ZHU Qian,ZHANG Yan,NI Xiaojie, et al. Single-center clinical study of cryptococcal neoformans meningitis after renal transplantation: a retrospective analysis[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2021, 51(8): 670-673.
Abstract：Objective: To analyze the clinical characteristics and difficulties in the diagnosis and treatment of cryptococcal neoformans meningitis in renal transplant patients. Methods: Clinical data of patients with Cryptococcal meningitis after kidney transplantation in the First Affiliated Hospital of Wenzhou Medical University from June 2014 to September 2019 were collected and analyzed retrospectively. Results: Of 320 cases after kidney transplantation, 9 were infected with cryptococcal meningitis,with first symptoms including fever (n=7), headache (n=4), cough (n=2), blurred vision (n=2) and consciousness disorder (n=1). The average time of infection after kidney transplantation was (1.6-14) years and the time from onset to confirmed diagnosis was 8-42 D. CSF culture was positive in 8 cases (88.9%). On the basis of tacrolimus+mortymecofenate+meponyolone (TAC+MMF+PRED) immunosuppressive regimen, antifungal therapy such as 5 fluorocytosine (5FC) 5G/D+amphotericin B liposome (L-AmB) 3 mg·kg-1D-1 were given for (5-11.5) months. After 6-month follow-up, 5 cases had complete remission (n=5), 5 partial remission (n=5) and 1 case died (n=1). Conclusion: Cryptococcus infection after kidney transplantation is characterized by a variety of clinical manifestations, long incubation period and long course of disease. Therefore, early detection, early diagnosis, multi-department cooperation and adequate standardized treatment are the key to the successful treatment of cryptococcal meningitis.
