艾滋病合并新型隱球菌腦膜炎文獻回顧課件

獲得性免疫缺陷綜合征

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新型隱球菌腦膜腦炎主訴：頭痛8天，復(fù)視4天，發(fā)熱意識欠清1天頭顱MRI：左側(cè)半卵圓中心點狀異常信號，T2Flair序列雙頂葉皮層下點狀略高信號（2016.4.27）入院后腰穿5.15.4潘式實驗（1+）（1+）腦脊液RBC210*106/L420*106/L腦脊液WBC6*106/L2*106/L墨汁染色陽性陽性蛋白0.4g/L0.55g/L葡萄糖1.4mmol/L4.7mmol/L氯化物115mmol/L123mmol/L壓力778mmH2O347mmH2O腦脊液細胞學(xué)—成團及散在帶莢膜藍染顆粒Wright-Giemsa染色放大倍數(shù)1：400腦脊液培養(yǎng)新生隱球菌報陽時間：48小時化驗—白細胞計數(shù)及淋巴細胞計數(shù)AIDS確診實驗診斷新型隱球菌腦膜腦炎獲得性免疫缺陷綜合征ClinicalInfectiousDiseases2010;50:291–322ChinJMycol,April2010,Vol5,No2Cryptococcus/隱球菌

Incidence在免疫抑制患者中，隱球菌感染的發(fā)病率約為5%~10%，在AIDS患者中，隱球菌的感染率可以高達30%，而在免疫功能正常的人群中，隱球菌的感染率約為十萬分之一左右ItisestimatedthattheglobalburdenofHIV-associatedcryptococcosisapproximates1millioncasesannuallyworldwide

ClinicalInfectiousDiseases2010;50:291–322ChinJMycol,April2010,Vol5,No2MortalityDespiteaccesstoadvancedmedicalcareandtheavailabilityofHAART,the3-monthmortalityrateduringmanagementofacutecryptococcalmeningoencephalitisapproximates20%Furthermore,withoutspecificantifungaltreatmentforcryptococcalmeningoencephalitisincertainHIV-infectedpopulations,mortalityratesof100%havebeenreportedwithin2weeksafterclinicalpresentationtohealthcarefacilities

ClinicalInfectiousDiseases2010;50:291–322臨床表現(xiàn)ChinJMycol,April2010,Vol5,No2CSFinterpretationforthemanagementofpatientswithsuspectedencephalitisJournalofInfection(2012)64,347e373艾滋病合并新型隱球菌腦膜腦炎的影像學(xué)表現(xiàn)血管周圍間隙擴大膠狀假囊（治療3個月后）RadiolPractice，sep2009，Vol24，N0.9V-R間隙（血管周圍間隙）擴大血管周圍間隙是與軟腦膜下隙接續(xù)的,是軟腦膜隨著穿通動脈和流出靜脈進出腦實質(zhì)的延續(xù)而成擴大的V-R間隙意味著大量的隱球菌酵母細胞聚集于血管周圍間隙或者部分阻滯了腦脊液的流出ClinicalInfectiousDiseases2010;50:291–322ChinJMycol,April2010,Vol5,No2ElevatedCSFPressureIftheCSFpressureis>25cmofCSFandtherearesymptomsofincreasedintracranialpressureduringinductiontherapy,relievebyCSFdrainage(bylumbarpuncture,reducetheopeningpressureby50%ifitisextremelyhighortoanormalpressureof<20cmofCSFIfthereispersistentpressureelevation>25cmofCSFandsymptoms,repeatlumbarpuncturedailyuntiltheCSFpressureandsymptomshavebeenstabilizedfor12daysandconsidertemporarypercutaneouslumbardrainsorventriculostomyforpersonswhorequirerepeateddailylumbarpuncturesPermanentVPshuntsshouldbeplacedonlyifthepatientisreceivingorhasreceivedappropriateantifungaltherapyandifmoreconservativemeasurestocontrolincreasedintracranialpressurehavefailed.Ifthepatientisreceivinganappropriateantifungalregimen,VPshuntscanbeplacedduringactiveinfectionandwithoutcompleteste