艾滋病合并隐球菌脑膜炎18例临床分析

摘要

Objective　To increase the awareness of AIDS with cryptococcal meningitis.rnMethods　Eighteen cases of confirmed AIDS with cryptococcal meningitis in the Bata Regional Hospital, Equatorial Guinea from January 1997 to November 1999 were analyzed. rnResults　The clinical manifestations of the 18 cases were: insidious onset, fever, severe headache, generalized pain, nausea and vomiting, weight loss and dehydration, and enlarged cervical lymph nodes. Boa's and Cullen's signs were positive. The positive rates of cerebrospinal fluid (CSF) India ink stain and the polysaccharide capsule antigen (ELISA) were 77.8% and 99.4%, respectively. The positive rate of CSF culture of cryptococcus was 100%. The mortality rate was 83.3%.rnConclusion　Cryptococcal meningitis is the most common opportunistic infection and one of the major causes of deaths in AIDS patients. The misdiagnosis and mortality rates were very high and could be explained by a lack of awareness for the occurrence of AIDS with cryptococcal meningitis, late presentation, serious illness and severe complications, and delayed and inadequate therapy.%目的提高对艾滋病（AIDS）合并隐球菌脑膜炎的认识。rn方法对赤道几内亚巴塔地区医院1997年1月～1999年11月确诊的18例AIDS合并隐球菌脑膜炎进行分析。rn结果 18例患者的临床主要表现为：起病隐匿；发热、剧烈头痛、全身疼痛、恶心呕吐、消瘦脱水、颈淋巴结肿大、布氏征与克氏征阳性、巴彬氏征阳性；脑脊液检查：隐球菌印度墨汁染色及隐球菌多糖荚膜抗原阳性率分别为77.8%，94.4%；脑脊液隐球菌培养均为阳性。病死率为83.3%。rn结论隐球菌脑膜炎是AIDS患者最常见的机会感染和致死病因。误诊及病死率高的主要原因系临床医生对本病的认识不足，治疗欠及时合理。