CAJ | 학술논문

目的：探讨外周血嗜酸粒细胞（EC）与免疫功能正常宿主隐球菌肺炎、菌血症的相关性及其治疗方法，提高对本病的认识。方法报道1例经病理及血培养确诊的免疫功能正常宿主隐球菌肺炎、菌血症伴嗜酸粒细胞增多病例并进行相关文献复习。以“隐球菌”和“菌血症”、“隐球菌”和“嗜酸性粒细胞”为关键词通过CHKD期刊全文数据库及万方数据库进行检索；以“Cryptococcus”和“eosinophilia”、“Cryptococcus”和“fungemia”为关键词通过PubMed、Elsevier、Springer、Wiley、OVID、EBSCO数据库进行检索，检索时间截止2013年12月31日。结果患者男，33岁，因“发热、咳嗽、气喘1周”于2013年9月15日入院。外周血EC比例为0.31，EC计数为6.12×109/L，拟诊“肺炎、支气管哮喘”，经静脉滴注广谱抗菌药及口服糖皮质激素治疗无效。后经支气管镜穿刺纵隔淋巴结活检血培养确诊为新生隐球菌血症、隐球菌肺炎。给予氟康唑联合氟胞嘧啶治疗2周无效，改用两性霉素B联合氟胞嘧啶治疗，病情缓解，持续治疗2个月改用氟康唑联合氟胞嘧啶治疗。再次持续治疗2个月，病情反复，改用伏立康唑治疗，病情好转，此后维持治疗1年，并随访至今未再次复发。数据库上共检索到国内外相关文献93篇，其中共6篇报道免疫功能正常宿主新型隐球菌血症和（或）播散性隐球菌病6例。本例与此6例均有发热，除1例未描述外周血EC外，其余均有不同程度EC升高，经治疗后1例死亡，其余均好转。结论外周血EC增多可能是免疫功能正常宿主新型隐球菌病儿童患者或全身播散患者的早期或急性期特点，且可作为隐球菌病好转与反复的一个提示。隐球菌血症首先按标准方案治疗，而伏立康唑则可作为难治性隐球菌病的备选方案之一。
목적：탐토외주혈기산립세포（EC）여면역공능정상숙주은구균폐염、균혈증적상관성급기치료방법，제고대본병적인식。방법보도1례경병리급혈배양학진적면역공능정상숙주은구균폐염、균혈증반기산립세포증다병례병진행상관문헌복습。이“은구균”화“균혈증”、“은구균”화“기산성립세포”위관건사통과CHKD기간전문수거고급만방수거고진행검색；이“Cryptococcus”화“eosinophilia”、“Cryptococcus”화“fungemia”위관건사통과PubMed、Elsevier、Springer、Wiley、OVID、EBSCO수거고진행검색，검색시간절지2013년12월31일。결과환자남，33세，인“발열、해수、기천1주”우2013년9월15일입원。외주혈EC비례위0.31，EC계수위6.12×109/L，의진“폐염、지기관효천”，경정맥적주엄보항균약급구복당피질격소치료무효。후경지기관경천자종격림파결활검혈배양학진위신생은구균혈증、은구균폐염。급여불강서연합불포밀정치료2주무효，개용량성매소B연합불포밀정치료，병정완해，지속치료2개월개용불강서연합불포밀정치료。재차지속치료2개월，병정반복，개용복립강서치료，병정호전，차후유지치료1년，병수방지금미재차복발。수거고상공검색도국내외상관문헌93편，기중공6편보도면역공능정상숙주신형은구균혈증화（혹）파산성은구균병6례。본례여차6례균유발열，제1례미묘술외주혈EC외，기여균유불동정도EC승고，경치료후1례사망，기여균호전。결론외주혈EC증다가능시면역공능정상숙주신형은구균병인동환자혹전신파산환자적조기혹급성기특점，차가작위은구균병호전여반복적일개제시。은구균혈증수선안표준방안치료，이복립강서칙가작위난치성은구균병적비선방안지일。
Objective To explore the relationship and treatment of eosinophil cells and pulmonary cryptococcosis, cryptococcal fungemia in immunocompetent host. To improve the understanding of pulmonary cryptococcosis and cryptococcal fungemia.Methods To report a patient suffering from pulmonary cryptococcosis, fungemia and eosinophilia in an immunocompetent host. Confirmed by pathology and blood culture, and relevant literature was reviewed. ‘Cryptococcus’ and ‘fungemia’, ‘Cryptococcus’ and ‘eosinophil cell’ as the Chinese keywords, to retrieve the literature from Wanfang database and CHKD Chinese Journal Full-text database, ‘Cryptococcus’ and ‘eosinophilia’, ‘Cryptococcus’ and ‘fungemia’ as the English keywords, to retrieve the literature from PubMed, Elsevier, Springer, Wiley, OVID and EBSCO database, by the end of September 2013. Results A 33 years old male patient was admitted to hospital on September 15, 2013, suspected ‘pneumonia, bronchial asthma’ with the chief complaint ‘fever, cough, dyspnea of 1 week’. Peripheral blood EC ratio was 0.31, the EC count was 6.12×109/L. But it was ineffective with the treatment of broad-spectrum antibiotics and oral corticosteroids. He was finally diagnosed cryptococcus neoformans bacteremia, cryptococcal pneumonia after transbronchial needle aspiration (TBNA) and blood culture. It was invalid with the treatment of Fluconazole and Flucytosine after 2 weeks. The patient was treated with Amphotericin B and Fluorocytosine for 2 months, with the clinical symptoms were gradually relieved. Fluconazole and Flucytosine were treated in the next 2 months. Because the symptoms of patients were recurrent, the treatment was changed for Voriconazole. After 1 year maintenance treatment, and follow-up had not relapse again. A total of 93 relevant articles were searched in all the database. There were 6 cases about cryptococcus bacteremia and (or) disseminated cryptococcosis with normal immunological status were reported, All of the patients were related with fever. Eosinophil cells had the varying degree of increases except 1 patient. All of the patients were improved after treatment except 1 patient was dead.Conclusions The increase of peripheral blood EC may be the characteristics of the early or acute stage in cryptococcus neoformans children patients or disseminated cryptococcosis immunocompetent host, and can be used as improved cryptococcosis and repeated a hint. The preferred treatment should choose standard solution, and Voriconazole can be used as one of the alternatives for refractory cryptococcosis.