非HIV感染的新型隐球菌性脑膜脑炎患者的病例特征及文献复习
Case characteristics of non-HIV-infected patients with cryptococcus neoformans meningoencephalitis and review of Literature
马建鹏 1孙金梅 1朱先进 1张拥波 1脱厚珍1
作者信息
- 1. 首都医科大学附属北京友谊医院神经内科 北京 100050
- 折叠
摘要
目的 探讨新型隐球菌性脑膜脑炎(CM)在非HIV患者中的临床特征.方法 分析2019年1月至2024年1月首都医科大学附属北京友谊医院明确诊断的7例非HIV感染CM患者临床资料,记录患者的基本特征、临床症状、腰穿及实验室化验、辅助检查、治疗及预后.结果 7例患者中,男性5例,女性2例;发病年龄43～70岁;其中1例有白血病病史长期服用激素,1例肾移植术后服用免疫抑制剂,1例合并系统性红斑狼疮,感染途经不明;4例既往体健患者,有明确的鸽子粪接触史或接触霉变材料、潮湿环境,潜伏期可长达2年;除了引起脑膜受累外,还可导致脑梗死、脑脓肿、血管炎等.最终4例治愈,1例长期抗真菌治疗,2例死亡.结论 非HIV感染的CM发生率低,临床症状不典型,潜伏期更长,预后更差.
Abstract
Objective To investigate the clinical characteristics of non-HIV patients with cryptococcus neoformans meningoencephalitis(CM).Methods The medical data of 7 non-HIV-infected CM patients diagnosed at Beijing Friendship Hospital,Capital Medical University from January 2019 to January 2024 were analyzed.The basic characteristics,clinical symptoms,lumbar puncture and laboratory tests,auxiliary examinations,treatment,and prognosis of the patient were recorded.Results Among the 7 patients,there were 5 males and 2 females,aged from 43 to 70 years.One of them had a history of leukemia and was taking hormones for a long time,one of them received immunosuppressive drugs af-ter renal transplantation,one had systemic lupus erythematosus,and the route of infection in these patients was unknown.There were 4 previously healthy patients with a clear history of pigeon droppings contact or exposure to moldy materials and moist environments.The longest incubation pe-riod was 2 years.In 6 cases,cryptococcus neoformans was found in the cerebrospinal fluid by India ink staining or second-generation sequencing.In addition to causing symptoms of meningitis,it also included cerebral infarction,brain abscess,and vasculitis.Ultimately,4 cases were cured,1 case underwent long-term antifungal treatment,and 2 cases died during treatment.Conclusion The non-HIV-infected patients of CM have a lower incidence,the clinical symptoms are atypical,the incubation period is longer,and the prognosis is poorer.Non-HIV-infected CM has a lower incidence,atypical clinical symptoms,a longer incubation period,and a worse prognosis.
关键词
新型隐球菌性脑膜脑炎/非HIV感染/临床特征Key words
Cryptococcus neoformans meningoencephalitis/Non-HIV infection/Clinical characteristics引用本文复制引用
出版年
2024
NETL
NSTL
万方数据