23例小儿隐球菌病的临床研究

Clinical study of 23 pediatric patients with cryptococcosis.

作者信息

Luo F-L, Tao Y-H, Wang Y-M, Li H

机构信息

Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China.

出版信息

Eur Rev Med Pharmacol Sci. 2015 Oct;19(20):3801-10.

PMID:26531262

Abstract

OBJECTIVE

Cryptococcus neoformans is a common opportunistic infection in adults with acquired immunodeficiency syndrome. However, limited data exist for pediatric patients. The aim of this study was to describe the clinical characteristics of cryptococcosis in pediatric patients.

PATIENTS AND METHODS

A retrospective study was conducted at West China Second University Hospital, Sichuan University. Data on risk factors, clinical manifestations, diagnosis methods, treatment, and prognosis were evaluated. Clinical characteristics associated with cryptococcal meningitis and disseminated cryptococcosis were compared.

RESULTS

Twelve cases of cryptococcal meningitis and 11 cases of disseminated cryptococcosis were identified. Seventeen cases had no underlying disease, but 6 cases had malnutrition. Only 6 cases had a history of exposure to pigeon droppings. No cases had pulmonary cryptococcosis alone. Coughing, pulmonary moist rales, swollen lymph nodes, liver and spleen, and skin rashes were seen only in disseminated cryptococcosis. The prevalence of headache and positive meningeal irritation sign was higher in cryptococcal meningitis than disseminated cryptococcosis. The proportion of increase in eosinophils was higher in disseminated cryptococcosis than cryptococcal meningitis. The primary methods used for diagnosis included cerebrospinal fluid ink staining, cerebrospinal fluid culture, blood culture, and lymph node biopsy. Two patients stopped treatment, and 21 patients received antifungal therapy. The mortality rate was 39.13%.

CONCLUSIONS

Cryptococcosis occurs in non-HIV infected and immunocompetent children. Cryptococcosis lacks specific clinical manifestations. Disseminated cryptococcosis commonly occurs in children. Clinicians should consider a diagnosis of disseminated cryptococcosis for children who present with unexplained long-term fever, mild cough, chest imaging inconsistent with clinical symptoms, lymphadenectasis, hepatosplenomegaly, and eosinophilia.

摘要

目的

新型隐球菌是成人获得性免疫缺陷综合征常见的机会性感染病原体。然而，关于儿科患者的数据有限。本研究旨在描述儿科患者隐球菌病的临床特征。

患者与方法

在四川大学华西第二医院进行一项回顾性研究。评估危险因素、临床表现、诊断方法、治疗及预后的数据。比较与隐球菌性脑膜炎和播散性隐球菌病相关的临床特征。

结果

确诊12例隐球菌性脑膜炎和11例播散性隐球菌病。17例无基础疾病，但6例有营养不良。仅6例有接触鸽粪史。无单纯肺隐球菌病病例。咳嗽、肺部湿啰音、淋巴结肿大、肝脾肿大及皮疹仅见于播散性隐球菌病。隐球菌性脑膜炎患者头痛及脑膜刺激征阳性的发生率高于播散性隐球菌病。播散性隐球菌病患者嗜酸性粒细胞增多的比例高于隐球菌性脑膜炎。诊断的主要方法包括脑脊液墨汁染色、脑脊液培养、血培养及淋巴结活检。2例患者停止治疗，21例患者接受抗真菌治疗。死亡率为39.13%。