小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 全身性症状
- 呼吸困难
- 排痰性咳嗽
- 叩诊浊音
- 呼吸音减弱
- 爆裂音
- 头痛
- 意识状态改变
- 脑膜刺激征
- 视神经乳头水肿
- 皮肤病变
- 昏迷
其他诊断因素
- 胸痛
- 颅神经病变
- 眼部表现
危险因素
- HIV 感染
- 免疫抑制
- 合并症和吸烟
- 隐球菌属暴露
- 男性
- 妊娠期和产后期
诊断性检查
首要检查
- 血清隐球菌多糖抗原（CrAg）
- 脑脊液（CSF）隐球菌多糖抗原（CrAg）
- 胸腔积液隐球菌多糖抗原（CrAg）
- 培养物
- HIV 抗体
- 胸部 X 线检查
- 腰椎穿刺：
- 脑脊液（CSF）镜检
- 脑脊液（CSF）白细胞计数（个细胞/mm³）
需考虑的检查
- 胸部 CT
- 颅脑 MRI 扫描
- 头颅 CT
- 支气管镜检查
- 活检
新兴检查
- 隐球菌聚合酶链反应（PCR）检测
治疗流程
HIV 阴性
HIV阳性
撰稿人
作者
Radha Rajasingham, MD
Assistant Professor of Medicine
Infectious Diseases and International Medicine
Department of Medicine
University of Minnesota
Minneapolis
MN
利益声明
RR declares that she has no competing interests.
鸣谢
Dr Radha Rajasingham would like to gratefully acknowledge Dr David Boulware, Dr Renata L. Riha, and Dr Athanasia D. Pataka, previous contributors to this topic.
利益声明
DRB has received research support from Gilead. RLR and ADP declare that they have no competing interests.
同行评议者
William Powderly, MD
Professor of Medicine
Washington University in St Louis
St Louis
MO
利益声明
WP declares that he is a member of advisory boards for Gilead and Merck and his institution has received research grants from Merck; none of these are related to antifungal therapy. WP is a member of the Board of Directors (Past President) of the Infectious Diseases Society of America.
Ricardo Negroni, MD
Consultant
Muñiz Hospital
Honorary Professor
University of Buenos Aires
Buenos Aires
Argentina
利益声明
RN declares that he has no competing interests.
Aimee Zaas, MD, MHS
Assistant Professor of Medicine
Division of Infectious Diseases and International Health
Duke University Medical Center
Durham
NC
利益声明
AZ has received research funding from Enzon Pharmaceuticals and has been on the speaker's bureau for Astellas Pharma and Pfizer Inc.
Joseph Jarvis, BSc, MBBS, MRCP
Professor
Department of Clinical Research
Faculty of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
London
UK
利益声明
JJ declares that he has no competing interests.
鉴别诊断
- 结核病
- 原发性或转移性中枢神经系统（CNS）肿瘤
- 系统性感染的皮肤表现
更多 鉴别诊断指南
- 成人、青少年和儿童 HIV 携带者隐球菌病诊断、预防和管理指南
- 成人和青少年 HIV 感染者机会性感染的预防和治疗指南：隐球菌病
更多 指南
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