艾滋病合并新型隐球菌脑膜炎文献回顾课件PPT

获得性免疫缺陷综合征 新型隐球菌脑膜脑炎 主诉 头痛8天 复视4天 发热意识欠清1天 外院腰穿 2016 4 27 头颅MRI 左侧半卵圆中心点状异常信号 T2Flair序列双顶叶皮层下点状略高信号 2016 4 27 入院后腰穿 略浑浊脑脊液 入院后腰穿 脑脊液细胞学 成团及散在带荚膜蓝染颗粒 Wright Giemsa染色放大倍数1 400 脑脊液培养 新生隐球菌报阳时间 48小时 化验 白细胞计数及淋巴细胞计数 化验 T细胞亚群分类 AIDS确诊实验 诊断 新型隐球菌脑膜脑炎获得性免疫缺陷综合征 ClinicalInfectiousDiseases2010 50 291 322 ChinJMycol April2010 Vol5 No2 Cryptococcus 隐球菌 Incidence 在免疫抑制患者中 隐球菌感染的发病率约为5 10 在AIDS患者中 隐球菌的感染率可以高达30 而在免疫功能正常的人群中 隐球菌的感染率约为十万分之一左右ItisestimatedthattheglobalburdenofHIV associatedcryptococcosisapproximates1millioncasesannuallyworldwide ClinicalInfectiousDiseases2010 50 291 322 ChinJMycol April2010 Vol5 No2 Mortality DespiteaccesstoadvancedmedicalcareandtheavailabilityofHAART the3 monthmortalityrateduringmanagementofacutecryptococcalmeningoencephalitisapproximates20 Furthermore withoutspecificantifungaltreatmentforcryptococcalmeningoencephalitisincertainHIV infectedpopulations mortalityratesof100 havebeenreportedwithin2weeksafterclinicalpresentationtohealthcarefacilities ClinicalInfectiousDiseases2010 50 291 322 临床表现 ChinJMycol April2010 Vol5 No2 CSFinterpretationforthemanagementofpatientswithsuspectedencephalitis JournalofInfection 2012 64 347e373 艾滋病合并新型隐球菌脑膜脑炎的影像学表现 血管周围间隙扩大 胶状假囊 治疗3个月后 RadiolPractice sep2009 Vol24 N0 9 V R间隙 血管周围间隙 扩大 血管周围间隙是与软脑膜下隙接续的 是软脑膜随着穿通动脉和流出静脉进出脑实质的延续而成扩大的V R间隙意味着大量的隐球菌酵母细胞聚集于血管周围间隙或者部分阻滞了脑脊液的流出 Threeriskgroupsofcryptococcalmeningoencephalitis ClinicalInfectiousDiseases2010 50 291 322 ChinJMycol April2010 Vol5 No2 Cryptococcosisinaresource limitedhealthcareenvironment WithCNSand ordisseminateddiseasewherepolyeneisnotavailable inductiontherapyisfluconazole 800mgperdayorally 1200mgperdayisfavored foratleast10weeksoruntilCSFcultureresultsarenegative followedbymaintenancetherapywithfluconazole 200 400mgperdayorally WhereAmBdisnotavailableoraffordable wherefacilitiesforadmissionandIVtherapydonotexist orwhererenalandpotassiummonitoringarenotsufficientlyrapidorreliabletoallowsafeuseofAmBd fluconazoleisoftentheonlytreatmentoption ElevatedCSFPressure IftheCSFpressureis 25cmofCSFandtherearesymptomsofincreasedintracranialpressureduringinductiontherapy relievebyCSFdrainage bylumbarpuncture reducetheopeningpressureby50 ifitisextremelyhighortoanormalpressureof25cmofCSFandsymptoms repeatlumbarpuncturedailyuntiltheCSFpressureandsymptomshavebeenstabilizedfor12daysandconsidertemporarypercutaneouslumbardrainsorventriculostomyforpersonswhorequirerepeateddailylumbarpuncturesPermanentVPshuntsshouldbeplacedonlyifthepatientisreceivingorhasreceivedappropriateantifungaltherapyandifmoreconservativemeasurestocontrolincreasedintracranialpressurehavefailed Ifthepatientisreceivinganappropriateantifungalregimen VPshuntscanbeplacedduringactiveinfectionandwithoutcompletesterilizationofCNS ifclinicallynecessary ClinicalInfectiousDiseases2010 50 291 322 颅高压处理 ChinJMycol April2010 Vol5 No2 谢谢各位专家指导