Cryptococcosis after renal transplantation: report of ten cases.
Cryptococcosis after renal transplantation: report of ten cases.
复制标题
肾移植术后隐球菌病十例报告。
作者：
G. P. Schröter;Donald R. Temple;B. Husberg;R. Weil;T. Starzl
在13年的650多例肾移植经验中，发现了10例隐球菌病。8名患者患有脑膜炎，1名患者患有脑肉芽肿，1名患者的感染似乎仅限于肺部。中枢神经系统感染常伪装成脑肿瘤，最初未被怀疑。最有用的诊断试验是脑脊液检查，包括印度墨水制备。用阿替霉素B和5-氟胞嘧啶的各种治疗方案对抑制感染有效。在5名仍然存活的患者中，低剂量的不影响肾功能的阿替霉素B与5-氟胞嘧啶联合治疗至少3个月与疾病缓解相关，其中3名患者没有复发超过1年。治疗开始后3周至4年的5例死亡不是由于隐球菌病; 4例死亡原因已知的患者中有3例死于血管疾病和败血症。中枢神经系统隐球菌病，除了罕见的脑肉芽肿外，几乎不伴有炎症。如果能预防颅内压升高或脑水肿导致的早期死亡，则延长阿替霉素B和5-氟胞嘧啶的治疗时间有望控制感染，即使是免疫抑制患者。
Ten cases of cryptococcosis have been identified in a 13 year experience with more than 650 renal transplants. Eight patients had meningitis, one patient had a cerebral granuloma, and in one patient the infection appeared to be limited to the lungs. The central nervous system infection often masqueraded as brain tumor and was not suspected initially. The most useful diagnostic test was cerebrospinal fluid examination including India ink preparation. Various ther apeutic regimens with amphotericin B and 5-fluorocytosine were effective in suppressing the infection. A combination of low doses of amphotericin B, not affecting kidney function, with 5-fluorocytosine for at least 3 months was associated with remission of disease in five patients who still are alive, including three patients without recurrence for longer than one year. Five deaths 3 weeks to 4 years after the beginning of treatment were not due to cryptococcosis; death resulted from vascular disease and septiciemia in three of the four patients with known causes of death. Central nervous system cryptococcosis, with the exception of the rare cerebral granuloma, is associated with little inflammation. If early death from increased intracranial pressure or cerebral edema is prevented, prolonged therapy with amphotericin B and 5-fluorocytosine may be expected to control the infection, even in immunosuppressed patients.