23例新型隐球菌性脑膜炎患者的临床特点及预后分析

发布时间：2018-04-20 09:04

  本文选题：新型隐球菌 + 脑膜炎　； 参考：《中国地方病防治杂志》2017年02期

【摘要】：目的探究23例新型隐球菌性脑膜炎患者的临床特点及预后分析。方法选择2013年3月至2014年12月经本院病原学确诊的23例新型隐球菌性脑膜炎患者。结果 123例患者中,12例患者为亚急性起病,11例患者为慢性起病,病程9 d至3个月不等,均出现了不同程度的发热、头痛、脑膜刺激征,所有患者HIV-Ab检查均呈阴性;2患者病程9 d至3个月,平均病程:45.7±39.8 d;确诊时间1至23 d,平均天数:7.3±5.7 d;确诊腰穿次数1至9次,平均次数:2.3±1.7次;入院治疗前被误诊为结核性脑膜炎11例,误诊为病毒性脑炎3例,误诊为狼疮性脑病1例;323例患者均检测到新型隐球菌感染,脑脊液墨汁染色阳性的患者17例,脑脊液培养出新型隐球菌19例;4颅脑影像学检查均出现了不同程度的脑膜强化、脑积水、脑室扩大以及肉芽肿等病变;523例患者中治愈11例,有效7例,无效3例,死亡2例,2例患者均死于多脏器功能衰竭,同时治愈患者与未治愈患者在年龄、病程时间、首次腰穿压力值、基础疾病、是否出现意识障碍以及脑积水方面存在明显差异(P0.05)。结论患者年龄超过60岁,基础疾病超过3种,病程≥3个月、颅内压超过420mmH_2O、脑脊液蛋白含量≥1.75 g/L时患者预后不良及死亡率明显增加。
[Abstract]:Objective to investigate the clinical features and prognosis of 23 patients with Cryptococcus neoformans meningitis. Methods 23 patients with Cryptococcus neoformans meningitis diagnosed by etiology from March 2013 to December 2014 were selected. Results among 123 patients, 12 cases were subacute onset and 11 cases were chronic onset. The course of disease ranged from 9 days to 3 months. All of them had different degrees of fever, headache and meningeal irritation. All the patients showed negative HIV-Ab examination for 9 days to 3 months, the average course of disease was 45.7 卤39.8 days, the time of diagnosis was 1 to 23 days, the average number of days was 7: 7.3 卤5.7 days, the number of lumbar puncture was 1 to 9 times, the average number of times was 2.3 卤1.7 times. 11 cases were misdiagnosed as tuberculous meningitis, 3 cases were misdiagnosed as viral encephalitis, and 323 cases were misdiagnosed as lupus encephalopathy. In 19 cases of Cryptococcus neoformans cultured in cerebrospinal fluid (CSF), meningeal enhancement appeared in 19 cases of Cryptococcus neoformans. Among 523 patients with hydrocephalus, ventricular dilatation and granuloma, 11 cases were cured, 7 cases were effective and 3 cases were ineffective. Two patients died of multiple organ failure. There were significant differences in age, duration of disease, first lumbar puncture pressure, basic disease, consciousness disorder and hydrocephalus between cured and uncured patients. Conclusion patients over 60 years old, more than 3 basic diseases, the course of disease 鈮，

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