目前甲型流感病毒与隐球菌共感染的研究较少，本文报道1例甲型流感病毒感染后继发格特隐球菌（Cryptococcus gattii）感染致脑膜脑炎的患者，旨在提高临床对该病的认识。患者为58岁男性，确诊甲流后反复头晕头痛1月余，后出现发热、发作性双下肢无力、间断性意识障碍，行胸部CT、头颅MRI和腰椎穿刺脑脊液检查，脑脊液病原学培养结果提示检出格特隐球菌，确诊为隐球菌脑膜脑炎。予两性霉素B脂质体+氟康唑诱导治疗，同时辅以降颅压、抗细菌感染治疗，4周后患者意识好转，脑脊液蛋白恢复正常，但颅内压仍大于400mmH2O，后患者转院行进一步治疗。相较于新型隐球菌，格特隐球菌更常见于免疫功能正常的人群。本例患者免疫功能正常，但甲型流感病毒性肺炎可能通过改变其肺部微环境增加了格特隐球菌感染的风险，且甲型流感病毒可通过多重机制加剧格特隐球菌感染的严重性，因此临床需重视流感患者继发隐球菌感染的风险，积极探索联合抗病毒、抗真菌、免疫调节和改善预后的综合治疗策略。
Abstract
At present, there are few studies on co-infection with Influenza A virus and Cryptococcus. This paper reports a case of a patient who developed cryptococcal (Cryptococcus gattii) infection secondary to Influenza A and subsequently suffered from meningoencephalitis, in order to enhance clinical understanding of this disease. The patient, a 58-year-old male, was diagnosed with Influenza A and experienced recurrent dizziness and headache for over a month. Later, he developed fever, episodic bilateral lower limb weakness, and intermittent consciousness disorders. Chest CT, head MRI, and cerebrospinal fluid examination after lumbar puncture were performed and Cryptococcus gattii was detected through the pathogen culture of cerebrospinal fluid. Thus the patient was diagnosed with cryptococcal meningoencephalitis. The patient was treated with liposomal amphotericin B and fluconazole for induction therapy, along with treatment reducing intracranial pressure and resisting bacterial infection. Four weeks later, the patient's consciousness improved, and the protein level of cerebrospinal fluid returned to normal. However, the intracranial pressure remained higher than 400 mmH2O. The patient was then transferred to another hospital for further treatment. Compared to Cryptococcus neoformans, Cryptococcus gattii is more commonly found in individuals with normal immune function. In this case, the patient's immune function was normal, but the influenza virus-induced pneumonia might have increased the risk of cryptococcal infection by altering the microenvironment of the lungs. Besides, Influenza A Virus can exacerbate the severity of Cryptococcus gattii infection through multiple mechanisms. Clinicians need to pay attention to the risk of secondary cryptococcal infection in influenza patients and explore comprehensive treatment strategies that combine antiviral, antifungal, immunomodulatory and prognosis-improving measures.
关键词
格特隐球菌 /
甲型流感病毒 /
脑膜脑炎
Key words
Cryptococcus gattii /
Influenza A Virus /
meningoencephalitis
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