摘要
目的分析新型隐球菌感染的临床分布、症状体征、体外药敏及脑脊液生化检查,提高临床医生对新型隐球菌感染的认识,降低误诊率。方法回顾性分析中国人民解放军联勤保障部队第910医院2014年-2020年确诊为新型隐球菌病患者的临床分布、症状、治疗情况及体外药敏结果。结果28例患者中,男性18例,女性10例,HIV患者2例(7.1%),非HIV患者24例(85.7%),余2例(7.1%)患者未行HIV检测;18例(64.3%)有基础疾病。28株新型隐球菌,根据来源分别为:脑脊液源性18株(64.3%),全血源性6株(21.43%),灌洗液源性3株(4.68%),皮肤脓液源性1株(3.57%)。18例隐球菌脑膜炎患者症状主要集中在头痛、发热、呕吐;6例隐球菌血流感染中有5例菌血症患者有发热,1例患者无发热,6例均无中枢神经系统感染症状;3例肺隐球菌感染中有2例合并肺结核,1例没有基础疾病。28株新型隐球菌中,6株患者未做药敏,22株药敏结果显示,除1株对伊曲康唑有获得性耐药、1株对伏立康唑有获得性耐药外,为非野生型菌,其余菌株均为野生型,没有获得性耐药。结论新型隐球菌好发于细胞免疫功能低下患者,临床早期表现不典型,容易误诊,治疗难度大,临床需结合症状特点和药敏试验更精准地使用抗真菌药物。
Objective To improve clinicians'understanding of Cryptococcus neoforman infection and reduce the misdiagnosis rate,the clinical distribution,symptoms and signs,antifungal susceptibility testing and cerebrospinal fluid biochemical examination of Cryptococcus neoforman infectionwere analyzed.Methods The clinical distribution,symptoms,treatment and antifungal susceptibility testing results of Cryptococcosis patients diagnosed in the 910th hospitalof People's Liberation Army from 2014 to 2020 were analyzed retrospectively.Results Among 28 patients,there were 18 males and 10 females.Among them,there were 2 HIV patients(7.1%),24 non-HIV patients(85.7%)and the remaining 2 patients(7.1%)who were not tested for HIV.18 patients(64.3%)had underlying diseases.28 isolates of Cryptococcus neoformans were derived from cerebrospinal fluid(64.3%),whole blood(21.43%),lavage fluid(4.68%)and skin pus(3.57%).The symptoms of 18 patients with cryptococcal meningitis were headache,fever and vomiting;among the 6 cases of cryptococcus bloodstream infection,5 patients with bacteremia had fever,1 patient had no fever,and 6 patients had no symptoms of central nervous system infection.Among3 cases of cryptococcus pneumoniae infection,2 cases were complicated with pulmonary tuberculosis,and 1 case had no underlying disease.Among 28 strains of Cryptococcus neoformans,6 strains were not sensitized,and 22 strains were non-wild-type bacteria,except for 1 strain with acquired resistance to itraconazole and 1 strain which had acquired resistance to voriconazole,and the other strains were wild-type bacteria without acquired resistance.Conclusion Cryptococcus neoformosis is more likely to occur in patients whowere low cellular immune function,the early clinical manifestations are not typical,easy to misdiagnosis,and difficult to treat.It is necessary to combine clinical symptoms and antifungal susceptibility testing to make sure that the use of antifungal drugs are accurately.
作者
周少波
洪小兰
蔡媛媛
曹香香
ZHOU Shaobo;HONG Xiaolan;CAI Yuanyuan;CAO Xiangxiang(Laboratory Department,the 910th Hospital,People's Liberation Army,Quanzhou 362000,Fujian,China)
出处
《新疆医学》
2023年第5期570-572,597,共4页
Xinjiang Medical Journal
作者简介
周少波,男,检验技师,研究方向:临床微生物与免疫检验。
