Schmutzhard E, Boongird P, Gerstenbrand F, Jitpimolmard S, Ponglikitmongkol S, Vejjajiva A
Department of Neurology, University Hospital Innsbruck, Austria.
Trop Geogr Med. 1990 Apr;42(2):133-9.
Twenty-four consecutive patients with central nervous system cryptococcosis (C.C.) have been studied retrospectively. In contrary to many reports from America or Europe only two patients suffered from an underlying immunocompromising disease. All patients were treated uniformly by amphotericin B and 5-fluorocytosin. They were monitored closely and dose-adjustment was done according to laboratory data. None of the patients died. Sixteen were available for a six-month post-treatment follow-up: seven had various degrees of neurological long-term sequelae whereas nine had no complaints and neurological examination was without abnormal findings. Our series is compared with others both from tropical and non-tropical countries. In accordance with all but one larger series from the tropics the relatively good prognosis and extremely rare occurrence of C.C. in immunocompromised persons is noted. Since different varieties of Cryptococcus neoformans have been shown to exist in different climate zones, this might be one of the possible explanations for the lack of preceding immune-compromising conditions in persons suffering from C.C. in the tropics and the benign course of disease.
对24例连续性中枢神经系统隐球菌病（C.C.）患者进行了回顾性研究。与来自美国或欧洲的许多报道相反，只有两名患者患有潜在的免疫功能低下疾病。所有患者均接受两性霉素B和5-氟胞嘧啶的统一治疗。对他们进行密切监测，并根据实验室数据进行剂量调整。所有患者均未死亡。16例患者可进行治疗后6个月的随访：7例有不同程度的神经学长期后遗症，而9例无不适主诉，神经学检查无异常发现。将我们的系列病例与来自热带和非热带国家的其他病例进行了比较。与来自热带地区的所有（除一个较大系列外）系列病例一致，注意到C.C.在免疫功能低下者中的预后相对较好且极为罕见。由于已证明新型隐球菌的不同变种存在于不同气候区，这可能是热带地区患有C.C.的人缺乏先前免疫功能低下状况以及疾病呈良性病程的可能解释之一。
