Schröter G P, Temple D R, Husberg B S, Weil R, Starzl T E
Surgery. 1976 Mar;79(3):268-77.
Ten cases of cryptococcosis have been identified in a 13 year experience with more than 650 renal transplants. Eight patients had meningitis, one patient had a cerebral granuloma, and in one patient the infection appeared to be limited to the lungs. The central nervous system infection often masqueraded as brain tumor and was not suspected initially. The most useful diagnostic test was cerebrospinal fluid examination including India ink preparation. Various ther apeutic regimens with amphotericin B and 5-fluorocytosine were effective in suppressing the infection. A combination of low doses of amphotericin B, not affecting kidney function, with 5-fluorocytosine for at least 3 months was associated with remission of disease in five patients who still are alive, including three patients without recurrence for longer than one year. Five deaths 3 weeks to 4 years after the beginning of treatment were not due to cryptococcosis; death resulted from vascular disease and septiciemia in three of the four patients with known causes of death. Central nervous system cryptococcosis, with the exception of the rare cerebral granuloma, is associated with little inflammation. If early death from increased intracranial pressure or cerebral edema is prevented, prolonged therapy with amphotericin B and 5-fluorocytosine may be expected to control the infection, even in immunosuppressed patients.
在超过650例肾移植的13年经验中，已确诊10例隐球菌病。8例患者患有脑膜炎，1例患者有脑肉芽肿，1例患者的感染似乎仅限于肺部。中枢神经系统感染常伪装成脑肿瘤，最初未被怀疑。最有用的诊断测试是脑脊液检查，包括墨汁负染。使用两性霉素B和5-氟胞嘧啶的各种治疗方案在抑制感染方面有效。低剂量的两性霉素B（不影响肾功能）与5-氟胞嘧啶联合使用至少3个月，使5例患者病情缓解且仍存活，其中3例患者无复发超过1年。治疗开始后3周至4年的5例死亡并非由隐球菌病所致；已知死因的4例患者中有3例死于血管疾病和败血症。除罕见的脑肉芽肿外，中枢神经系统隐球菌病炎症反应轻微。如果能预防因颅内压升高或脑水肿导致的早期死亡，即使是免疫抑制患者，使用两性霉素B和5-氟胞嘧啶进行长期治疗也有望控制感染。
