隱球菌腦膜炎之臨床觀察

Clinical Observation of Cryptococcal Meningitis

李芳輝(Fuan-Hwei Lee) ； 謝貴雄(Kue-Hsiung Hsieh) ； 李慶雲(Chin-Yun Lee)

《Acta Paediatrica Sinica》 24卷4期 (1983/12) Pp. 290-296

摘要

近年由於副腎皮質素、免疫抑制劑及化學療法製劑的廣泛使用，隱球菌腦膜炎有增加的趨勢。此病可發生於免疫機能異常的病人，也可發生於正常人。自1980年至1982年我們收集了5例隱球菌腦膜炎患者，年齡由5歲至14歲，2男3女。有2例為免疫機能異常者，其中1例為最高IgE症候羣，另1例為系統性狼瘡紅斑症，且長期使用副腎皮質素。剛開始中症狀包括頭痛、嘔吐、發燒及頸部僵硬等。症狀開始到診斷確立由2天至3年4個月不等。腦脊髓液檢查並無特殊變化，因此若臨床上可疑，應做墨汁染色、微菌培養及隱球菌抗原定量。有時甚至需屢作腰椎穿刺方能診斷，如例4於第6次腰椎穿刺才有結果。這5例對amphotericin B 及flucytosine合併療法效果皆良好，治療期間由43天至100天。除短暫低血鉀症、發燒及畏寒外，無其他嚴重副作用。例5於停藥後1星期症狀再發，施以相同療法，反應亦不錯。這些病例追蹤迄今未見明顯後遺症。

並列摘要

The incidence of cryptococcal meningitis seems to have been increasing in the recent years especially after the use of steroids, immunosuppresants and chemotherapeutic agents. Although cryptococcal meningitis occurs mostly in immunocompromised patients, it also can affects normal individuals. During the 3 year period from 1980 to 1982, we observed five cases of cryptococcal meningitis. They were two boys and three girls, aged 5 to 14 years. Two of them were immunocompromised patients. One with hyper-IgE syndrome and the other with systemic lupus erythematosus receicving long-term steroid treatment. The initial symptoms and signs were headache, vomiting, fever and stiff neck. The interval between onset and diagnosis varied from two days to three years and four months. The diagnosis of cryptococcal meningitis in Case 4 was established only at the time of the sixth lumbar puncture when Indian ink preparation revealed cryptococci and cryptococal antigen titer in the Cerebrospinal fluid was found to be high. All five cases responded well to the combined amphotericin B and flucytosine therapeutic regimen. The total course of treatment ranged from 42 to 100 days. No serious side effect was encountered although transient hypokalemia, fever and chillness occurred in three patients. The symptoms and signs recurred in Case 5 about one week after discontinuation of the treatment but they were soon brought under control several days after reinstitution of the combined therapy. No sequela was found during the follow up period.

並列關鍵字

meningitis ； cryptococcal ； amphotericin B ； flucytosine