艾滋病合并新型隱球菌腦膜炎文獻回顧

艾滋病合并新型隱球菌腦膜炎文獻回顧第一頁，共30頁。主訴：頭痛8天，復(fù)視4天，發(fā)熱意識欠清1天第二頁，共30頁。外院腰穿（2016.4.27）4.27潘式實驗（-）腦脊液細胞總數(shù)1440*106/L腦脊液白細胞計數(shù)20*106/L墨汁染色蛋白0.184g/L葡萄糖2.6mmol/L氯化物113.0mmol/L壓力第三頁，共30頁。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（）第四頁，共30頁。入院后腰穿--略渾濁腦脊液第五頁，共30頁。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第六頁，共30頁。腦脊液細胞學—成團及散在帶莢膜藍染顆粒Wright-Giemsa染色放大倍數(shù)1：400第七頁，共30頁。腦脊液培養(yǎng)新生隱球菌報陽時間：48小時第八頁，共30頁?；灐准毎嫈?shù)及淋巴細胞計數(shù)第九頁，共30頁?；灐猅細胞亞群分類百分比(%)參考范圍總T淋巴細胞（CD3+）24.561.0~85.0T輔助/誘導(dǎo)細胞（Th,CD3+CD4+CD8-）1.834.0~70.0T抑制/細胞毒細胞（Ts,CD3+CD4-CD8+）93.325.0~54.0輔助/抑制T淋巴細胞比值0.020.68~2.47第十頁，共30頁。AIDS確診實驗第十一頁，共30頁。診斷新型隱球菌腦膜腦炎獲得性免疫缺陷綜合征第十二頁，共30頁。ClinicalInfectiousDiseases2010;50:291–322第十三頁，共30頁。ChinJMycol,April2010,Vol5,No2第十四頁，共30頁。Cryptococcus/隱球菌

第十五頁，共30頁。第十六頁，共30頁。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,No2第十七頁，共30頁。MortalityDespiteaccesstoadvancedmedicalcareandtheavailabilityofHAART,the3-monthmortalityrateduringmanagementofacutecryptococcalmeningoencephalitisapproximates20%Furthermore,withoutspecificantifungaltreatmentforcryptococcalmeningoencephalitisincertainHIV-infectedpopulations,mortalityratesof100%havebeenreportedwithin2weeksafterclinicalpresentationtohealthcarefacilities

ClinicalInfectiousDiseases2010;50:291–322第十八頁，共30頁。臨床表現(xiàn)ChinJMycol,April2010,Vol5,No2第十九頁，共30頁。CSFinterpretationforthemanagementofpatientswithsuspectedencephalitisJournalofInfection(2012)64,347e373第二十頁，共30頁。艾滋病合并新型隱球菌腦膜腦炎的影像學表現(xiàn)血管周圍間隙擴大膠狀假囊（治療3個月后）RadiolPractice，sep2009，Vol24，N0.9第二十一頁，共30頁。V-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第二十二頁，共30頁。Threeriskgroupsofcryptococcalmeningoencephalitis第二十三頁，共30頁。ClinicalInfectiousDiseases2010;50:291–322第二十四頁，共30頁。ChinJMycol,April2010,Vol5,No2第二十五頁，共30頁。Cryptococcosisinaresource-limitedhealthcareenvironmentWithCNSand/ordisseminateddiseasewherepolyeneisnotavailable,inductiontherapyisfluconazole(800mgperdayorally;1200mgperdayisfavored)foratleast10weeksoruntilCSFcultureresultsarenegative,followedbymaintenancetherapywithfluconazole(200–400mgperdayorally)WhereAmBdisnotavailableoraffordable,wherefacilitiesforadmissionandIVtherapydonotexist,orwhererenalandpotassiummonitoringarenotsufficientlyrapidorreliabletoallowsafeuseofAmBd,fluconazoleisoftentheonlytreatmentoption.第二十六頁，共30頁。ElevatedCSFPressureIftheCSFpressureis>25cmofCSFandtherearesymptomsofincreasedintracranialpressureduringinductiontherapy,relievebyCSFdrainage(bylumbarpuncture,reducetheopeningpressureby50%ifitisextremelyhighortoanormalpressureof<20cmofCSFIfthereispersistentpressureelevation>25cmofCSFandsymptoms,repeatlumbarpuncturedailyuntiltheCSFpressureandsymptomshavebeenstabilizedfor12daysandconsidertemporarypercutaneouslumbardrainsorventriculostomyforpersonswhorequirerepeateddailylumbarpuncturesPermanentVPshuntsshouldbeplacedonlyifthepatientisreceivingorhasreceivedappropriateantifungaltherapyandifmoreconservativemeasurestocontrolincreasedintracranialpressurehavefailed.Ifthepatientisreceivinganappropriateantifungalregimen,VPshuntscanbeplacedduringactiveinfectionandw