目的:分析肾移植术后新生隐球菌病的临床特点,旨在提高诊治水平. 方法:回顾性分析6例肾移植术后新生隐球菌感染患者的临床特点、实验室检查结果、治疗及转归. 结果:6例患者中5例原发病为慢性肾小球肾炎,1例为原发性高草酸尿症(Ⅰ型)；全部患者均系首次肾移植,发病中位时间为移植术后6年.6例患者HIV均阴性,2例乙肝表面抗原携带者,1例丙型病毒性肝炎；3例合并糖尿病,且血糖控制不佳；3例合并高血压；3例合并皮肤感染；1例有鸽子接触史.所有患者均存在发热和头痛症状,且有不同程度意识障碍,其中3例癫痫；5例脑膜刺激征阳性；2例视力下降,1例听力下降.本组患者均体型消瘦,T淋巴细胞亚群CD4+、CD8+计数偏低,存在不同程度贫血,白蛋白和前白蛋白低下,移植肾功能不全.6例患者均颅内高压(23.5 ～41 cmH2O),脑脊液蛋白含量均高于正常,但葡萄糖降低；5例脑脊液墨汁染色找到新生隐球菌,4例脑脊液培养出新生隐球菌；3例新生隐球菌菌血症,3例皮损活检组织培养新生隐球菌阳性,2例合并肺部酵母菌感染,4例诊断符合全身播散性新生隐球菌病.4例采用氟康唑治疗,1例伊曲康唑,1例氟康唑续伏立康唑；经上述药物治疗后,3例治愈并行维持性血液透析治疗,余3例死亡. 结论:肾移植术后新生隐球菌易播散至皮肤,常因非特异性皮肤改变而延误诊断,因此有必要早期行皮肤组织活检以及特殊染色.早期明确诊断和及时治疗是提高此病救治成功率的关键.%Objective; To retrospectively investigate the clinical features and outcomes of kidney transplant patients with cryptococcosis. Methodology; Six patients, 3 male and 3 female, with cryptococcosis after renal transplantation were involved in this study. The clinical manifestations, laboratory data, skin tissue pathological examination,treatment and prognosis were analyzed. ResultS;The original renal diseases were chronic glomerulonephritis except one who was primary hyperoxaluria type 1. Three patients were complicated diabetes mellitus, and three with hypertension. All of the patients were performed renal transplantation for the first time. Every patient was HIV negative,two HBV positive, and one with HCV coinfection. Only one patient definitely contacted bird droppings, the others were undetermined. There were headache, fever, and different degree of consciousness disorders in every case. 3 of them had seizure,5 meningeal irritation sign positive,2 blurred vision,and one had hearing impaired. Body weight lost in all patients, with count of CD4+, CD8+ T lymphocytes low, varying degrees of anemia, low albumin and prealbumin and renal dysfunction. The intracranial pressure was increased ( 23. 5～41 cmH2O), cerebrospinal fluid (CSF) analysis showed low glucose and high protein level. 5 patients were diagnosed as cryptococcosis in CSF by means of India ink,4 were confirmed cryptococcosis by CSF culture, 3 had cryptococcal fungemia by blood culture, and 3 patients had cutaneous disseminated cryptococcosis comfirmed by skin tissue biopsy. 2 cases had yeasts coinfection, and 4 were diagnosed as systemic disseminated cryptococcosis. According to drug sensitivity test, fluconazole were given to 4 patient, itraconazole was given to the other, the last one was given fluconazole, then voriconazole. Finally, 3 patients survived, however, with maintenance hemodialysis. Conclusion; Cryptococcosis in renal allograft recipients can disseminate to skin, leading to misdiagnoseeasily. It is necessary to make appropriate tissue biopsies and special stain to establish correct diagnosis. Early diagnosis and timely treatment is the key to improve outcomes.
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