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新型隐球菌性脑膜炎的临床治疗:基于新出现临床数据的循证综述

Clinical treatment of cryptococcal meningitis: an evidence-based review on the emerging clinical data.

作者信息

Liu Mao-Zhu, Dai Xin-Hua, Zeng Ming-Tang, Chen En-Qiang

机构信息

Center of Infectious Diseases, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, China.

Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, 610041, China.

出版信息

J Neurol. 2024 Jun;271(6):2960-2979. doi: 10.1007/s00415-024-12193-8. Epub 2024 Jan 30.

Abstract

Cryptococcal meningitis (CM) is a fatal fungal central nervous system (CNS) infection caused by Cryptococcus infecting the meninges and/or brain parenchyma, with fever, headache, neck stiffness, and visual disturbances as the primary clinical manifestations. Immunocompromised individuals with human immunodeficiency virus (HIV) infection or who have undergone organ transplantation, as well as immunocompetent people can both be susceptible to CM. Without treatment, patients with CM may have a mortality rate of up to 100% after hospital admission. Even after receiving therapy, CM patients may still suffer from problems such as difficulty to cure, poor prognosis, and high mortality. Therefore, timely and effective treatment is essential to improve the mortality and prognosis of CM patients. Currently, the clinical outcomes of CM are frequently unsatisfactory due to limited drug choices, severe adverse reactions, drug resistance, etc. Here, we review the research progress of CM treatment strategies and discuss the suitable options for managing CM, hoping to provide a reference for physicians to select the most appropriate treatment regimens for CM patients.

摘要

隐球菌性脑膜炎(CM)是一种由隐球菌感染脑膜和/或脑实质引起的致命性真菌中枢神经系统(CNS)感染,主要临床表现为发热、头痛、颈部僵硬和视觉障碍。感染人类免疫缺陷病毒(HIV)的免疫功能低下个体或接受过器官移植的人以及免疫功能正常的人都可能易患CM。未经治疗,CM患者入院后的死亡率可能高达100%。即使接受治疗后,CM患者仍可能面临难以治愈、预后不良和死亡率高等问题。因此,及时有效的治疗对于提高CM患者的死亡率和预后至关重要。目前,由于药物选择有限、严重不良反应、耐药性等原因,CM的临床治疗效果常常不尽人意。在此,我们综述CM治疗策略的研究进展,并讨论管理CM的合适选择,希望为医生为CM患者选择最合适的治疗方案提供参考。

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