外瓶霉所致中枢神经系统感染1例并文献复习

来源 :中华医学会第十八次全国儿科学术会议 | 被引量 : 0次 | 上传用户:charles93
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目的:通过对科室收治的1例外瓶霉所致中枢神经系统感染的病例进行总结,讨论本病的临床表现,影像学改变,诊断及治疗。方法:通过对所收治的病人的资料进行总结分析,并进行相关文献的复习。结果:本例患儿为一8岁男童,主因“头晕2月,间断发热,月伴抽搐2次”入院。患儿曾于2年前发现胆管占位性病变,病例提示真菌,给予抗真菌治疗但并不系统。患儿此次发病后出现神经系统症状,并逐渐出现了意识障碍及肢体活动的障碍。于本次入院前进行了头颅核磁的检查提示颅内多发的占位性病变,伴有病灶周围水肿。最终脑活检病理检查提示丝状真菌,培养结果确诊为外瓶霉。入院后给予了两性霉素B脂质体、伏立康唑及5-氟胞嘧啶的联合抗真菌的治疗以及对症的处理。经正规系统治疗后患儿病情逐渐好转,意识逐渐恢复,治疗2月余后患儿可以与人正常交流,并可以自行活动。监测头颅影像提示病灶范围略有缩小,病灶周围水肿减轻。后续改为伏立康哇口服维持。随访至今患儿病情稳定。结论:外瓶霉所致的中枢神经系统感染发病率低,临床罕见,临床表现与其它真菌所致的颅内感染无特异性差别,影像学可有颅内团块样病灶,确诊仍有赖于病理检查及培养结果,由于病情重,诊治经验少,预后差。
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