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Article Navigation >  Medical Journal of Peking Union Medical College Hospital  > 2018  >  9(5): 431-436
Ying GE, Kai-yu ZHANG, Xiao-jun MA, Zheng-yin LIU, Tai-sheng LI. Clinical Analysis of 62 Patients with Cryptococcal Meningitis[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(5): 431-436. doi: 10.3969/j.issn.1674-9081.2018.05.011
Citation: Ying GE, Kai-yu ZHANG, Xiao-jun MA, Zheng-yin LIU, Tai-sheng LI. Clinical Analysis of 62 Patients with Cryptococcal Meningitis[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(5): 431-436. doi: 10.3969/j.issn.1674-9081.2018.05.011
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Clinical Analysis of 62 Patients with Cryptococcal Meningitis

doi: 10.3969/j.issn.1674-9081.2018.05.011
  • 1.

    Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Infectious Diseases, The First Hospital of Jilin University, Changchun 130021, China

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  • Corresponding author: LI Tai-sheng   Tel:010-69155046，E-mail:litsh@263.net
  • Received Date: 2018-06-11
  • Publish Date: 2018-09-30
    Abstract
  •   Objective  The aim was to study the clinical characteristics and therapeutic strategies of cryptococcal meningitis and provide further evidence for clinical diagnosis and therapy.  Methods  Data of the inpatients with cryptococcal meningitis who were admitted in the Department of Infectious Diseases, Peking Union Medical College Hospital from January 2000 to December 2016, including clinical data (age, gender, comorbidity, history of avian contact), clinical manifestations, laboratory examination, CT and magnetic resonance imaging findings, therapy, and prognosis, were analyzed retrospectively.  Results  The age of the 62 enrolled inpatients ranged from 16 to 68 years (median 39). 41 patients were male and 21 were female. There were 37 patients (59.7%, 37/62) with comorbidity and 23 patients (37.1%, 23/62) had contacted with pigeons or poultries. The number of cases misdiagnosed with tubercular meningitis or virus meningitis was 20 (32.3%, 20/62) and 9 (14.5%, 9/62), respectively. The main clinical symptoms included headache (98.4%, 61/62) and fever (82.3%, 51/62); 19 (30.6%, 19/62) patients had blurred vision; 13(21.0%, 13/62) had organ involvement beyond the central nervous system. The intracranial pressure increased in 55 patients (88.7%, 55/62) and 34 (61.8%, 34/55) had an opening pressure of more than 330 mm H2O. The white blood cell count of cerebrospinal fluid had a median of 71×106 cells/L(range 0-408×106 cells/L), dominated by mononuclear cells in 55 patients (88.7%, 55/62). Fifty-three (85.5%) of the 62 cases were positive of cryptococcus by India ink stain of cerebrospinal fluid; latex coagulate test was performed in 55 cases with 51 (92.7%, 51/55) positive; cerebrospinal fluid culture was positive in 28 cases (49.1%, 28/57). Twenty-five patients with a dilated ventricle received brain ventricular drainage. Only 4 cases used fluconazole monotherapy; 7 patients received intravenous amphotericin B (AmB) and flucytosine combined therapy; 16 patients took AmB and fluconazole combined therapy; 35 patients received AmB, flucytosine, and fluconazole combined therapy. The average dosage of AmB was 4139 mg; the median treatment duration was 19.6 weeks (range 2-42 weeks). In general, 10 of the 62 cases were cured, 44 improved, 6 no response, and 2 died; the total effective rate was 87.1% (54/62).  Conclusions  Cryptococcal meningitis might occur in immunocompetent patients with a high misdiagnosis rate. India ink stain and cryptococcal antigen test of cerebrospinal fluid are useful assays for early diagnosis of cryptococcal meningitis and therapeutic effect evaluation. We recommend the combination of amphotericin B with flucytosine and fluconazole as the standard therapy for cryptococcal meningitis. Early ventricular drainage is the key point to improve the treatment success for cryptococcal meningitis.
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    • References(20)
  • [1] Lúcia KHS, Carolina RC, Orionalda FLF, et al. Clinical and microbiological features of cryptococcal meningitis[J]. Rev Soc Bras Med Trop, 2013, 46: 343-347. doi:  10.1590/0037-8682-0061-2012
    [2] 《中国真菌学杂志》编辑委员会.隐球菌感染诊治专家共识[J].中国真菌学杂志, 2010, 5: 65-68, 86. http://www.cnki.com.cn/Article/CJFDTotal-ZJXZ201002000.htm
    [3] Jennie MK, Sean B, Brandon N, et al. Prevalence, correlates, and outcomes of cryptococcal antigen positivity among patients with AIDS, United States, 1986-2012[J]. Clin Infec Dis, 2015, 60: 959-965. doi:  10.1093/cid/ciu937
    [4] 谢静, 葛瑛, 邱志峰, 等.人类免疫缺陷病毒阴性隐球菌性脑膜炎患者外周血淋巴细胞亚群分析[J].中国真菌学杂志, 2017, 12: 262-267 https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-mycology_thesis/0201255482511.html
    [5] Ding Y, Li P, He Q, et al. The CD4+ T-lymphocyte count is an important predictor for the prognosis of cryptococcosis[J]. Eur J Clin Microbiol Infect Dis, 2017, 36: 897-904. doi:  10.1007/s10096-016-2880-9
    [6] Rohatgi S, Pirofski LA. Host immunity to Cryptococcus neoformans[J]. Future Microbiol, 2015, 10: 565-581. doi:  10.2217/fmb.14.132
    [7] Tinago W, Coghlan E, Macken A, et al. Clinical, immunological and treatment-related factors associated with normal-ized CD4+/CD8+ T-cell ratio: effect of naive andmemory T-cell subsets[J]. PLoS One, 2014, 9: e97011. doi:  10.1371/journal.pone.0097011
    [8] Voelz K, May RC. Cryptococcal interactions with the host immune system[J]. Eukaryot Cell, 2010, 9: 835-846. doi:  10.1128/EC.00039-10
    [9] Fang W, Fa ZZ, Liao WQ, et al. Epidemiology of cryptococcus and cryptococcosis in China[J]. Fungal Genetics Biol, 2015, (78): 7-15.
    [10] Liao CH, Chi CY, Wang YJ, et, al. Different presentations and outcomes between HIV-infected and HIV-uninfected patients with Cryptococcal meningitis[J]. J Microbiol Immunol Infect, 2012, 45: 296-304. doi:  10.1016/j.jmii.2011.12.005
    [11] Liu Q, Lv XJ, Liu YB, et al. Clinical analysis of 53 patients with Cryptococcal neoformans meningitis[J]. Chin J Infect Chemother, 2007, 7: 22-24. http://en.cnki.com.cn/article_en/cjfdtotal-kghl200701010.htm
    [12] 李娟, 吕晓菊, 叶惠, 等.隐球菌抗原在隐球菌脑膜炎诊断与治疗中的价值初探[J].四川大学学报(医学版), 2010, 41:1074-1075, 1079. http://www.cnki.com.cn/Article/CJFDTotal-HXYK201006038.htm
    [13] Marilena AM, Kate BB, Terezinha AM, et al. Molecular diagnosis of cryptococcal meningitis in cerebrospinal fluid: comparison of primer sets for Cryptococcus neoformans and Cryp tococcus gattii species complex[J]. Braz J infect Dis, 2015, 19: 62-67. doi:  10.1016/j.bjid.2014.09.004
    [14] 马小军, 李桂萍, 周炯, 等.两性霉素B治疗侵袭性真菌感染的回顾性研究[J].中华内科杂志, 2007, 46: 718-720. http://www.cnki.com.cn/Article/CJFDTotal-ZHNK200709008.htm
    [15] 徐斌, 吴吉芹, 欧雪婷, 等.隐球菌脑膜炎患者154例临床特征及其抗真菌疗效分析[J].中华传染病杂志, 2010, 28: 37-41. doi:  10.3760/cma.j.issn.1000-6680.2010.01.011
    [16] 刘正印, 王贵强, 朱利平, 等.隐球菌性脑膜炎诊治专家共识[J].中华内科杂志, 2018, 57: 317-323. http://med.wanfangdata.com.cn/Paper/Detail?dbid=WF_QK&id=PeriodicalPaper_zhnk201805003
    [17] 冯晓博, 姚志荣, 蔡志国, 等. 80株新生隐球菌的体外药敏试验分析[J].中华传染病杂志, 2009, 27: 268-272. http://www.cqvip.com/Main/Detail.aspx?id=30476137
    [18] Chau TT, Mai NH, Phu NH, et al. A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam—high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease[J]. BMC Infect Dis, 2010, 10: 199-207. doi:  10.1186/1471-2334-10-199
    [19] Tseng HK, Liu CP, Ho MW, et al. Microbiological, epidemiological, and clinical characteristics and outcomes of patients with cryptococcosis in Taiwan, 1997-2010[J]. PLoS One, 2013, 8: e61921. doi:  10.1371/journal.pone.0061921
    [20] Yuchong C, Fubin C, Jianghan C, et al. Cryptococcosis in China (1985-2010): review of cases from Chinese database[J]. Mycopathologia, 2012, 173: 329-335. doi:  10.1007/s11046-011-9471-1
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