摘要
目的了解国内三家医院临床确诊隐球菌病的分布、药敏试验、临床特点以及抗生素治疗等,提高临床对隐球菌病临床特征的认识。方法回顾性分析2018~2019年国内三家医疗机构33例确诊隐球菌病患者的临床表现、治疗、预后及实验室检查和药敏结果。结果33例隐球菌病患者(男性25例,女性8例)平均年龄50.4±12.6岁,10例无基础疾病。33株隐球菌中新生隐球菌31株,格特隐球菌2株,其中16株(48.5%)来自脑脊液,7株(21.2%)来自肺穿组织。常见的中枢神经系统的临床症状有发热18例,头痛14例,恶心呕吐9例。药敏结果显示,所有菌株对两性霉素B、氟康唑、伊曲康唑和伏立康唑均没有获得耐药;1株对氟胞嘧啶有获得性耐药。脑隐球菌病主要选择两性霉素B进行治疗,肺隐球菌病选择氟康唑,好转15例,死亡3例,转院8例,另有7例未经治疗转院。结论隐球菌对人类致病的主要是新生隐球菌和格特隐球菌。中枢神经系统症状以发热、头痛和恶心呕吐最常见,单纯肺隐球菌病无典型的中枢神经系统的症状;绝大多数菌株均没有获得耐药;临床应重视病原学检测,及时使用抗真菌治疗,对疾病的诊治和预后十分重要。
Objective To understand the distribution,antifungal susceptibility profile,clinical characteristics and antibiotic treatment of Cryptococcosis in three hospitals in China,so as to improve the clinical understanding of Cryptococcosis.Methods The clinical manifestations,treatment,outcomes,laboratory examination and antifungal susceptibility testing results of Cryptococcosis patients diagnosed in three healthcare-centers in China from 2018 to 2019 were analyzed retrospectively.Results Collected 33 Cryptococcosis cases,including 25 males and 8 females,aged 50.4±12.6 years,and 10 patients had no underlying diseases.Among 33 Cryptococcosis,31 Cryptococcus neoformans and 2 C.gattii,of which 16(48.5%)were isolated from cerebrospinal fluid and 7(21.2%)from lung tissue.The common clinical symptoms of cryptococcal meningitis were fever(18 cases),headache(14),nausea(9)and vomiting(9).The antifungal results revealed that all strains were susceptible to Amphotericin B,Fluconazole,Itraconazole and Voriconazole,and one strain resistant to Flucytosine.Amphotericin B was the mainstay in the treatment for cryptococcal meningitis,while Fluconazole for cryptococcal pneumoniae.After treatment,15 cases improved,3 were dead,8 were transferred to other hospitals after some treatment,and 7 were transferred without treatment.Conclusion Cryptococcus and Cryptococcus gattii are the main pathogens of Cryptococcus neoformans.Fever,headache,nausea and vomiting are the most common symptoms of the central nervous system.Most Cryptococcus strains had no acquired antifungal mechanism.Should pay attention to pathogenic identification and timely antifungal treatment,which is very important for the diagnosis,treatment and prognosis of Cryptococcosis.
作者
李晨
陈杏春
张小团
LI Chen;CHEN Xing-chun;ZHANG Xiao-tuan(Liuyang Traditional Chinese Medicine Hospital,Hunan Liuyang 410300,China;Guangxi Zhuang Autonomous Region People's Hospital,Nanning 530000,China;the Second Affiliated Hospital of Nanhua University,Hunan Hengyang 42100,China)
出处
《现代检验医学杂志》
CAS
2020年第4期113-115,138,共4页
Journal of Modern Laboratory Medicine
关键词
隐球菌
新生隐球菌
脑隐球菌病
肺隐球菌病
Cryptococcus
Cryptococcus neoformans
cryptococcal meningitis
cryptococcal pneumoniae
