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隐球菌病

最后审阅: 4 Oct 2024
最后更新: 11 May 2023

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
完整详情

其他诊断因素

  • 胸痛
  • 颅神经病变
  • 眼部表现
完整详情

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
完整详情

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)
完整详情

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
完整详情

新兴检查

  • 隐球菌聚合酶链反应(PCR)检测

治疗流程

持续性治疗

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.

  • 隐球菌病 images
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    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
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