Clinical Analysis Of 59 Patients With Cryptococcal Meningitis

Objective: To investigate the clinical characteristics of patients with cryptococcal meningitis,in order to improve the diagnosis,treatment and prognosis of this disease.Methods: The clinical data of 59 patients with cryptococcal meningitis admitted to The First Affiliated Hospital of Chongqing Medical University from March 2013 to June 2019 were retrospectively analyzed.The general condition,combined underlying diseases,clinical manifestations,cerebrospinal fluid(CSF)examination,imaging examination,treatment and outcome were analyzed.Results: Of the 59 cases of cryptococcal meningitis,6 cases(10.17%)had a history of pigeon exposure.There were 18 cases(30.51%)with HIV infection,41 cases(69.49%)with underlying diseases,5 cases(8.47%)with long-term use of glucocorticoids,and 2 cases(3.39%)with long-term use of immunosuppressive agents.Main symptoms and signs: There were54 cases(91.53%)with headache,44 cases(74.58%)with nausea and vomiting,39 cases(66.10%)with fever.There were 50 cases(84.75%)with positive meningeal stimulation,19 cases(32.20%)with positivepathological symptoms.The cranial nerves most frequently affected were the optic nerve and the auditory nerve.There were 24 cases(40.68%)of optic nerve damage and 11 cases(18.64%)of auditory nerve damage.Cerebrospinal fluid examination: 45 patients(76.27%)had increased intracranial pressure.The positive rate of ink staining was 81.48%.The positive rate of cryptococcus culture was 45.76%,and the positive rate of cryptococcus capsular polysaccharide antigen detection was 97.56%.All the patients were treated with amphotericin B,fluorocytosine and fluconazole(or voriconazole),as a single drug or a combination of anti-infection therapy.The difference in the rate of improvement was statistically significant(P<0.05).Among them,amphotericin B combined with fluorocytosine had the highest conversion rate.However,there was no significant difference between the three drug combinations and the two drug combinations(P>0.05).Among the 59 patients,8 cases(13.56%)were completely cured,23 cases(38.98%)were improved,27 cases(45.76%)were discharged from the hospital without recovery,and 1 case(1.7%)died.In the anti-infection process,51 patients(86.44%)showed adverse drug reactions,the most common of which was electrolyte disorder(mainly hypokalemia)and liver and kidney function damage,among which 1patient died due to acute kidney injury.Conclusion: Cryptococcal meningitis may be related to decreased immune function.The main clinical manifestation of this disease isperformance of high cranial pressure.The early and rapid diagnosis value of cryptococcus capsular polysaccharide antigen detection is high.Amphotericin B combined with fluorocytosine is probably the most effective treatment option.Adverse drug reactions should be closely monitored during antifungal treatment.Early diagnosis,standardized and individualized treatment should be taken for this disease.