埃塞俄比亚西北部贡德尔医学科学院医院抗逆转录病毒治疗时代之前获得性免疫缺陷综合征患者的隐球菌性脑膜炎

Cryptococcal meningitis in patients with acquired immunudeficiency syndrome in prehaart era at Gondar College of Medical Sciences Hospital north-west Ethiopia.

作者信息

Seboxa Teshale, Alemu Shitaye, Assefa Abraham, Asefa Atakilti, Diro Ermias

机构信息

Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia.

出版信息

Ethiop Med J. 2010 Jul;48(3):237-41.

PMID:21073085

Abstract

BACKGROUND

CIyptococcal meningitis is an important opportunistic funimgal infection that became very common after the era of HIV infection.

OBJECTIVES

To determine the magnitude of Clyptococcal meningitis and study the clinical pattern among inpatients with HV infection at Gondar Hospital.

METHODS

A descriptive study was done among ELISA confirmed admitted HIV patients. Clinically suspected cases of meningitis underwent lumbar puncture and cerebrospinal fluid analysis. The clinical profile and outcomes of the confirmed Cryptococcal meningitis cases were described.

RESULTS

Among 375 HIV serology positive patients 31 were confirmed to have Cryptococcal meningitis. Their median age was 29 years (range 16-64); and 22 were males. The major manifestation at presentation included headache and fever each in 90% malaise (65%), stiffness of the neck (48%), altered Mentation (32%) and nausea and vomiting (32%), photophobia (23%) and seizure (3.6%). Median duration of illness was 16 days; ranging from 1-40 days. Temperature was above 38.4 degreees C in 80%. Meningial signs were observed in 32% altered Mentation was noted in 29% and focal neurologic deficit in 19% Cerebrospinal fluid examination revealed visually increased pressure (measured opening pressure >200 mmH2O in six patients) in 81% glucose < 50 mg/dl (50-70 mg/ dl) in 55% Protein >40 mg/dl (15-40 mg/dl) in 35% leukocytes count < 20/mm3 (poor prognostic sign) in 58% Indian ink staining detected encapsulated yeasts in 71% C. neoformans was cultivated in 90% of sample. Highest case fatality rate of the disease was observed during the pre HAART era.

CONCLUSION

Cryptococcal Meningitis is common among patients with immune-suppression. It could be the initial manifestation of HIV infection and should be suspected in any potential HIV infected patient with neurological symptoms especially headache and fever. As it has highest case fatality rate, early diagnosis and prompt therapy is strongly recommended Better treatment options like boosting their immunity with HAART should also be investigated

摘要

背景

隐球菌性脑膜炎是一种重要的机会性真菌感染，在HIV感染时代后变得非常常见。

目的

确定贡德尔医院HIV感染住院患者中隐球菌性脑膜炎的发病率，并研究其临床特征。

方法

对ELISA确诊的住院HIV患者进行描述性研究。临床疑似脑膜炎病例进行腰椎穿刺和脑脊液分析。描述确诊的隐球菌性脑膜炎病例的临床特征和结局。

结果

在375例HIV血清学阳性患者中，31例确诊为隐球菌性脑膜炎。他们的中位年龄为29岁（范围16 - 64岁）；22例为男性。就诊时的主要表现包括头痛和发热各占90%，不适（65%），颈部僵硬（48%），意识改变（32%），恶心和呕吐（32%），畏光（23%）和癫痫发作（3.6%）。疾病的中位持续时间为16天；范围为1 - 40天。80%的患者体温高于38.4摄氏度。32%的患者出现脑膜刺激征，29%的患者出现意识改变，19%的患者出现局灶性神经功能缺损。脑脊液检查显示81%的患者视压力升高（6例患者测量的初压>200 mmH2O），55%的患者葡萄糖<50 mg/dl（50 - 70 mg/dl），35%的患者蛋白质>40 mg/dl（15 - 40 mg/dl），58%的患者白细胞计数<20/mm3（预后不良征象），71%的患者印度墨汁染色检测到有荚膜酵母菌，90%的样本培养出新型隐球菌。在HAART时代之前，该疾病的病死率最高。