Kovacs J A, Kovacs A A, Polis M, Wright W C, Gill V J, Tuazon C U, Gelmann E P, Lane H C, Longfield R, Overturf G
Ann Intern Med. 1985 Oct;103(4):533-8. doi: 10.7326/0003-4819-103-4-533.
The clinical course and response to therapy of 27 patients with cryptococcosis and the acquired immunodeficiency syndrome were reviewed. Cryptococcosis was the initial manifestation of the syndrome in 7 patients, and the initial opportunistic infection in an additional 7. Meningitis was the commonest clinical feature (18 patients). Blood cultures and serum cryptococcal antigen were frequently positive. In patients with meningitis, leukocyte count, protein level, and glucose level in cerebrospinal fluid were frequently normal; cerebrospinal fluid India ink test (82%), culture (100%), and cryptococcal antigen (100%) were usually positive. Only 10 of 24 patients had no evidence of clinical activity of cryptococcal infection after completion of therapy; 6 of these 10 had relapses shown by clinical findings or at autopsy. Standard courses of amphotericin B alone or combined with flucytosine were ineffective. Cryptococcosis in patients with the syndrome is a debilitating disease that does not respond to conventional therapy; earlier diagnosis or long-term suppressive therapy may improve the prognosis.
对27例隐球菌病合并获得性免疫缺陷综合征患者的临床病程及治疗反应进行了回顾。隐球菌病是7例患者综合征的初始表现，另有7例为初始机会性感染。脑膜炎是最常见的临床特征（18例患者）。血培养和血清隐球菌抗原常呈阳性。脑膜炎患者脑脊液中的白细胞计数、蛋白水平和葡萄糖水平常正常；脑脊液墨汁染色检查（82%）、培养（100%）和隐球菌抗原（100%）通常呈阳性。24例患者中只有10例在完成治疗后没有隐球菌感染临床活动的证据；这10例中的6例经临床检查或尸检显示有复发。单独使用两性霉素B或与氟胞嘧啶联合使用的标准疗程均无效。该综合征患者的隐球菌病是一种消耗性疾病，对传统治疗无反应；早期诊断或长期抑制性治疗可能改善预后。
