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新型隐球菌性脑膜炎近年来并非少见,从我科6年来10多例新型隐球菌性脑膜炎病例(以下仅选择3例作介绍)中看到,该病临床表现多以亚急性或慢性起病,无特异性,轻重不一,主要为发烧、颅内压增高、脑膜刺激征,脑脊液(CSF)改变或无特殊改变,神经系统检查有或无定位体征,故一时难与结核性脑膜炎、脑肿瘤、脑脓肿等鉴别,均有赖于CSF之特异检查,即找到新型隐球菌方可确诊。新型隐球菌性脑膜炎的治疗成败似决定于是否能坚持使用二性霉素B的治疗。病情重、副作用大(如高烧、呕吐)并非需绝对停药,如病情许可及支持疗法得当,剂量可偏大。病情虽轻,使用三苯甲咪唑及曲古霉素,其疗效尚不如二性霉素B。病例介绍例1 阮××,男,19岁,未婚,农民,中山县家边公社。住院号209490。因持续性头痛3个月于1979年4月2日入院。患者于3个月前开始双侧颞部胀痛,约10天后为右侧头痛,伴头晕、发烧(多为低烧),头痛剧烈时呕吐。以后渐觉听力下降,以右侧明显,近月来出现复视,但一直无咳嗽、胸痛、颈痛,抽搐、意识障碍及遗大小便等,唯易便秘,5～8天大便1次。起病后曾在当地县医院住院10多天。小便检查正常,脑脊液白细胞2,104,中性85%,淋巴15%,右侧脑血管造影正常,后按结核性脑膜炎治疗无效而转我院。
Cryptococcus neoformans meningitis is not uncommon in recent years, from our department over the past six years, more than 10 cases of new cryptococcal meningitis (the following selection of only 3 cases for the introduction) to see the clinical manifestations of the disease and more sub-acute or chronic Sickness, nonspecificity, severity, mainly fever, increased intracranial pressure, meningeal irritation, changes in cerebrospinal fluid (CSF) or no special changes, nervous system examination with or without signs of positioning, it is sometimes difficult and tuberculous meningitis , Brain tumors, brain abscess and other identification, all depends on the CSF specific examination, that is, to find the new cryptococcosis before diagnosis. The success or failure of Cryptococcus neoformans meningitis depends on whether or not amphotericin B can be consistently used. Serious illness, side effects (such as high fever, vomiting) is not required to stop the absolute withdrawal, such as the condition permit and supportive treatment properly, the dose can be large. Although the disease is mild, the use of tribenzimidazole and trichostatin, its efficacy is not as good as amphotericin B. Case introduction example 1 Nguyen × ×, male, 19 years old, unmarried, peasant, Zhongshan County home side commune. Hospital number 209490. 3 months due to persistent headache on April 2, 1979 admission. The patient started bilateral temporal tenderness 3 months earlier and had right-sided headache about 10 days later with dizziness, fever (mostly low-grade fever) and vomiting during severe headache. After hearing gradually decreased hearing to the right obviously, diplopia appeared in recent months, but has been no cough, chest pain, neck pain, convulsions, disturbance of consciousness and left urinate and so on, only easy to constipation, 5 to 8 days a stool. After onset in the local county hospital for more than 10 days. Pee examination was normal, cerebrospinal fluid leukocytes 2,104, 85% neutral, lymphatic 15%, right cerebral angiography was normal, followed by tuberculous meningitis invalid and transferred to our hospital.