Experiences of diagnosis and treatment of 102 cases with cryptococcal meningitis and/or cryptococcal meningoencephalitis

• Main Authors: Yan-yu CHANG, Xue-qiang HU
• Format: Article
• Language: English
• Published: Tianjin Huanhu Hospital 2014-08-01
• Series: Chinese Journal of Contemporary Neurology and Neurosurgery
• Subjects: Cryptococcus neoformans; Meningitis; Encephalitis; Antifungal agents; Review
• Online Access: http://www.cjcnn.org/index.php/cjcnn/article/view/1015

<p><strong>Objective</strong> To summarize the clinical manifestations and diagnostic and therapeutic strategies of 102 cases with cryptococcal meningitis and/or cryptococcal meningoencephalitis, and to improve the diagnosis and treatment of cryptococcal meningitis.  <strong>Methods</strong> The clinical manifestations, diagnostic and therapeutic strategies and outcomes of 102 cases with cryptococcal meningitis and/or cryptococcal meningoencephalitis were analyzed retrospectively.  <strong>Results</strong> The incidence of cryptococcal meningitis and/or cryptococcal meningoencephalitis raised in recent years. The signs of high intracranial pressure, meningeal irritation and cranial nerves impairment are the main clinical manifestations of cryptococcal meningitis, while seizures, hemiplegia, mental disorders and ataxia can occur when the brain parenchyma is involved. Cryptococcal meningitis and/or cryptococcal meningoencephalitis is easy to be misdiagnosed, especially misdiagnosed as tuberculous meningitis. Repeated cerebrospinal fluid (CSF) smear and latex agglutination test can ensure the diagnostic accuracy. Amphotericin B, flucytosine and fluconazole combined therapy is the most widely used therapeutic strategy at present, which has been proved to be effective; surgery operations (such as ventriculo-peritoneal shunt) are effective in the treatment of cryptococcal meningitis complicating hydrocephalus.  <strong>Conclusions</strong> The diagnosis of cryptococcal meningitis and/or cryptococcal meningoencephalitis is difficult for its lack of specific clinical manifestations. Suspected patients should receive repeated CSF smear, latex agglutination test as well as imageological examination to make an accurate diagnosis. Combined, long-term antifungal therapy should be used immediately in confirmed cases, and surgery operations can be used in necessity to improve outcomes.</p><p> </p><p>doi: 10.3969/j.issn.1672-6731.2014.08.008</p>