摘要
目的分析儿童隐球菌性脑膜炎临床特点及误诊原因,降低误诊率。方法回顾性分析24例误诊为结核性脑膜炎的隐球菌性脑膜炎患儿临床资料。结果24例中男童14例,女童10例,平均年龄(7.5±3.8)岁,主要临床表现为发热(100%)、头痛(87.5%)、呕吐(87.5%)。院外误诊15例(62.5%),院内误诊9例(37.5%)。抗真菌治疗后,痊愈出院8例(33.3%),未愈16例(66.7%)。意识障碍、脑脊液葡萄糖及氯化物水平低为预后不良危险因素(P<0.05)。结论儿童隐球菌性脑膜炎易误诊,适当、多次腰穿有助于明确诊断,多种检测方法并用可提高隐球菌检出率,减少误诊。意识障碍、脑脊液葡萄糖及氯化物水平低提示预后不良。
Objective To review the clinical characteristics and causes of misdiagnosis of cryptococcal meningitis in children for the purpose to reduce the rate of misdiagnosis.Methods Clinical data of 24 children with cryptococcal meningitis misdiagnosed as tuberculous meningitis were analyzed retrospectively.Results The patients included 14 boys and 10 girls with an average age of(7.5±3.8)years.The main clinical manifestations were fever(100%),headache(87.5%),and vomiting(87.5%).The misdiagnosis was made outside of the hospital in 15 cases(62.5%)and in-hospital in 9 cases(37.5%).Eight patients(33.3%)were cured and discharged from hospital and 16 patients(66.7%)did not recover after antifungal treatment.Disturbance of consciousness,lower cerebrospinal fluid glucose and chloride levels were risk factors for poor outcome(P<0.05).Conclusions Cryptococcal meningitis in children is easily misdiagnosed.Repeated,multiple lumbar punctures are conducive to the diagnosis.Combination of multiple testing methods can improve the detection rate of Cryptococcus and reduce misdiagnosis.Disturbance of consciousness,lower levels of glucose and chloride in the cerebrospinal fluid suggest a poor prognosis.
作者
刘文卉
陈军华
LIU Wenhui;CHEN Junhua(Department of Infection,Children's Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Child Infection and Immunity,Chongqing 400014,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第1期37-41,共5页
Chinese Journal of Infection and Chemotherapy
关键词
儿童
隐球菌性脑膜炎
误诊
children
cryptococcal meningitis
misdiagnosis
