Study On Clinical Effects Of Crypotoccal Meningitis And Relevant Experimental Study

Objective: to evaluate the antifungal activity of amphotericin B(AmB), fluconazole (FCZ) and amphotericin B- fluconazole combination therapy on the murine with cryptococcal meningitis,and then to render the theory for rational treatment.Methods: We establish the experimental cryptococcal meningitis model by intracerebral challenge of C. neoformans suspension. We observe the effect of different antifungal agents on survival time and mortality of experimental mice and contrast the mycologic burden of brain tissue of different group(the number of CFU of C.neoformans per gram of brain tissue).Results: the mycologic burden of AmB-FCZ combination group is significantly lower, compared with AmB group, FCZ group and untreated group(P<0.01), but there were no difference between AmB group and FCZ group. The mortality of FCZ group is apparently reduced(P<0.05). There were no apparent difference between AmB-FCZ group and AmB group in decreasing the mortality.Conclusion: AmB-FCZ combination therapy could reduce the mycologic burden. The morality of AmB-FCZ group is higher than that of FCZ group. Objective To explore the clinical characters, diagnosis, treatment and prognosis of cryptococcus neoformans meningitis(CNM).Methods We retrospectively analysed the clinical data of 18 patients with cryptococcal meningitis.Results All patients were identified by pathogen. Most showed subacute clinical course. Clinical presentations of CNM were not special, so it was easily misdiagnosised. Misdiagnosis rate was 72% at first time to consult a doctor. The cases misdiagnosised with tubercular encephameningitis accounted for 69%. Three of 6 patients were successfully cured with fulconazole. Ten of 12 patients completely recovered with amphotericin B and fulconazole sequential therapy. Paraventriculostomy was performed in 5 patients with enlarged ventricle. Conclusions Diagnosis is dependent on the finding of Cryptococcus neoformans. Rapid methods should be united to improve early diagnosis.Combination of antifungal therapy could achieve better effect; Ventriculostomy could release symptoms and ameliorate prognosis.