The clinical characteristics of 13 cases of patients with cryptococcus meningitis
DENG Linlin
YU Jiazhen
DU Lijun
ZHANG Hong
Abstract：Objective To improve the level of the clinical diagnosis and treatment by analyzing the clinical features and combined antifungal therapy in patients with cryptococcal meningitis(CM).Methods Thirteen patients with cryptococcosis neoformans infection in Nanchong City Central Hospital from January 2013 to August 2023 were retrospectively enrolled.Clinical features including clinical characteristics,clinical responses,drugrelated adverse events,and prognosis were evaluated.Results The age of the 13 patients with CM ranged from 38 to 81 years old.One patient had a history of bird exposure.Of the 13 patients,8 patients suffered had comorbidities,including 5 cases of AIDS(HIV infection),2 cases of kidney disease,and 1 case of COPD with Parkinson's disease.The most common symptoms of CM were headache and fever.Abnormalities of imaging examination were found in 6 cases.Twelve cases had positive microscopic examination of cryptococcus in cerebrospinal fluid,and 10 cases had positive fungal culture.Eleven cases had significantly decreased levels of CD4+T cells.Ten patients were treated with amphotericin B(AmB)in combination with 5-flucytosine(5-FC).Two patients experienced infections that were difficult to control,and 1 patient discontinued treatment due to family reasons.The median course for the 7 patients was 7 weeks(4-8 weeks).Hypokalemia was the most prominent adverse effect with an incidence of 57.1%(4/7).Mild abnormal liver and kidney function tests were found.Two patients with nephropathy in this study were treated with different combination regimens(high-dose fluconazole and voriconazole,AmB combined with 5-FC).Two patient required to change regimen due to adverse effects.Two patients had surgical drainage(1 case of lateral ventricle-peritoneal shunt,1 case of extraventricular drainage).At the end of antifungal treatment,10 cases were in complete remission,1 case failed,and 2 cases died due to cryptococcal meningitis.Conclusion Low immune function may be a susceptible factor for cryptococcal infection.The main antifungal treatment was AmB combined with 5-FC.Active control of intracranial pressure is the key to reduce the case-fatality rate and improve the prognosis.
Keywords：cryptococcal meningitisclinical featureretrospective studytreatmentside-effect
Publication Date：2024-10-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 443-446,454 )