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目的:探讨儿童隐球菌病的临床表现、诊断、治疗及疗效,以提高对儿童隐球菌病的诊疗水平。方法:回顾分析郑州大学第一附属医院收治的15例确诊隐球菌病患儿的临床资料。结果:15例患儿发病年龄1岁2月～10岁,首发症状发热13例,伴头痛、呕吐6例,伴咳嗽5例,伴皮疹2例;首发症状头痛2例,伴精神异常。肺部查体13例正常,2例可闻及湿性罗音。脑膜刺激征阳性6例,肝脾肿大5例,浅表淋巴结肿大3例。10例免疫功能检查正常,1例支气管肺门淋巴结结核,4例免疫功能低下。11例累及中枢神经系统患儿联用两性霉素B+氟康唑或5-氟胞嘧啶治疗后,7例有效,4例死亡或放弃治疗;1例难治性隐球菌性脑膜炎患儿联用两性霉素B、氟康唑、5-氟胞嘧啶治疗后治愈;3例未合并脑膜炎患儿单用氟康唑治疗有效。结论:隐球菌在免疫功能健全儿童中的感染呈增高趋势,儿童隐球菌病的临床表现无特异性。隐球菌感染中枢神经系统几率较高,一旦确诊隐球菌病,建议常规行脑脊液检查。氟康唑、两性霉素B、5-氟胞嘧啶治疗儿童隐球菌病疗效确切。
Objective: To investigate the clinical manifestations, diagnosis, treatment and curative effect of children with cryptococcosis in order to improve the diagnosis and treatment of children with cryptococcosis. Methods: The clinical data of 15 children diagnosed with cryptococcosis admitted to the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results: The age of onset in 15 cases was from 1 year old to 10 years old. The first symptom was fever in 13 cases, with headache and vomiting in 6 cases, cough in 5 cases and rash in 2 cases. The first symptom was headache in 2 cases with psychosis. 13 cases of normal lung examination, 2 cases can be heard and wet rales. Meningeal signs were positive in 6 cases, hepatosplenomegaly in 5 cases, superficial lymph nodes in 3 cases. 10 cases of normal immune function test, 1 case of bronchial hilar lymph node tuberculosis, 4 cases of immune dysfunction. Of the 11 children with central nervous system who were treated with amphotericin B + fluconazole or 5-fluorocytosine, 7 were effective and 4 died or their treatment was discontinued. One child with refractory cryptococcal meningitis After treatment with amphotericin B, fluconazole, 5-fluorocytosine, 3 cases of children without meningitis were treated with fluconazole alone. CONCLUSIONS: The prevalence of cryptococcosis in immunocompromised children is increasing, and the clinical manifestations of cryptococcosis in children are nonspecific. Cryptococcal infection higher risk of central nervous system, once diagnosed cryptococcal disease, it is recommended routine routine cerebrospinal fluid examination. Fluconazole, amphotericin B, 5-fluorocytosine treatment of cryptococcosis in children is effective.