脑脊液乳胶凝集试验在儿童新型隐球菌性脑膜炎诊断和治疗中的应用

Value of latex agglutination test in the diagnosis and treatment of cryptococcal meningitis in children

摘要:

目的：探讨脑脊液乳胶凝集试验在隐球菌性脑膜炎诊断和治疗中的应用价值。方法：回顾性分析10例新型隐球菌性脑膜炎患儿的临床资料。通过临床表现，结合脑脊液墨汁染色、乳胶凝集试验与真菌培养，确诊新型隐球菌脑膜炎。随访2~4年抗真菌治疗的效果和乳胶凝集试验滴度变化。结果：10例患儿中，首次脑脊液检查乳胶凝聚试验和/或墨汁染色阳性者8例（乳胶凝集试验滴度1∶64~1∶1024）；另2例中1例在第4次检查时始出现乳胶凝集试验阳性（滴度1∶256），1例在第11次检查时墨汁染色阳性而确诊。经正规抗真菌治疗后，6例痊愈，2例死亡，2例失访。治疗后6个月、1年、2年和4年脑脊液乳胶凝集试验仍阳性（滴度1∶2~1∶16）者分别有6例、3例、2例和1例。结论：脑脊液乳胶凝集试验对于新型隐球菌性脑膜炎的快速诊断具有重要价值，但不宜作为停止抗真菌治疗的依据。

Abstract:

OBJECTIVE: To evaluate the value of cryptococcal latex agglutination test in the diagnosis and treatment of cryptococcal meningitis in children. METHODS: The clinical data of 10 children with cryptococcal meningitis were retrospectively studied. Cryptococcal meningitis was confirmed based on clinical manifestations, India ink stain, cryptococcal latex agglutination test or cryptococcal culture. The outcome of antifungal treatment and the changes of latex agglutination test titer were followed up for 2 to 4 years. RESULTS: Latex agglutination test and/or India ink stain were positive (titer 1 : 64-1 : 1024) in 8 patients in the first examination of cerebrospinal fluid. In the other 2 patients, latex agglutination test was positive (titer 1 : 256) in the fourth examination of cerebrospinal fluid in one, and India ink stain was positive in the eleventh examination in the other. After antifungal treatment, six patients were cured, two patients died, and two patients were lost to follow-up. The positive cryptococcal latex agglutination test (titer 1 : 2-1 : 16) was seen respectively in six, three, two and one cured patients 6 months, 1 year, 2 years and 4 years later. CONCLUSIONS: The cryptococcal latex agglutination test of cerebrospinal fluid is valuable for the quick and early diagnosis of cryptococcal meningitis; however, the decision of withdrawal of antifungal treatment should not rely on the results of the test.