| Object:(1)To analyze and summarize the clinical data of 71 patients with non-HIVrelated cryptococcal meningitis in Jiangxi Chest Hospital between June 2016 and June 2018.(2).To observe in vitro antifugal susceptibility of 71 clinical Cryptococcal strains isolated from Jiangxi Chest Hospital.(3)To investigate the mating type of 71 clinical Cryptococcal strains isolated from Jiangxi Chest Hospital.Methods:(1)The clinical data of 71 non-HIV cryptococcal meningitis patients in Jiangxi Chest Hospital between June 2016 and June 2018 were retrospectively analyzed.(2)Determining 71 clinical Cryptococcal strains in vitro antifugal susceptibility to nine antifungal drugs,including amphotericin B,5-flucytosine,fluconazole,itraconazole,voriconazole,anidulafungin,micafungin,caspofungin,posaconazole.(3)Analysis of mating type for 71 clinical Cryptococcal strains by PCR using two specific primer pairs.Results:1.71 cases were included in this study,the ratio of male to female was close to 2:1,and middle-age of onset was(51.38±18.03)years old.The main occupation was farmers(59.15%).42 patients had a normal immune system(59.15%)and 29 patients had one or more underlying diseases(40.85%).Most patients with subacute onset,clinical symptoms mainly including headache(90.14%),fever(74.64%),nausea and vomiting(46.47%).Cerebrospinal fluid examination: 46 patients(64.79%)with increased intracranial pressure,70 patients,(98.59%)cerebrospinal fluid cells increased,56(78.88%)patients had elevated cerebrospinal fluid protein levels,49(69.02%)patients,cerebrospinal fluid chloride and 51(71.83%)patients cerebrospinal fluid sugar content decreased.A total of 63 patients underwent CT and/or MRI,mainly with abnormal brain signal(30.16%)and meningeal enhancement(25.40%).The average time from onset to diagnosis was(39.17±25.95)days in 71 patients.The main antifungal therapy was amphotericin B / amphotericin B liposome combined with 5-fluorocytosine(88.73%).In 71 patients,18 patients were discharged automatically due to personal and economic reasons,two died,51 patients had a good prognosis.(2)In vitro drug sensitivity: The minimum inhibitory concentration ranges of 71 strains of Cryptococcus neoformans to fluconazole,itraconazole,voriconazole,posaconazole,5-fluorocytosine,amphotericin B,anifenin,caspofungin,micafungin are 0.5~4 ug / ml,0.015~0.12 ug / ml,0.008~0.06 ug / ml,0.008~0.12 ug / ml,0.5~64 ug / ml,0.125~0.5 ug / ml,> 8 ug / ml,> 8 ug / ml,4~>8 ug / ml,respectively.71 strains were 100% sensitive to zolium and amphotericin B,and 95.78% to 5-fluorocytosine,all isolates not sensitive to echinocandins.(3)All isolates studied were mating type ?.Conclusion:1.Most patients with non-HIV-associated Cryptococcal meningitis in Jiangxi Province were immunocompetent.Patients with cryptococcal meningitis often have insidious onset,and the clinical manifestations are mostly non-specific,The rate of missed diagnosis and misdiagnosis were high.Pathogen diagnosis is the gold standard.Treatment is mainly based on staged treatment,and the induction period of amphotericin combined with 5-fluorocytosine can improve the therapeutic effect.Effective management of intracranial pressure and complications can improve cure rate.2.The clinical strains of Cryptococcus neoformans are basically sensitive to amphotericin B,fluorocytosine,fluconazole,itraconazole,posaconazole and voriconazole,and not sensitive to anifenin,caspofungin and micafungin.3.The majority of the clinical strains of Cryptococcus neoformans were mating type ?. |
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