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[马里巴马科一名HIV阴性患者的神经脑膜隐球菌病]

[Neuromeningeal cryptoccosis in an HIV-negative patient in Bamako, Mali].

作者信息

Coulibaly Farimadiané, Doumbia Yama, Issa Hama Hamidou, Dao Sounkalo

机构信息

Service des maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali.

Faculté de médecine et d'odontostomatologie de l'Université des sciences, des techniques et des technologies de Bamako, Mali.

出版信息

Med Trop Sante Int. 2024 Jan 11;4(4). doi: 10.48327/mtsi.v4i4.2024.593. eCollection 2024 Dec 31.

DOI:10.48327/mtsi.v4i4.2024.593
PMID:40070977
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11892387/
Abstract

INTRODUCTION/RATIONALE: Neuromeningeal cryptococcosis (NMC) is a common fungal infection in immunocompromised patients with HIV infection. Its rarity outside HIV/AIDS requires a systematic search for other immunosuppressive factors and a differential diagnosis. We report a case of NMC in an immunocompetent patient admitted to the Point G University Hospital Center in Bamako, Mali.

CASE DESCRIPTION

The patient presented with fever (39.3°C), general deterioration, Glasgow Coma Scale score of 10/15 without motor deficits, neck stiffness, and helmet-like headache unresponsive to analgesics. The patient had a CD4 count of 932 cells/mm. No other immunosuppressive conditions were noted. The diagnosis of NMC was confirmed based on clinical and microbiologic findings. The patient was successfully treated in Bamako using an alternative protocol with fluconazole, a more accessible, less expensive treatment with fewer side effects compared to amphotericin B.

DISCUSSION/CONCLUSION: The occurrence of cryptococcosis in an immunocompetent host is rare. However, it can occur in the absence of predisposing factors. Fluconazole is an effective alternative therapy.

摘要

引言/基本原理：神经脑膜隐球菌病（NMC）是HIV感染免疫功能低下患者中常见的真菌感染。在HIV/AIDS以外的情况下其罕见性需要系统地寻找其他免疫抑制因素并进行鉴别诊断。我们报告了一例在马里巴马科的G点大学医院中心收治的免疫功能正常患者发生NMC的病例。

病例描述

患者出现发热（39.3°C）、全身状况恶化、格拉斯哥昏迷量表评分为10/15且无运动功能障碍、颈部僵硬以及对镇痛药无反应的头盔样头痛。患者的CD4细胞计数为932个/mm³。未发现其他免疫抑制情况。根据临床和微生物学检查结果确诊为NMC。该患者在巴马科使用氟康唑替代方案成功治愈，与两性霉素B相比，氟康唑更容易获得、成本更低且副作用更少。

讨论/结论：免疫功能正常宿主发生隐球菌病很罕见。然而，在没有易感因素的情况下也可能发生。氟康唑是一种有效的替代疗法。

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本文引用的文献

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[Neuromeningeal cryptococcosis in an HIV-negative patient with pulmonary tuberculosis in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako, Mali].[马里巴马科G点大学教学医院感染与热带病科一名患有肺结核的HIV阴性患者的神经脑膜隐球菌病]
Med Trop Sante Int. 2022 Oct 19;2(4). doi: 10.48327/mtsi.v2i4.2022.282. eCollection 2022 Dec 31.
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