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目的了解儿童隐球菌病的临床特征,探讨其诊治方法。方法回顾分析2004—2006北京儿童医院收治的9例隐球菌病患儿的临床资料。结果急性起病2例,亚急性或慢性起病7例。发热8例,头痛、呕吐5例,咳嗽4例,皮肤黄疸3例。脑膜刺激征阳性5例,肝大、脾大各4例,淋巴结肿大5例。视乳头水肿3例。白细胞、C反应蛋白均增高,脑脊液异常5例。肺CT异常8例。血清隐球菌抗原均阳性。1例放弃治疗;8例出院时临床症状消失,病原学检查阴性。结论儿童隐球菌病临床表现多样,无特异性体征,误诊率高。对于中枢神经系统感染或多脏器损害且经抗结核、抗感染治疗无效者,应考虑该病可能。确诊依赖于脑脊液墨汁染色、血清或脑脊液乳胶凝集试验,组织病理及病原培养。
Objective To understand the clinical features of cryptococcosis in children and explore its diagnosis and treatment. Methods The clinical data of 9 cases of cryptococcosis admitted to Beijing Children’s Hospital from 2004 to 2006 were retrospectively analyzed. Results Acute onset in 2 cases, subacute or chronic onset in 7 cases. Fever in 8 cases, headache, vomiting in 5 cases, cough in 4 cases, skin jaundice in 3 cases. Meningeal irritation positive in 5 cases, liver, splenomegaly in 4 cases, 5 cases of lymphadenopathy. 3 cases of optic disc edema. Leukocytes, C-reactive protein were elevated, 5 cases of cerebrospinal fluid abnormalities. 8 cases of abnormal lung CT. Serum cryptococcal antigen were positive. 1 case gave up treatment; 8 cases disappeared when the clinical symptoms, pathogenic negative. Conclusion The clinical manifestation of cryptococcosis in children is diverse, with no specific signs and high misdiagnosis rate. For central nervous system infections or multiple organ damage and anti-TB, anti-infective treatment ineffective, should consider the possibility of the disease. Diagnosis depends on cerebrospinal fluid ink stain, serum or cerebrospinal fluid latex agglutination test, histopathology and pathogen culture.