| Objective: 1 Analyze and summarize the clinical characteristics,cerebrospinal fluid characteristics,treatment and prognosis of cryptococcal meningitis(CM)to offer experience for early diagnosis and effective treatment.2 Explore the diagnostic value of cerebrospinal fluid and plasma levels of 1,3-beta-D glucan for CM.Methods:1 We analyzed 95 cases of CM patients admitted to the Second Hospital of Hebei Medical University in Shijiazhuang from January 2003 to January 2017 to summarize the clinical characteristics,cerebrospinal fluid characteristics,treatment and prognosis.2 Detect the 1,3-beta-D glucan in the cerebrospinal fluid and plasma of CM patients by dynamic turbidity method.Results:A total of 95 CM patients were summarized.The mean age was 42.86±19.33 years old.The male to female ratio was 59 to 36.Including 67 farmers,account for about 70.53% of the total.50 cases were healthy before the onset of the disease,45 cases were with the basic disease.18 cases were with oral hormone,6 cases were with immunosuppressive agents.10 cases had dove and poultry contact history.75(78.95%)cases of them were with a subacute or chronic onset.The main clinical manifestations were headache,fever,vomit and meningeal irritation.Abduction nerve damage,visual impairment and hearing impairment were the most common.There were 88.04% patients(81/92)with high intracranial pressure.The intracranial pressure was more than 200 mm H2O and less than 500 mm H2O in 59 patients,more than 500 mm H2O in 22 cases.There were 80.28% cases with elevated leukocyte in CSF(57/71),with a median of 50×106/L(0 ~ 828).CSF glucose decreased in 55.79% patients(51/71),with the mean value of 1.87±1.28mmol/L(0.08~5.3).CSF protein increased in 90.14% cases(64/71),with the median of 0.73g/L(0.06~4.83).CSF chloride decreased in 49.47% cases(48/71),with the mean value of 114.46±7.84mmol/L(97~134).There was a linear correlation between the cerebrospinal fluid pressure,white blood cell count,glucose content and the severity of the disease.There was no linear correlation between the cerebrospinal fluid protein and chloride level and the severity of the disease.There were 55cases(57.89%)with abnormal background cells for cerebrospinal fluid cytology.Including 15 cases of neutrophil reaction,19 cases of mixed cell reaction and 21 cases of lymphocyte reaction.Cerebrospinal fluid cytology mainly showed as neutrophils reaction or neutrophil mixed cell reaction primarily(12/14)for patients with onset time no more than 10 days,the cytology of patients with onset time between 10~30 days mainly showed as mixed cell reaction(10/24),the cytology of patients with onset time more than 30 days manifested as lymphocyte reaction(10/17).Meningeal reinforcement,hydrocephalus and inflammatory lesions were the most common head imaging.The most common lung CT manifested as inflammatory change.The misdiagnosis rate of CM is high,there were 34 cases(35.79%)were misdiagnosed as other diseases,16 cases were misdiagnosed as tuberculous meningitis among them which account for the largest proportion.The cerebrospinal fluid cytology May-Grünwald-Giemsa staining positive rate was 75.79% and alcian blue staining positive rate was 77.89% for the first time,the positive rate was 100% combined with the two staining methods more than 2 times.1,3-beta-D glucan could be detected in cerebrospinal fluid of CM patients by 1,3-beta-D glucan assay.17 cases(62.96%)were positive among the 27 patients.1,3-beta-D glucan can also be detected in the plasma,one out of 11 CM patients(9.09%)was positive.There was difference in diagnostic sensitivity for the 4 different diagnosis methods of CM.There was no significant difference between the three methods.The sensitivity of 1,3-beta-D glucan detection in plasma is different from the other 3 methods.82 patients in this group were received antifungal therapy,38 cases with amphotericin B or liposome combined with fluconazole,20 cases with amphotericin B or liposome combined with voriconazole,15 cases with fluconazole monotherapy,5 cases with amphotericin B monotherapy,4 cases of voriconazole monotherapy.The total effective rate of antifungal therapy was 71.95%,the effective rate of combination therapy was 82.76%,single-drug treatment effective rate was 45.83%.The stubbornly high intracranial pressure can be alleviated effectively by cerebrospinal fluid drainage.Conclusion:1 CM is more common in middle-aged men than women and it is common in farmers,with subacute or chronic onset generally.Headache,and fever were the most common initial symptoms.Abducent nerve,optic nerve and vestibular cochlear nerve damages were the most common cranial nerve damages.2 The higher of the cerebrospinal fluid pressure and the white blood cell count or the lower of the glucose content,the heavier of the disease.3 There was a correlation between the type of cerebrospinal fluid cytology and the time of onset.4 The misdiagnosis rate of CM is high,and it is most likely to be misdiagnosed as tuberculous meningitis before diagnosis.5 1,3-beta-D glucan can be detected in cerebrospinal fluid of CM patients and it can provide useful information for clinical diagnosis.6 The sensitivity of the cerebrospinal fluid cytology alcian blue staining,May-Gr ü nwald-Giemsa staining and 1,3-beta-D glucan detection in cerebrospinal fluid for CM is higher than 1,3-beta-D glucan detection in plasma.7 The rate of the combination therapy is higher than monotherapy in CM patients. |
