特发性 CD4+T 淋巴细胞减少症合并水痘-带状疱疹病毒感染导致播散性隐球菌病：病例报告及文献复习。
Disseminated cryptococcosis with varicella-zoster virus coinfection of idiopathic CD4 + T lymphocytopenia: a case report and literature review.
机构信息
Department of Infectious Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Hangzhou, 310020, China.
出版信息
Virol J. 2022 Mar 5;19(1):38. doi: 10.1186/s12985-022-01765-7.
BACKGROUND
Idiopathic CD4 + T lymphocytopenia (ICL) is a rare immunodeficiency syndrome, unaccompanied by various opportunistic infections. Cryptococcus and varicella-zoster viruse are the most common opportunistic infections.
METHOD
We described a case of disseminated cryptococcosis with varicella-zoster virus coinfection in a patient with ICL and reviewed all published reports. A total of 26 cases with cryptococcal meningitis in ICL were enrolled.
DISCUSSION
ICL remains poorly understood to clinicians. Patients with cryptococcal meningitis in ICL mostly suffered with headache and fever in a subacute or chronic period, while some patients might have atypical manifestations which makes a difficulty for early diagnosis. Some characteristics of cerebrospinal fluid can help to predict the prognosis of the disease. Cryptococcosis with varicella-zoster virus coinfection is rare but serious.
CONCLUSION
We recommed CD4 + T cells should be assessed in patients with unusual or recurrent infections. As the underlying pathophysiology is poorly understood, there is no standard therapy for ICL. Increased awareness of the disease and early prevention for CD4 reduction are needed.
背景
特发性 CD4+T 淋巴细胞减少症（ICL）是一种罕见的免疫缺陷综合征，不伴有各种机会性感染。隐球菌和水痘-带状疱疹病毒是最常见的机会性感染。
方法
我们描述了一例 ICL 患者合并播散性隐球菌病和水痘-带状疱疹病毒感染，并复习了所有已发表的报告。共纳入 26 例 ICL 合并隐球菌性脑膜炎的病例。
讨论
ICL 仍不为临床医生所了解。ICL 合并隐球菌性脑膜炎的患者多以亚急性或慢性头痛和发热起病，部分患者可有不典型表现，导致早期诊断困难。一些脑脊液特征有助于预测疾病的预后。隐球菌病合并水痘-带状疱疹病毒感染虽然少见但很严重。
结论
我们建议对出现不寻常或复发性感染的患者评估 CD4+T 细胞。由于潜在的病理生理学尚不清楚，ICL 没有标准的治疗方法。需要提高对该病的认识，并早期预防 CD4 减少。
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