艾滋病合并新型隐球菌脑膜炎文献回顾ppt课件

1 获得性免疫缺陷综合征 50:291322 14 Chin J Mycol ,April 2010,Vol 5,No 2 15 Cryptococcus /隐球菌 16 17 Incidence 在免疫抑制患者中，隐球菌感染的发病率约为 5%10% ，在 AIDS患者中，隐球菌的感染率可以高达 30%，而在 免疫功能正常的人群中，隐球菌的感染率约为十万分之 一左右 It is estimated that the global burden of HIV-associated cryptococcosis approximates 1 million cases annually worldwide Clinical Infectious Diseases 2010; 50:291322 Chin J Mycol ,April 2010,Vol 5,No 2 18 Mortality Despite access to advanced medical care and the availability of HAART, the 3-month mortality rate during management of acute cryptococcal meningoencephalitis approximates 20% Furthermore, without specific antifungal treatment for cryptococcal meningoencephalitis in certain HIV- infected populations,mortality rates of 100% have been reported within 2 weeks after clinical presentation to health care facilities Clinical Infectious Diseases 2010; 50:291322 19 临床表现 Chin J Mycol ,April 2010,Vol 5,No 2 20 CSF interpretation for the management of patients with suspected encephalitis Journal of Infection (2012) 64, 347e373 21 艾滋病合并新型隐球菌脑膜脑炎的影像学表 现 血管周围间隙扩大 胶状假囊（治疗 3个月后） Radiol Practice， sep 2009 ， Vol 24， N 0 .9 22 V-R 间隙（血管周围间隙）扩大 血管周围间隙是与软脑膜 下隙接续的 ,是软脑膜随着 穿通动脉和流出静脉进出 脑实质的延续而成 扩大的 V-R 间隙意味着大 量的隐球菌酵母细胞聚集 于血管周围间隙或者部分 阻滞了脑脊液的流出 23 Three risk groups of cryptococcal meningoencephalitis 24Clinical Infectious Diseases 2010; 50:291322 25 Chin J Mycol ,April 2010,Vol 5,No 2 26 Cryptococcosis in a resource- limited health care environment With CNS and/or disseminated disease where polyene is not available, induction therapy is fluconazole (800 mg per day orally; 1200 mg per day is favored) for at least 10 weeks or until CSF culture results are negative, followed by maintenance therapy with fluconazole (200 400 mg per day orally) Where AmBd is not available or affordable, where facilities for admission and IV therapy do not exist, or where renal and potassium monitoring are not sufficiently rapid or reliable to allow safe use of AmBd, fluconazole is often the only treatment option. 27 Elevated CSF Pressure If the CSF pressure is 25 cm of CSF and there are symptoms of increased intracranial pressure during induction therapy, relieve by CSF drainage (by lumbar puncture, reduce the opening pressure by 50% if it is extremely high or to a normal pressure of 25 cm of CSF and symptoms, repeat lumbar puncture daily until the CSF pressure and symptoms have been stabilized for 12 days and consider temporary percutaneous lumbar drains or ventriculostomy for persons who require repeated daily lumbar punctures Permanent VP shunts should be placed only if the patient is receiving or has received appropriate antifungal therapy and if more conservative measures to control increased intracranial pressure have failed. If the patient is receiving an appropriate antifungal regimen, VP shunts can be placed during active infection and without c