艾滋病合并新型隱球菌腦膜炎文獻回顧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，復視4天，發(fā)熱意識欠清1天3外院腰穿（2016.4.27）4頭顱MRI：左側(cè)半卵圓中心點狀異常信號，T2Flair序列雙頂葉皮層下點狀略高信號（2016.4.27）5入院后腰穿略渾濁腦脊液6入院后腰穿7腦脊液細胞學—成團及散在帶莢膜藍染顆粒WrightGiemsa染色放大倍數(shù)1：4008腦脊液培養(yǎng)新生隱球菌報陽時間：48小時9化驗—白細胞計數(shù)及淋巴細胞計數(shù)10化驗—T細胞亞群分

2、類11AIDS確診實驗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30%，而在免疫功能正常的人群中，隱球菌的感染率約為十萬分之一左右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表現(xiàn)血管周圍間隙擴大膠狀假囊（治療3個月后）RadiolPractice，sep2009，Vol24，N0.922VR間隙（血管周圍間隙）擴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脈和流出靜脈進出腦實質(zhì)的延續(xù)而成擴大的VR間隙意味著大量的隱球菌酵母細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