艾滋病合并新型隐球菌脑膜炎文献回顾

1获得性免疫缺陷综合征

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新型隐球菌脑膜脑炎整理ppt2主诉：头痛8天，复视4天，发热意识欠清1天整理ppt3外院腰穿（2016.4.27）4.27潘式实验（-）脑脊液细胞总数1440*106/L脑脊液白细胞计数20*106/L墨汁染色蛋白0.184g/L葡萄糖2.6mmol/L氯化物113.0mmol/L压力整理ppt4头颅MRI：左侧半卵圆中心点状异常信号，T2Flair序列双顶叶皮层下点状略高信号（2016.4.27）整理ppt5入院后腰穿--略浑浊脑脊液整理ppt6入院后腰穿5.15.4潘式实验（1+）（1+）脑脊液RBC210*106/L420*106/L脑脊液WBC6*106/L2*106/L墨汁染色阳性阳性蛋白0.4g/L0.55g/L葡萄糖1.4mmol/L4.7mmol/L氯化物115mmol/L123mmol/L压力778mmH2O347mmH2O整理ppt7脑脊液细胞学—成团及散在带荚膜蓝染颗粒Wright-Giemsa染色放大倍数1：400整理ppt8脑脊液培养新生隐球菌报阳时间：48小时整理ppt9化验—白细胞计数及淋巴细胞计数整理ppt10化验—T细胞亚群分类百分比(%)参考范围总T淋巴细胞（CD3+）24.561.0~85.0T辅助/诱导细胞（Th,CD3+CD4+CD8-）1.834.0~70.0T抑制/细胞毒细胞（Ts,CD3+CD4-CD8+）93.325.0~54.0辅助/抑制T淋巴细胞比值0.020.68~2.47整理ppt11AIDS确诊实验整理ppt12诊断新型隐球菌脑膜脑炎获得性免疫缺陷综合征整理ppt13ClinicalInfectiousDiseases2010;50:291–322整理ppt14ChinJMycol,April2010,Vol5,No2整理ppt15Cryptococcus/隐球菌

整理ppt16整理ppt17Incidence在免疫抑制患者中，隐球菌感染的发病率约为5%~10%，在AIDS患者中，隐球菌的感染率可以高达30%，而在免疫功能正常的人群中，隐球菌的感染率约为十万分之一左右ItisestimatedthattheglobalburdenofHIV-associatedcryptococcosisapproximates1millioncasesannuallyworldwide

ClinicalInfectiousDiseases2010;50:291–322ChinJMycol,April2010,Vol5,No2整理ppt18MortalityDespiteaccesstoadvancedmedicalcareandtheavailabilityofHAART,the3-monthmortalityrateduringmanagementofacutecryptococcalmeningoencephalitisapproximates20%Furthermore,withoutspecificantifungaltreatmentforcryptococcalmeningoencephalitisincertainHIV-infectedpopulations,mortalityratesof100%havebeenreportedwithin2weeksafterclinicalpresentationtohealthcarefacilities

ClinicalInfectiousDiseases2010;50:291–322整理ppt19临床表现ChinJMycol,April2010,Vol5,No2整理ppt20CSFinterpretationforthemanagementofpatientswithsuspectedencephalitisJournalofInfection(2012)64,347e373整理ppt21艾滋病合并新型隐球菌脑膜脑炎的影像学表现血管周围间隙扩大胶状假囊（治疗3个月后）RadiolPractice，sep2009，Vol24，N0.9整理ppt22V-R间隙（血管周围间隙）扩大血管周围间隙是与软脑膜下隙接续的,是软脑膜随着穿通动脉和流出静脉进出脑实质的延续而成扩大的V-R间隙意味着大量的隐球菌酵母细胞聚集于血管周围间隙或者部分阻滞了脑脊液的流出整理ppt23Threeriskgroupsofcryptococcalmeningoencephalitis整理ppt24ClinicalInfectiousDiseases2010;50:291–322整理ppt25ChinJMycol,April2010,Vol5,No2整理ppt26Cryptococcosisinaresource-limitedhealthcareenvironmentWithCNSand/ordisseminateddiseasewherepolyeneisnotavailable,inductiontherapyisfluconazole(800mgperdayorally;1200mgperdayisfavored)foratleast10weeksoruntilCSFcultureresultsarenegative,followedbymaintenancetherapywithfluconazole(200–400mgperdayorally)WhereAmBdisnotavailableoraffordable,wherefacilitiesforadmissionandIVtherapydonotexist,orwhererenalandpotassiummonitoringarenotsufficientlyrapidorreliabletoallowsafeuseofAmBd,fluconazoleisoftentheonlytreatmentoption.整理ppt27ElevatedCSFPressureIftheCSFpressureis>25cmofCSFandtherearesymptomsofincreasedintracranialpressureduringinductiontherapy,relievebyCSFdrainage(bylumbarpuncture,reducetheopeningpressureby50%ifitisextremelyhighortoanormalpressureof<20cmofCSFIfthereispersistentpressureelevation>25cmofCSFandsymptoms,repeatlumbarpuncturedailyuntiltheCSFpressureandsymptomshavebeenstabilizedfor12daysandconsidertemporarypercutaneouslumbardrainsorventriculostomyforpersonswhorequirerepeateddailylumbarpuncturesPermanentVPshuntsshouldbeplacedonlyifthepatientisreceivingorhasreceivedappropriateantifungaltherapyandifmoreconservativemeasurestocontrolincreasedintracranialpressurehavefailed.Ifthepatientisreceivinganappropriateantifungalregimen,VPshuntscanbeplacedduring