隐球菌脑膜炎文献总结.doc

一、New Insights in the Prevention, Diagnosis, and Treatment of Cryptococcal Meningitis 2012 Introduction： CM是高HIV流行区中一个普遍的，且常常为十分严重的疾病。在非洲HIV患者中，有大约10%-20%的患者死于CM【1，2】。Cryptococcus species are a common cause of bloodstream infections among HIV patients in Thailand[4] and are responsible for the most commonly diagnosed meningitis syndromes in many African countries, accounting for 40% of meningitis cases in Malawi[5]. Epidemiology 新型隐球菌在环境中普遍存在，可致CM的隐球菌分为两类：C. neoformans and C, gattii。 在发展中国家，C. neoformans variant grubii 可以在严重的免疫缺陷患者中造成CM【6】。C.gattii 有造成免疫正常（immunocopetent）患者致病的倾向，并且是has the cause of an ongoing outbreak of CM in North America in the Pacific Northwest for over a decade[7,8]。隐球菌通常通过吸入传染性的繁殖体而进入人体。从胎盘可以扩散到婴儿但是很少见【9】，从一个具有隐球菌传染性的供体内进行器官移植可以导致隐球菌的传播[10.11]。Cryptococcal capsular polysaccharide and protein antigen are antibody stimulants. Both of these studies reinforce the belief that cryptococcal disease may be caused by a reactivation of latent disease during profound immunosuppression Clicnical presentation： CM通常表现为无明显症状的亚急性脑膜炎，在一些明显细胞免疫缺乏的患者身上，如HIV或各种各样的免疫缺陷患者。Classical meningismus is present in approximately one quarter of patients [14].ICP症状很常见，如严重的头痛，意识水平降低，癫痫，视乳头水肿，第六颈椎神经麻痹。 Diagnosis： 隐球菌抗原（CrAg）可以通过latexagglutination or enzyme immunoassay kit在血清和脑脊液中检测出来。在HIV相关的和非HIV相关的患者中，血清CrAg titer测定，作为一种初始的筛查，在近85-90%病例中是阳性的【15-16】。在CSF中，CrAg 阳性的敏感度接近100%，although specificity is less, with occasional false-positives [17, 18].。Confirmation of diagnosis can be made by culturing CSF on Sabouraud agar plates, which remains the gold standard.。 India ink This method is highly sensitive (90 %) and specific (approaching 100 %) when experienced technicians are available and disease burden is high [21], In a patient with CM the most significant negative prognostic indicators are reduced level of consciousness, low weight, seizures, fungemia at baseline, and increased fungal burden in CSF, as manifest by elevated CSF CrAg or increased baseline quantitative culture of t