Clinical Characteristics And Prognosis Of 18 Cases Of Cryptococcal Meningitis

ObjectiveTo analyze the clinical characteristics and prognostic factors of patients with cryptococcal meningitis in our hospital from 2008 to 2017,and provide reference for clinical treatment of patients with cryptococcal meningitis.Materials and Methods SourceClinical data of 18 patients with cryptococcal meningitis diagnosed by pathogens and complete case data in our hospital for the past 9 years.The data comes from the case management database of our hospital.MethodsThe clinical data of 18 patients with cryptococcal meningitis admitted to our hospital from January 1,2008 to December 31,2017 were collected.Record patient gender,age of onset,occupational composition,course of admission,time of diagnosis,history of contact with pigeons,underlying disease,diagnosis and treatment,clinical symptoms,signs,routine cerebrospinal fluid routine,biochemical and pathogenic findings,cranial imaging findings,treatment plan,prognosis and other information.Statistical analysis was performed on the collected data.ResultsAmong the 18 patients,8 were male and 10 were female,with an average of44.83±17.01 years old;9 of them were occupational,accounting for 50%,the median admission course was 25?15,60?days,and the median time from admission to diagnosis was 1?1,2.50?days.There were 3 cases?16.67%?of the history,13 cases?72.22%?with basic diseases,including 4 cases of systemic lupus erythematosus,2 cases of AIDS/HIV,2 cases of malignant tumor surgery,5 cases of other diseases;newly diagnosed tuberculous meningitis There were 4 cases and 2 cases of lupus encephalopathy;the clinical symptoms were headache,fever,nausea and vomiting,including 18 cases?100%?with headache,15 cases?83.33%?with fever,and 12 cases?66.67%?with nausea and vomiting.Conventional cerebrospinal fluid test showed that the white blood cell count was10×10⁶-1237×10⁶/L,with a median of 61?28,105?×10⁶/L,and 14 cases were classified as monocytes.Biochemical examination showed that the median protein was 0.73?0.37,1.55?g/L;the median sugar weight was 1.53?1.11,3.50?mmol/L;the average chloride was 112.37±5.50mmol/L;the cerebrospinal fluid stain was found in 14 cases?14/18,77.78?.%),cerebrospinal fluid fungal culture positive in 6 cases?33.33%?,cerebrospinal fluid cryptococcal antigen positive in 11 cases?11/11,100%?,intracranial pressure increased significantly?300mmH₂O in 8 cases;cranial imaging examination There were 2 cases with enlarged ventricles,2 cases with meningeal enhancement,4cases with single or multiple low-density shadows,3 cases with multiple softening lesions,and 1 case with granuloma.Amphotericin B?or its liposomes?was combined with flucytosine in the treatment of 15cases,severe cases of early compatibility with fluconazole in 3 cases,accompanied by dehydration,intracranial pressure reduction treatment,6 cases cured,improved 2 cases10 cases died?55.56%?.ConclusionsCerebrospinal fluid cryptococcal capsular antigen detection is the most sensitive indicator of diagnosis,which is superior to cerebrospinal fluid ink staining and fungal culture.High intracranial pressure is the leading cause of death in patients with cryptococcal meningitis.