Mycology Center & Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Mycoses. 2012 Mar;55(2):168-71. doi: 10.1111/j.1439-0507.2011.02063.x. Epub 2011 Jul 18.
To describe clinical characteristics, treatment and outcome of cryptococcal meningitis in immunocompetent children. Immunocompetent children with cryptococcal meningitis who attended Changzheng Hospital between 1998 and 2007 were retrospectively reviewed. During the 10 years reviewed, 11 children with cryptococcal meningitis were admitted to Changzheng hospital and identified as immunocompetent. The 11 children had a median age of 7.25 years. Headache (100%), fever (81.8%), nausea or vomiting (63.6%) and visual or hearing damage or loss (36.4%) were the most common symptoms before treatment. There is no evidence for other site infection of cryptococcus although all the cryptococcal antigen titre is high in blood. All the patients received amphotericin B or AmB liposome with 5-flucytosine for at least 6 weeks followed by fluconazole or itraconazole as consolidation treatment for at least 12 weeks. Nine patients were cured mycologically; however, sequela of visual damage was showed in one patient. Cryptococcal meningitis seems to be uncharacteristic of symptoms, and central nervous system may be the only common site for infection. Amphotericin B with 5-flucytosine should be the choice of induction treatment in this group of patients.
描述免疫功能正常儿童的隐球菌性脑膜炎的临床特征、治疗和转归。对 1998 年至 2007 年期间在长征医院就诊的免疫功能正常的隐球菌性脑膜炎患儿进行回顾性分析。在回顾的 10 年中，长征医院共收治 11 例免疫功能正常的隐球菌性脑膜炎患儿，患儿中位年龄为 7.25 岁。治疗前最常见的症状为头痛（100%）、发热（81.8%）、恶心或呕吐（63.6%）和视觉或听觉损害或丧失（36.4%）。尽管所有隐球菌抗原滴度均较高，但无其他部位感染隐球菌的证据。所有患者均接受两性霉素 B 或两性霉素 B 脂质体联合 5-氟胞嘧啶至少 6 周，随后氟康唑或伊曲康唑巩固治疗至少 12 周。9 例患者经培养证实治愈，但 1 例患者出现视觉损害后遗症。隐球菌性脑膜炎的症状似乎无特征性，中枢神经系统可能是唯一常见的感染部位。对于这组患者，两性霉素 B 联合 5-氟胞嘧啶应作为诱导治疗的选择。
