没有头痛的密码球菌脑膜炎:一个案例报告突出了非典型的呈现.
Yvanne Joshua Rabe1,2, Ailleen M Villegas1, Valmarie S Estrada3,4
1Section of Adult Neurology, Department of Internal Medicine, Cardinal Santos Medical Center, San Juan, PHL.
Cureus
|October 15, 2025
概括
严重的真菌感染Cryptococcus neoformans脑膜大脑炎,可能发生在免疫功能低下的患者中. 即使没有典型症状,早期中央神经系统 (CNS) 评估对于及时诊断和治疗至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 菌类学 菌类学是指菌类学.
- 神经学 神经学
背景情况:
- 加密球菌新型脑膜炎 (Cryptococcus neoformans meningoencephalitis) 是免疫力低下个体的常见并发症,包括那些患有获得性免疫缺陷综合征 (AIDS) 的人.
- 免疫抑制可能是葡萄糖皮质激素治疗,器官移植或恶性瘤的结果,增加对传播真菌感染的易感性.
- 典型的症状包括头痛,发烧,吐和精神状态变化,但在某些患者群体中可能缺席或掩盖.
研究的目的:
- 突出早期中枢神经系统 (CNS) 评估在具有高血清密码球菌抗原标位的免疫受损患者中的重要性.
- 强调需要及时诊断和治疗Cryptococcus neoformans脑膜炎,即使没有经典的神经症状.
- 为了说明高剂量皮质类固醇如何掩盖脑膜炎症状,强调高怀疑指数的重要性.
主要方法:
- 一个61岁的女性患有自身免疫性血液溶解性贫血,在高剂量葡萄糖皮质类药物治疗中出现呼吸障碍和发烧的病例介绍.
- 诊断工作包括血培养,血清加密球菌抗原检测和脑脊液 (CSF) 通过腰椎穿刺进行分析.
- 用脂质体安福特里辛B和可纳治疗,然后进行连续的腰部刺穿,以监测抗原标位和内压力.
主要成果:
- 血清加密球菌抗原标位升高 (1:4096) 和阳性CSF加密球菌抗原乳聚合系统 (CALAS).
- 尽管没有头痛或神经症状,但CSF开口压力升高 (51cmH2O).
- 用抗真菌疗法成功治疗,导致抗原标位和内压力下降,并临床稳定.
结论:
- 早期的中枢神经系统评估对于免疫受损患者具有高血清密码球菌抗原标位至关重要,无论神经症状如何.
- 接受高剂量皮质类固醇治疗的患者没有头痛,不应排除对密码球菌脑膜炎的诊断.
- 迅速诊断,全面评估和及时的抗真菌治疗对于改善Cryptococcus neoformans脑膜炎的结果至关重要.
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