免疫功能正常的隐球菌性脑膜炎病例报告

Y. B. Bello, Hanna Guapyassu Machado, J. O. Silveira, F. Schettini, Gilberto Canedo Martins Junior, Sergio Dortas Junior, C. Reis, M. Orsini, P. Salem, D. Machado, V. Bastos, Amanda Júlia Ramos Bezerra, F. Catharino, A. Catharino
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引用次数: 4

摘要

隐球菌性脑膜炎(CM)是免疫功能正常患者中一种罕见的感染。一种由囊化酵母样真菌新隐球菌引起的中枢神经系统感染。一名59岁男子到新伊瓜苏总医院神经科就诊,主诉最近感到“神志不清”,并无明显原因感到膈肌痉挛。此外,在神经学检查中,患者有轻微的困惑,在精神状态小检查中,他的得分低于20分,感觉“缓慢”,没有颅神经功能障碍,“步态和动作僵硬,右侧更明显,左侧更强烈地注意到双侧锥体征象”。他的MRI、腰椎穿刺、真菌分离和Nakin Ink对隐球菌病呈阳性,而HIV测试I和II均为阴性。治疗开始时给予两性霉素B 50 mg IV,每天1次,加地塞米松。根据我们的临床病例,我们决定在MedLine和Pubmed研究中对免疫能力者和隐球菌性脑膜炎做一个简短的回顾,使用术语“隐球菌性脑膜炎”,“免疫能力者隐球菌性脑膜炎”和“隐球菌性脑膜炎”。结论:CM在免疫功能者中并不常见,但它是引起非急性脑膜炎的重要原因,应列入可预防失明的原因范围。在这个意义上,本文旨在提醒临床医生和专家,认识免疫功能正常的隐蔽性局部脑膜炎的临床表现和诊断,尽量避免误诊和以下并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CRYPTOCOCCAL MENINGITIS IN IMMUNOCOMPETENT PATIENT-CASE REPORT
Cryptococcal Meningitis (CM) is a rare infection in immunocompetent patients. A kind of central nervous system infection caused by encapsulated yeast-like fungus Cryptococcus neoformans . A 59-year-old man presented to the Neurology Department of Nova Iguacu General Hospital, complaining has felt “muddled” recently and feeling diaphragmatic spasm without an y apparent cause. In addition, at neurological examination, the patient was slightly confused and during the mini-mental state examination he scored less than 20 points, feeling “slowed down”, no cranial n erve dysfunction, “rigidity of gait as well as of h and movements, more pronounced on the right one, pyramidal signs bilaterally were more intensely noted on the left”. His MRI, lumbar puncture, fungal isolation a nd Nakin Ink were positive to Cryptococcosis while, in turn, HIV tests I and II were both negative. The tr eatment was started with Amphotericin B 50 mg IV, once a day, plus Dexamethashone. From our clinical case, we decided to do a brief review about Cryptococcoa l Meningitis in immunocompetents and Cryptococcoma, researching at MedLine and Pubmed, using terms “Cryptococcal meningitis”, “Cryptococcal meningitis in immunocompetent” and “Cryptococcomas”. It is concluded that CM in immunocompetents is uncommon, but an important cause of non-acute meningitis, that should be included in the range of causes of p reventable blindness. In this sense, this article p urposes advertise clinicians and specialists, to recognize the clinical manifestation and diagnosis of cryptoc occal meningitis in immunocompetents, trying to avoid a l ater diagnosis and the following complications.
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