76例儿童隐球菌性脑膜炎临床分析

目的分析儿童隐球菌性脑膜炎临床特点。方法回顾性分析76例隐球菌性脑膜炎患儿临床资料。结果男47例,女29例,平均年龄(6.34±3.67)岁;主要临床表现为发热(100%)、头痛(78.95%)、呕吐(81.58%);首次脑脊液墨汁染色阳性46例(60.53%),首次脑脊液真菌培养阳性21例(27.63%),两性霉素B联合5-氟胞嘧啶抗真菌治疗好转率(74.19%),两性霉素B联合氟康唑治疗好转率(62.96%),差异无统计学意义(P=0.75)。结论儿童隐球菌性脑膜炎极易误诊、漏诊,反复、多次腰穿有助于早期诊断;两性霉素B联合5-氟胞嘧啶是抗真菌治疗首选方案,早期诊断、积极降颅压是改善预后的关键。

Clinical analysis of 76 pediatric cases of cryptococcal meningitis

Objective To analyze the clinical features of cryptococcal meningitis in children.Methods Clinical date of 76 children with cryptococcal meningitis were analyzed.Results There were 47 males and 29 females,with an average age of(6.34±3.67)years.The main clinical manifestations were fever(100%),headache(78.95%)and vomiting(81.58%).The etiological test turned out that the positive rate of cerebrospinal fluid ink staining accounted for 60.53%(46 cases),the cryptococcal culture positive rate accounted for 27.63%(21 cases)at the first time.There were 74.19%patients cured after receiving the combined treatment of amphotericin B and 5-fluorocytosine,62.96%patients cured after receiving the treatment of amphotericin B and fluconazole,but the difference was not statistically significant(P=0.75).Conclusions Crypotococcal meningitis in children was easely misdiagnosed,multiple and repeated lumbar punctures were beneficial to the diagnosis.amphotericin B combined with 5-fluorocytosine was the first choice for antifungal therapy.The key to improve the prognosis was early diagnosis and reduce intracranial pressuer effectively.