Management of Cryptococcus gattii meningoencephalitis
Management of Cryptococcus gattii meningoencephalitis
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DOI：
10.1016/s1473-3099(14)70945-4
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发表时间：
2015-03-01
影响因子：
56.3
通讯作者：
Marr, Kieren A.
中科院分区：
文献类型：
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作者：
Franco-Paredes, Carlos;Womack, Tanea;Marr, Kieren A.
隐球菌病是由新生隐球菌和格特隐球菌引起的真菌性疾病。通过吸入和随后的肺部感染，它可能传播到中枢神经系统，引起脑膜炎或脑膜脑炎。大多数病例发生在免疫抑制的宿主中，包括HIV/AIDS患者、接受免疫抑制药物的患者和实体器官移植受者。然而，隐球菌病也发生在免疫系统明显健康的个体中。越来越多的病例是由格特隐球菌引起的，感染发生在免疫抑制和免疫活性个体中。在大多数有记录的病例中，治疗CNS的格特隐球菌感染需要积极治疗颅内压升高，沿着标准抗真菌治疗。通常需要通过经皮腰椎引流或脑室造口术进行早期脑脊液排空。此外，有时需要使用高剂量地塞米松的药理学免疫抑制来改善持续增加的炎症反应并降低颅内压。在这一轮，我们提出的情况下，其他健康的青少年女性患者，谁，尽管积极的管理，屈服于C gattii脑膜脑炎。我们还提出了现有的文献回顾，并讨论了最佳的临床管理脑膜脑炎引起的C gattii。
Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the CNS and cause meningitis or meningoencephalitis. Most cases occur in immunosuppressed hosts, including patients with HIV/AIDS, patients receiving immunosuppressing drugs, and solid organ transplant recipients. However, cryptococcosis also occurs in individuals with apparently healthy immune systems. A growing number of cases are caused by C gattii, with infections occurring in both immunosuppressed and immunocompetent individuals. In the majority of documented cases, treatment of C gattii infection of the CNS requires aggressive management of raised intracranial pressure along with standard antifungal therapy. Early cerebrospinal fluid evacuation is often needed through placement of a percutaneous lumbar drain or ventriculostomy. Furthermore, pharmacological immunosuppression with a high dose of dexamethasone is sometimes needed to ameliorate a persistently increased inflammatory response and to reduce intracranial pressure. In this Grand Round, we present the case of an otherwise healthy adolescent female patient, who, despite aggressive management, succumbed to C gattii meningoencephalitis. We also present a review of the existing literature and discuss optimum clinical management of meningoencephalitis caused by C gattii.