital. A retrospective review of medical records and findings was described. Results The children had a male predominance （2.2： 1 ） and a median age of 7.25 years （range, 2 - 15 yr）. Headache （87.5%） , fever （81.25% ） , and nausea or vomiting （75%） were most common presenting symptoms. Ten of 16 patients had abnormal intracranial pressure. The diagnosis of eryptoeoeeal meningitis was made by the positive results of CSF smear or culture, and/or eryptocoecal latex agglutination test. All the patients who survived received amphoterieine B and/or amphoterieine B liposome with 5-FC as basic medication, combined with amphoterieine B intrathecal injection and oral fluconazole or itraeonazole, except two children who died of cerebral hernia and lupus nephritis induced renal failure, respectively. Conclusion First-time examination of cerebrospinal fluid is suggested for suspected CNS infectious disease in children, because the clinical characteristics of cryptoeeal meningitis are lack of specificity. Early diagno- sis and systematical, full-dosage, long-term antifungal treatment is the key to raise the cure rate and promote the life quality.