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首页> 外文期刊>感染症学雑誌 >A clinical study of cryptococcal meningitis--sequential changes of cryptococcal antigen titers
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A clinical study of cryptococcal meningitis--sequential changes of cryptococcal antigen titers

机译：隐球菌性脑膜炎的临床研究-隐球菌抗原滴度的顺序变化

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We reviewed the clinical manifestations, sequential changes in cryptococcal antigen titers in serum and cerebrospinal fluid (CSF), and the antifungal drug susceptibility of Cryptococcus neoformans in three patients with cryptococcal meningitis between 1996 and 2000. Cryptococcal antigen titers were measured using the latex agglutination method with Pastrex Cryptococcus (Fuji Mebio, Tokyo) and Serodirect Cryptococcus (Eiken Chemical, Tokyo). The underlying systemic diseases in the three patients were liver cirrhosis, non-Hodgkin's lymphoma associated with miliary tuberculosis, and malignant thymoma associated with systemic lupus erythymatosus. The CSF samples showed positive indian ink staining in two of the three patients and C. neoformans was cultured from all three. The cryptococcal antigen titers in serum were higher than those in the CSF. The serum and CSF cryptococcal antigen titers measured by Serodirect Cryptococcus were higher than those measured by Pastrex Cryptococcus. The maximum titers of antigen in serum and CSF measured by Serodirect Cryptococcus were greater than 1,024 in all three patients. The treatment regimens used for the three patients were amphotericin-B (AMPH-B) and flucytosine (5-FC), fluconazole (FLCZ) and intrathecal AMPH-B, FLCZ and 5-FC, and intrathecal AMPH-B, respectively. The antigen titers in serum and CSF decreased after treatment in all three patients. The antigen titers decreased slowly over 7.3 months in the most seriously ill patient who had non-Hodgkin's lymphoma associated with miliary tuberculosis. The time between the beginning of treatment and CSF cryptococal antigen titers falling to less than 8 was 1.7 to 7.3 months in the three patients, but the serum titers did not decrease to less than 8 during this period. The minimum inhibitory concentration was 0.06-0.25 microgram/ml for AMPH-B, 4-8 micrograms/ml for 5-FC, 2-8 micrograms/ml for FLCZ, 0.125-0.5 microgram/ml for miconazole and 0.03-0.125 microgram/ml for itraconazole. The measurement of sequential changes incryptococcal antigen titers in serum and CSF was useful for evaluating the response to treatment.
机译：我们回顾了1996年至2000年之间3例隐球菌性脑膜炎患者的临床表现，血清和脑脊液（CSF）中隐球菌抗原滴度的连续变化以及新隐球菌的抗真菌药敏性。使用乳胶凝集法测量了隐球菌抗原滴度与Pastrex Cryptococcus（东京的富士美宝）和Serodirect Cryptococcus（东京的Eiken Chemical）合作。三名患者的潜在全身性疾病为肝硬化，伴有粟粒性结核的非霍奇金淋巴瘤和伴有系统性红斑狼疮的恶性胸腺瘤。 CSF样品在三名患者中的两名中显示出印度墨水染色阳性，并且从这三名患者中培养了新孢子虫。血清中的隐球菌抗原滴度高于CSF。 Serodirect隐球菌测定的血清和CSF隐球菌抗原滴度高于Pastrex隐球菌测定的血清和CSF隐球菌抗原滴度。在所有三名患者中，通过血清直接隐球菌测定的血清和脑脊液中抗原的最大效价均大于1,024。三名患者使用的治疗方案分别是两性霉素B（AMPH-B）和氟胞嘧啶（5-FC），氟康唑（FLCZ）和鞘内AMPH-B，FLCZ和5-FC和鞘内AMPH-B。所有三名患者在治疗后血清和CSF的抗原滴度均降低。在患有严重粟粒性结核的非霍奇金淋巴瘤的病情最严重的患者中，抗原滴度在7.3个月内缓慢下降。从开始治疗到三名患者的CSF隐球菌抗原滴度降至小于8的时间为1.7至7.3个月，但在此期间血清滴度并未降低至小于8。最小抑菌浓度为：AMPH-B为0.06-0.25微克/毫升，5-FC为4-8微克/毫升，FLCZ为2-8微克/毫升，咪康唑为0.125-0.5微克/毫升和0.03-0.125微克/毫升毫升为伊曲康唑。血清和脑脊液中隐球菌抗原滴度的顺序变化测量可用于评估对治疗的反应。

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