Clinical Analysis Of 36 Case With Cryptococcal Neoformans Meningitis

Objective: To analysis the clinical data of patients with cryptococcal neoformans meningitis, TO investigate the early diagnosis and treatment.Methods: Totally 36 patients with cryptococcal neoformans meningitis who were hospitalized in the Second Afiliated Hospital of Dalian University from October 1998 to October 2010 were enrolled in this study. The clinical data including clinical manifestations, diagnosis and misdiagnosis, experimental and etiology tests, treatments from all the patients were analyzed retrospectively.Results: Among the 36 patients enrolled in the study, 16 patients (44.44%) had concomitant diseases, 20 patients(56.5%) had unconcomitant diseases. The clinical manifestations of headache and fever were most common. All of the patients have intracranial hypertension (100%). In biochemical tests of cerebrospinal fluid (CSF), glucose decreasing in 31 cases (86.11%), lowering chloride were 31 cases (87.33%), protein increased in 35 cases (97.22%). The positive rate of CSF India ink smear was 36 cases (100%). The treatments were as follows: 18 cases were single therapy of Amphotericin B (AmB), AmB combined with flucytosine (5-FC) (2 cases), single therapy of Fluconazole (FCZ) (14 cases), FCZ combined with 5-FC (1 cases). AmB intrathecal injection (1 cases). There were 18 patients cured, improved in 8 cases, 6 cases deaths,30 cases withdrawn from our hospital. The mainly drug reactions is the gastrointestinal, followed by renal insufficiency, and abnormal liver biochemistry.Conclusion: The cryptococcal neoformans meningitis of patients has high fatality rate. Immunodefieiency is the major risk factor for cryptococcal meningitis. It is significantly that timely and effective diagnosis and treatment would increase to cure rate of patients for the cryptococcal neoformans meningitis. While the repeatedly and cerebrospinal fluid smears can greatly improve the diagnosis rate for patients for further treatment time. Joint treatment of multi-drug therapy, mainly FUZ with AmB can antifungal therapy, increased intracranial pressure in patients supported by continuous lumbar catheter drainage and intrathecal injection can reduce the brain herniation, improving utilization of drugs. To control of acute intracranial hypertension are the keys to improve prognosis of cryptococcal meningitis.