一个免疫能力强的患者的加密球菌脑膜炎,最初的脑脊液分析是假负的:一个病例报告
Sheau Wei Tan1, Chuin Chi Yap1, Sri Siva Shakti Ratanasamy1
1Internal Medicine, Hospital Sultanah Nora Ismail, Batu Pahat, MYS.
Cureus
|March 13, 2026
概括
密码球菌脑膜炎 (CM) 可能发生在免疫能力强的个体中,这给诊断带来了挑战. 早期怀疑和连续测试对于及时的Cryptococcus neoformans诊断和治疗至关重要.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 医学诊断 医学诊断 医学诊断
背景情况:
- 密码球菌脑膜炎 (CM) 通常与免疫受损状态有关.
- 它在免疫能力较强的人群中的发生率正在上升,并带来诊断困难.
- 亚急性脑膜炎和水脑炎可以是最初的症状.
研究的目的:
- 要突出CM在免疫能力良好的宿主中的诊断挑战.
- 强调在无法解释的神经疾病中考虑CM的重要性.
- 为了强调串行脑脊液 (CSF) 分析和分子诊断的实用性.
主要方法:
- 一个56岁的免疫能力强的男性患有亚急性神经症状的病例报告.
- 最初的不起眼的CSF分析包括印度墨水,密码球菌抗原和文化.
- 随后的脑部MRI显示了脑膜增强和小脑结节.
- 用真菌培养和PCR重复CSF研究以诊断.
主要成果:
- 最初的CSF研究对Cryptococcus neoformans是负的.
- 大脑核磁共振扫描显示了渐进的脑膜增强和小脑结节.
- 重复的CSF分析通过真菌培养和PCR证实了Cryptococcus neoformans.
- 一名患者成功地接受了安福特素B,细胞素和可纳的治疗.
结论:
- 在分辨诊断亚急性脑膜炎或水脑炎时,无论免疫状况如何,都应考虑CM.
- 高度的临床怀疑对于及时诊断至关重要.
- 序列性脑液采样和先进的分子诊断对于及时治疗Cryptococcus neoformans感染至关重要.
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