Glück T, Weber P, Wiedmann K H
Abteilung Innere Medizin I, Medizinische Universitätsklinik Tübingen.
Dtsch Med Wochenschr. 1991 Dec 20;116(51-52):1955-8. doi: 10.1055/s-2008-1063845.
A 30-year-old, HIV-positive, man who had been repeatedly treated with amphotericin B for oral thrush, developed headaches, fever up to 38.5 degrees C, dizzy spells with falling tendency, as well as disorder of speech and word finding. Cerebrospinal fluid (CSF) contained 5700/3 cells, of which 90% were encapsulated yeast-fungus. Cryptococcal antigen titres were elevated both in serum (1:256) and CSF (1:1024), providing the diagnosis of cryptococcal meningitis. Intravenous treatment was started with amphotericin B, 0.3 mg/kg daily and flucytosine, 150 mg/kg daily. The clinical, microbiological and serological findings regressed after 4 weeks. After 8 weeks the creatinine concentration rose to 2.5 mg/dl. Because amphotericin B nephrotoxicity was suspected, further intravenous administration was stopped after a cumulative dosage of 2 g. He was placed on a prophylactic dosage of fluconazole, 100 mg by mouth twice daily. The cryptococcal antigen titre had fallen to normal within one year. The prophylactic regimen has been continued now for three years without recurrence or other fungal infection.
一名30岁的HIV阳性男性，曾多次接受两性霉素B治疗口腔念珠菌病，现出现头痛、体温高达38.5摄氏度的发热、有跌倒倾向的头晕发作，以及言语和找词障碍。脑脊液（CSF）中有5700/3个细胞，其中90%为包膜酵母菌。血清（1:256）和脑脊液（1:1024）中的隐球菌抗原滴度均升高，确诊为隐球菌性脑膜炎。开始静脉注射两性霉素B，每日0.3mg/kg，以及氟胞嘧啶，每日150mg/kg。4周后临床、微生物学和血清学检查结果有所改善。8周后肌酐浓度升至2.5mg/dl。由于怀疑两性霉素B肾毒性，在累积剂量达2g后停止进一步静脉给药。他开始口服氟康唑预防剂量，每日两次，每次100mg。一年内隐球菌抗原滴度降至正常。目前预防性治疗方案已持续三年，无复发或其他真菌感染。
