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目的总结新型隐球菌颅内感染的临床特点及临床诊断。方法用临床病例分析统计方法,对101例确诊的新型隐球菌脑膜炎或脑炎患者的发病规律和临床特点进行归纳、分析。结果101例患者中95例(94.1%)为亚急性或慢性起病,85.0%以上的患者有头痛、发热,72例(71.3%)患者出现呕吐,另外意识障碍、精神异常、发作性抽搐、视力、听力损害也较常见。97例脑脊液涂片发现隐球菌;2例多次涂片阴性,隐球菌培养阳性;1例经脑实质穿刺活检病理确诊;1例小脑囊肿术后病理确诊。大部分病例确诊前被误诊为其他疾病。结论新型隐球菌颅内感染大多数以亚急性或慢性起病,临床表现、脑脊液常规、生化检查及头颅影像学检查均缺乏特异性。脑脊液或脑组织病原学检查发现隐球菌为诊断的金标准。
Objective To summarize the clinical features and clinical diagnosis of intracranial infection of Cryptococcus neoformans. Methods Clinical cases analysis of statistical methods, 101 cases of confirmed cryptococcal meningitis or encephalitis in patients with pathogenesis and clinical characteristics were summarized and analyzed. Results Of the 101 patients, 95 (94.1%) had subacute or chronic onset. More than 85.0% of the patients had headache and fever, and 72 (71.3%) patients had vomiting, other disturbance of consciousness, mental disorders, seizures, Visual acuity, hearing loss is also more common. Cryptococci were found in 97 cases of cerebrospinal fluid smear; 2 cases of multiple smears were negative, cryptococcal culture was positive; 1 case was confirmed by pathological examination of brain parenchymal biopsy; 1 case of cerebellar cyst was pathologically confirmed. Most cases were misdiagnosed as other diseases before they were diagnosed. Conclusion Most intracranial infections of Cryptococcus neoformans have subacute or chronic onset. Clinical manifestations, cerebrospinal fluid routine, biochemical examination and cephalometric examination are not specific. Cerebrospinal fluid or brain histopathological examination found cryptococcal gold standard for diagnosis.