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ID:9532656
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页数:9页
时间:2018-05-03
《隐球菌脑膜炎文献总结》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、一、NewInsightsinthePrevention,Diagnosis,andTreatmentofCryptococcalMeningitis2012Introduction:CM是高HIV流行区中一个普遍的,且常常为十分严重的疾病。在非洲HIV患者中,有大约10%-20%的患者死于CM【1,2】。CryptococcusspeciesareacommoncauseofbloodstreaminfectionsamongHIVpatientsinThailand[4]andareresponsibleforthemost
2、commonlydiagnosedmeningitissyndromesinmanyAfricancountries,accountingfor40%ofmeningitiscasesinMalawi[5].Epidemiology新型隐球菌在环境中普遍存在,可致CM的隐球菌分为两类:C.neoformansandC,gattii。在发展中国家,C.neoformansvariantgrubii可以在严重的免疫缺陷患者中造成CM【6】。C.gattii有造成免疫正常(immunocopetent)患者致病的倾向,并且是hasth
3、ecauseofanongoingoutbreakofCMinNorthAmericainthePacificNorthwestforoveradecade[7,8]。隐球菌通常通过吸入传染性的繁殖体而进入人体。从胎盘可以扩散到婴儿但是很少见【9】,从一个具有隐球菌传染性的供体内进行器官移植可以导致隐球菌的传播[10.11]。Cryptococcalcapsularpolysaccharideandproteinantigenareantibodystimulants.Bothofthesestudiesreinforcethe
4、beliefthatcryptococcaldiseasemaybecausedbyareactivationoflatentdiseaseduringprofoundimmunosuppressionClicnicalpresentation:CM通常表现为无明显症状的亚急性脑膜炎,在一些明显细胞免疫缺乏的患者身上,如HIV或各种各样的免疫缺陷患者。Classicalmeningismusispresentinapproximatelyonequarterofpatients[14].ICP症状很常见,如严重的头痛,意识水平降
5、低,癫痫,视乳头水肿,第六颈椎神经麻痹。Diagnosis:隐球菌抗原(CrAg)可以通过latexagglutinationorenzymeimmunoassaykit在血清和脑脊液中检测出来。在HIV相关的和非HIV相关的患者中,血清CrAgtiter测定,作为一种初始的筛查,在近85-90%病例中是阳性的【15-16】。在CSF中,CrAg阳性的敏感度接近100%,althoughspecificityisless,withoccasionalfalse-positives[17,18].。Confirmationofdi
6、agnosiscanbemadebyculturingCSFonSabouraudagarplates,whichremainsthegoldstandard.。IndiainkThismethodishighlysensitive(>90%)andspecific(approaching100%)whenexperiencedtechniciansareavailableanddiseaseburdenishigh[21],InapatientwithCMthemostsignificantnegativeprognostic
7、indicatorsarereducedlevelofconsciousness,lowweight,seizures,fungemiaatbaseline,andincreasedfungalburdeninCSF,asmanifestbyelevatedCSFCrAgorincreasedbaselinequantitativecultureoftheCSFforcryptococcalcolonies[14,26–28].Treatment:当考虑到如何治疗时需特别强调抗真菌药物治疗,ICP,immunerestorati
8、on.GuidelinesfortreatmentofCMhavebeenmadeavailablebytheInfectiousDiseasesSocietyofAmerica(IDSA)in2010[29••]andtheWorldHealthOrganiz
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