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目的 总结新型隐球菌脑膜炎 (简称隐脑 )患者临床特点和诊断、治疗经验。方法 对我院 1990年 1月～ 2 0 0 1年 6月期间确诊的隐脑患者进行临床回顾分析。结果 隐脑患者以中青年为多见 ,5 1.5 %患者既往有肾病综合征、肝硬化等疾病。起病缓慢 ,临床表现主要以头痛、发热和恶心呕吐为主。误诊率达 72 .7% ,主要误诊为结核性脑膜炎、病毒性脑炎和脑肿瘤等。治疗以二性霉素B(AMB)联用 5 -氟胞嘧啶 (5 -FC)或氟康唑 (Flu)等为主。病死率 3 9.4%。结论 隐脑早期缺乏典型临床表现 ,极易误诊。提高对本病临床认识水平 ,反复多次脑脊液 (CSF)涂片墨汁染色和真菌培养 ,开展免疫学检查是诊断本病的关键。AMB联合 5 -FC或Flu仍是隐脑的主要治疗方案
Objective To summarize the clinical features, diagnosis and treatment experience of Cryptococcus neoformans meningitis. Methods Clinical retrospective analysis of cryptoplex patients diagnosed in our hospital from January 1990 to June 2001. As a result, patients with occult brain were more common in middle-aged and young adults, and 1.5% of the patients had previous diseases such as nephrotic syndrome and cirrhosis. Slow onset, the main clinical manifestations of headache, fever and nausea and vomiting. Misdiagnosis rate of 72.7%, mainly misdiagnosed as tuberculous meningitis, viral encephalitis and brain tumors. Treatment with amphotericin B (AMB) combined with 5 - fluorocytosine (5 - FC) or fluconazole (Flu) based. Case fatality 3 9.4%. Conclusion The early clinical implicit absence of typical clinical manifestations, easily misdiagnosed. Improve the level of clinical awareness of the disease, repeatedly repeated cerebrospinal fluid (CSF) smear ink stains and fungal culture, to carry out immunological tests is the key to diagnosis of the disease. AMB combined with 5-FC or Flu is still the main treatment for cryptomuscular