新型隱球菌腦膜炎在老年人之研究：台灣北部一醫學中心十五年之經驗

Cryptococcal Meningitis in the Elderly Based on the 15-year Experience of a Medical Center in Northern Taiwan

曾祥洸(Hsiang-Kuang Tseng) ； 劉昌邦(Chang-Pan Liu) ； 卓文隆(Wen-Long Cho) ； 李聰明(Chun-Ming Lee)

《台灣老年醫學暨老年學雜誌》 3卷1期 (2007/08) Pp. 12-24

https://doi.org/10.29461/TGG.200708.0001

摘要

背景：新型隱球菌腦膜炎(cryptocococal meningitis)以老年人爲題材的臨床研究報告非常稀少。台灣由於老年人口的比例已漸升高，未來此病出現於老年人之病例應會增加，值得老年醫學領域之重視。
目的：比較新型隱球菌腦膜炎在65歲以上病人（以下稱老年組病人）及65歲以下病人（以下稱非老年組病人）的異同。
材料及方法：收集台灣北部一醫學中心，1992年1月至2006年12月出院病患中新型隱球菌腦膜炎之病例，做一回溯性病歷系列分析。
結果：收案病人共39例，老年組病人爲11例，故老年人新型隱球菌腦膜炎的比率爲28%。男女比率由2.1降爲0.6。臨床病徵分析：老年組病人步態不穩(73% vs. 21%，p=0.003)、頭暈(91% vs. 39%，p=0.004)、嗜睡(73% vs. 25%，p=0.006)及意識改變(73% vs. 32%，p=0.021)的比率較非老年組病人高。疾病嚴重度分析：老年組病人腦壓≧200mmH2O (33% vs. 80%，p=0.022) 的比率較非老年組病人低，而胸部X光片異常(91% vs. 57%，p=0.044) 的比率較非老年組病人高。兩組病人死亡率差異不顯著(27% vs. 39%，p=0.481)。
結論：在照顧逐年增加的老年人時，應多加留意新型隱球菌腦膜炎發生在老年人的非特異性臨床表現，配合傾病因素、接觸史及疾病嚴重度分析，儘早作治療介入安排，如早期投藥、相關之專業會診，以避免延遲，造成老年人死亡或導致健康功能受損。

關鍵字

老年人 ； 新型隱球菌腦膜炎

並列摘要

Background: Elderly people comprise one of the fastest growing sub-population in Taiwan. Incidence of many infectious diseases, including cryptococcal meningitis, is expected to increase in this particular group. However, clinical reports focusing on elderly patients with cryptococcal meningitis remain rare.
Objectives: The study aims at comparing the clinical characteristics of cryptococcal meningitis in elderly patients (aged 65 years or older) with those in younger patients.
Material and Methods: Patients diagnosed with cryptococcal meningitis at a medical center in northern Taiwan from January 1992 to December 2006 December were enrolled retrospectively for study.
Results: Of the 39 patients enrolled, 11 belonged to the elderly group (28%), and the male/female ratios in the elderly group and the younger group were 2.1 and 0.6, respectively. In terms of clinical manifestations, patients in the elderly group, as compared with those in the younger group, were more common to have unstable gait (73% vs. 21%, p=0.003), dizziness (91% vs. 39%, p=0.004), drowsiness (73% vs. 25%, p=0.006) and consciousness change (73% vs. 32%, p=0.022). In terms of disease severity, the occurrence of intracranial pressure ≧200 mmH2O was significantly less frequent (33% vs. 80%, p=0.022) in the elderly group, while the presence of abnormal chest X ray findings was significantly more common in elderly patients (91% vs. 57%, p=0.044). The mortality rate showed no significant difference in both groups (27% vs. 39%, p=0.481).
Conclusion: When treating up-growing elderly patients with health problems or morbid conditions, physicians should be aware of the characteristics of cryptococcal meningitis, including its non-specific clinical manifestations, predisposing factors, contact history and disease severity, suspicious patients can be referred to specialists as early as possible to avoid possible delay in detection and interrention, which might lead to death or impairment in the elderly.

並列關鍵字

elderly ； cryptococcal meningitis