Scott E N, Kaufman L, Brown A C, Muchmore H G
N Engl J Med. 1987 Oct 8;317(15):935-40. doi: 10.1056/NEJM198710083171505.
Eight patients have previously been reported to have central nervous system infections caused by Sporothrix schenckii. In those patients the fungus proved quite difficult to culture, delaying correct diagnosis and treatment. We describe seven additional patients with sporotrichosis meningitis, all of whom had antibody to this fungus in cerebrospinal fluid and serum. The antibody in the cerebrospinal fluid was most likely produced locally, as evidenced by its oligoclonality and the relatively high ratio of immunoglobulin to albumin in the cerebrospinal fluid as compared with the serum. Only one of these seven patients, who had active sporotrichosis of the knee joint, had obvious extrameningeal infection. None of 130 patients with meningitis known to be caused by other agents and none of 170 patients with other neurologic disorders had antibody to S. schenckii in their cerebrospinal fluid. We suggest that cerebrospinal fluid should be tested for S. schenckii antibody (in addition to other fungal agents) in any patient with chronic meningitis for which no cause is discovered by the usual diagnostic tests.
此前已有报道称8例患者因申克孢子丝菌感染导致中枢神经系统感染。在这些患者中，该真菌极难培养，从而延误了正确的诊断和治疗。我们描述了另外7例孢子丝菌病脑膜炎患者，他们的脑脊液和血清中均有针对这种真菌的抗体。脑脊液中的抗体很可能是在局部产生的，其寡克隆性以及脑脊液中免疫球蛋白与白蛋白的比例相对于血清较高就证明了这一点。这7例患者中只有1例膝关节有活动性孢子丝菌病，有明显的脑外感染。已知由其他病原体引起的130例脑膜炎患者以及170例其他神经系统疾病患者的脑脊液中均没有针对申克孢子丝菌的抗体。我们建议，对于任何经常规诊断检查未发现病因的慢性脑膜炎患者，都应检测脑脊液中是否存在申克孢子丝菌抗体（以及其他真菌病原体）。
