艾滋病合并新型隱球菌腦膜炎文獻(xiàn)回顧ppt課件

1、1獲得性免疫缺陷綜合征&新型隱球菌腦膜腦炎2主訴：頭痛8天，復(fù)視4天，發(fā)熱意識(shí)欠清1天3外院腰穿（2016.4.27）4頭顱MRI：左側(cè)半卵圓中心點(diǎn)狀異常信號(hào)，T2Flair序列雙頂葉皮層下點(diǎn)狀略高信號(hào)（2016.4.27）5入院后腰穿略渾濁腦脊液6入院后腰穿7腦脊液細(xì)胞學(xué)—成團(tuán)及散在帶莢膜藍(lán)染顆粒WrightGiemsa染色放大倍數(shù)1：4008腦脊液培養(yǎng)新生隱球菌報(bào)陽(yáng)時(shí)間：48小時(shí)9化驗(yàn)—白細(xì)胞計(jì)數(shù)及淋巴細(xì)胞計(jì)數(shù)10化驗(yàn)—T細(xì)胞亞群分

2、類11AIDS確診實(shí)驗(yàn)12診斷新型隱球菌腦膜腦炎獲得性免疫缺陷綜合征13ClinicalInfectiousDiseases201050:291–32214ChinJMycolApril2010Vol5No215Cryptococcus隱球菌1617Incidence在免疫抑制患者中，隱球菌感染的發(fā)病率約為5%~10%，在AIDS患者中，隱球菌的感染率可以高達(dá)30%，而在免疫功能正常的人群中，隱球菌的感染率約為十萬(wàn)分之一左右Itises

3、timatedthattheglobalburdenofHIVassociatedcryptococcosisapproximates1millioncasesannuallywldwideClinicalInfectiousDiseases201050:291–322ChinJMycolApril2010Vol5No218MtalityDespiteaccesstoadvancedmedicalcaretheavailabilityo

4、fHAARTthe3monthmtalityrateduringmanagementofacutecryptococcalmeningoencephalitisapproximates20%FurthermewithoutspecificantifungaltreatmentfcryptococcalmeningoencephalitisincertainHIVinfectedpopulationsmtalityratesof100%h

5、avebeenreptedwithin2weeksafterclinicalpresentationtohealthcarefacilitiesClinicalInfectiousDiseases201050:291–32219臨床表現(xiàn)ChinJMycolApril2010Vol5No220CSFinterpretationfthemanagementofpatientswithsuspectedencephalitisJournalo

6、fInfection(2012)64347e37321艾滋病合并新型隱球菌腦膜腦炎的影像學(xué)表現(xiàn)血管周圍間隙擴(kuò)大膠狀假囊（治療3個(gè)月后）RadiolPractice，sep2009，Vol24，N0.922VR間隙（血管周圍間隙）擴(kuò)大血管周圍間隙是與軟腦膜下隙接續(xù)的是軟腦膜隨著穿通動(dòng)脈和流出靜脈進(jìn)出腦實(shí)質(zhì)的延續(xù)而成擴(kuò)大的VR間隙意味著大量的隱球菌酵母細(xì)胞聚集于血管周圍間隙或者部分阻滯了腦脊液的流出23Threeriskgroupsofcr

7、yptococcalmeningoencephalitis24ClinicalInfectiousDiseases201050:291–32225ChinJMycolApril2010Vol5No226CryptococcosisinaresourcelimitedhealthcareenvironmentWithCNSdisseminateddiseasewherepolyeneisnotavailableinductionthera

8、pyisfluconazole(800mgperdayally1200mgperdayisfaved)fatleast10weeksuntilCSFcultureresultsarenegativefollowedbymaintenancetherapywithfluconazole(200–400mgperdayally)WhereAmBdisnotavailableaffdablewherefacilitiesfadmissionI

9、VtherapydonotexistwhererenalpotassiummonitingarenotsufficientlyrapidreliabletoallowsafeuseofAmBdfluconazoleisoftentheonlytreatmentoption.27ElevatedCSFPressureIftheCSFpressureis25cmofCSFtherearesymptomsofincreasedintracra

10、nialpressureduringinductiontherapyrelievebyCSFdrainage(bylumbarpuncturereducetheopeningpressureby50%ifitisextremelyhightoanmalpressureof25cmofCSFsymptomsrepeatlumbarpuncturedailyuntiltheCSFpressuresymptomshavebeenstabili

11、zedf12daysconsidertemparypercutaneouslumbardrainsventriculostomyfpersonswhorequirerepeateddailylumbarpuncturesPermanentVPshuntsshouldbeplacedonlyifthepatientisreceivinghasreceivedappropriateantifungaltherapyifmeconservat

12、ivemeasurestocontrolincreasedintracranialpressurehavefailed.IfthepatientisreceivinganappropriateantifungalregimenVPshuntscanbeplacedduringactiveinfectionwithoutcompletesterilizationofCNSifclinicallynecessaryClinicalInfec