Clincial Observation On The Efficacy And Safety Of Combined Intrathecal Injection In The Treatment Of Cryptococcal Meningitis

Objective:Cryptpcoccal meningitis（CM）is an opportunistic fungal infection caused by Cryptococcus neoformans and Cryptoccus gattii.Cryptococcus neofomans is a kind of encapsulated basidiomycete yeast,which is the main pathogen of human fungal meningitis.Although in recent years,with significant advances in diagnostic methods and treatments for CM,the overall mortality rate of patients has decreased significantly,but the incidence is still increasing in the world,especially in China.Although CM often occurs in immunodeficient patients such as those with positivw HIV,the prevalence in HIV-negative people is increasing year by year.To observe the efficacy and safety of intravenous infusion of antifungal drugs in combination with intrathecal injection Am B or L-Am B in the treatment of non-HIV related cryptococcal meningitis at induction period.Methods:A retrospective analysis was performed on 41 patients with non-HIV related cryptococcal meningitis in our hospital from April 2014 to May 2019.The the clinical manifestations,intracranial pressure,the number of white blood cells,cryptococcus in CSF,clinical efficacy,adverse reactions,conversion rate and follow-up information were recorded.Statistical software was used to analyze intracranial pressure,white blood cell count and cryptococcus in CSF at 1,2 and 3 weeks before and after intrathecal injection.Results:The main clinical manifestations were headache,fever,nausea and vomiting,consciousness disorders,optic nerve damage,vestibular nerve damage.There were 23 patients presented with elevated intracranial pressure（≥250mm H₂O）.The intracranial pressure after 1 week,2 weeks,3 week and4 week was lower than that of before intrathecal injection,and the differences were statistically significant（P<0.05）.However,there was no significant difference between the groups after intrathecal injection（P>0.05）.The WBC count of CSF after intrathecal injection 2 and 3 weeks was lower than thar of before intrathecal injection,and the difference was statistically significant（P<0.05）.There was no significant difference between the other groups about the number of CSF white blood cells（P>0.05）.After intrathecal injection,1patient complained about lumbar pain,1 patient about weakness of lower limbs and 1 patient abour urinary retention,which were completely relieved within 48 hours.Among the 41 patients,4 were cured,32vwere improved and5 were invalid..During a median follow-up period of 17.6 months,19 cases of cryptococcus CSF turned negative and 22 cases were positive.Conclusions:Drainage CSF combined with intrathecal injection could reduce intracranial pressure and the number of white blood cells in CSF,thus reducing mortality.Intrathecal injection is relatively safe.The strict sterilization and intrathecal injection slowly can reduce or even avoid the occurrence of adverse reactions.