摘要
目的 分析非HIV隐球菌性脑膜炎患者的临床特征及体外药物敏感情况。方法 回顾性分析医院2018-2021年收治的138例隐球菌性脑膜炎患者的临床资料,对患者临床表现、基础病情和实验室检查等数据进行分析。结果 138例非HIV隐球菌性脑膜炎患者墨汁染色检测阳性率为73.9%,CrAg检测阳性率为100%,42例患者存在免疫功能抑制疾病,49例伴有其他基础疾病,另外47名患者无基础疾病。患者多伴有头痛、发热、呕吐、四肢乏力和意识障碍等症状。脑脊液生化检查显示糖和氯化物减低,脑脊液蛋白升高。138株隐球菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑的MIC范围分别为≤4~≥16μg/mL、≤0.5~1μg/mL、1~16μg/mL、≤0.125~0.5μg/mL、≤0.06~0.5μg/mL。5种抗真菌药物中5-氟胞嘧啶敏感性为95.60%,氟康唑敏感性为94.93%,伊曲康唑敏感性65.22%,两性霉素B和伏立康唑的敏感性均为100%。结论 隐球菌性脑膜炎患者多伴有基础疾病(含免疫功能抑制疾病);CrAg检测阳性率明显高于墨汁染色检测;非HIV隐球菌性脑膜炎患者分离菌株对不同抗真菌药物敏感性有差异,为临床用药提供参考。
Objective To analyze the clinical characteristics and drug susceptibility in vitro of non-HIV patients with cryptococcal meningitis.Methods The clinical data of 138 patients with cryptococcal meningitis who were treated in the hospital from 2018 to 2021 were retrospectively analyzed,the clinical manifestations,underlying conditions,and results of laboratory examinations were observed.Results The positive rate of ink staining test and CrAg test was 73.9% and 100%in 138 patients with non-HIV cryptococcal meningitis.Forty-two patients had immunosuppressive diseases,49 patients had other underlying diseases,and 47 patients had no history of underlying diseases.Cerebrospinal fluid biochemical examination of patients with headaches,fevers,vomiting,limb weakness,consciousness disorders,and other symptoms showed a decrease in glucose and chloride and an increase in cerebrospinal fluid protein content.The MIC ranges of 138 cryptococcus strains against 5-flucytosine,amphotericin B,fluconazole,itraconazole and voriconazole were≤4~≥16μg/mL、≤0.5~1μg/mL、1~16μg/mL、≤0.125~0.5μg/mL、≤0.06~0.5μg/mL.The sensitivity of 5-flucytosine,fluconazole and itraconazole was 95.60%,94.93% and 65.22%,respectively.The sensitivities of both amphotericin B and voriconazole were 100%.Conclusion Patients with cryptococcal meningitis often have underlying diseases(including immunosuppressive diseases).The positive rate of CrAg test was significantly higher than that of ink staining test,and the strains isolated from patients with non-HIV cryptococcal meningitis had different sensitivity to different antifungal drugs,which provided references for clinical medication.
作者
王奇
卢润禹
肖珂
陆锦辉
朱冬林
周文营
李晓杰
席云
Wang Qi;Lu Runyu;Xiao Ke;Lu Jinhui;Zhu Donglin;Zhou Wenying;Li Xiaojie;Xi Yun(Department of Laboratory Medicine,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou,510630;Huangpu District Branch Hospital of Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou 510700;Department of Transfusion Medicine,School of Laboratory Medicine and Biotechnology,Southern Medical University,Guangzhou 510515)
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2024年第2期227-231,共5页
Chinese Journal of Antibiotics
基金
中山大学附属第三医院国家自然科学基金培育青年项目(No.2020G2RPYQN25)。
关键词
隐球菌
隐球菌性脑膜炎
药敏试验
抗真菌药
脑脊液
Cryptococcus
Cryptococcal meningitis
Drug sensitive test
Antifungal drugs
Cerebrospinal fluid
