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典型病例例1 丁某,女,23岁。急性粒细胞白血病,治疗四个月后,出现头痛、呕吐、颈强直等脑膜刺激症状伴高烧,实验室检查:脑压2.25kPa(230mmH_2O)。脊髓液蛋白0.85g/L(85mg%)、涂片检查发现具有巨大荚膜的球菌。每天大蒜注射液80ml,红霉素140mg静滴,三个月后痊愈。该患者因急性白血病疗效不佳而死亡。例2 周某,男、45岁。肝硬变腹水伴发烧,护肝治疗二个月后,出现与例1相同的脑膜刺激症状。实验室检查:脑压3.136kPa(320mmH_2O)脊髓液细胞1.41×10~5个/L(144个/mm~3)糖0.555mmol/L(10mg%),蛋白0.6g/L(60mg%),涂片墨汁染色、镜下发现与例1相同球菌。每天给大蒜素180mg静滴、10天后因病情恶化,抢救无效死亡。尸检检、脊髓液中仍发现大量具有巨大荚膜的球菌。例3 程某,男,50岁、因头痛、呕吐、复视,高烧入院,后渐加重、出现昏迷,诊为结脑。抗痨治疗无效,进一步检查、脑压4.116kPa(420mm H_2 O)、脊髓液细胞1.4×10~5个/L(140个/mm~3)、蛋白0.84g/L(84mg%),糖1.11mmol/L(20mg%),涂片染色镜下所见与以上两例相同,改用二性霉素B,每天50mg,治疗半年,症状消失,脊髓液检查转为阴性,病人痊愈出现,4年后随访,病人健在,生活正常。检查鉴定
Typical case 1 Dingmou, female, 23 years old. Acute myeloid leukemia, four months after treatment, headache, vomiting, neck stiffness and other meningeal irritation with high fever, laboratory tests: cerebral pressure 2.25kPa (230mmH2O). Spinal fluid protein 0.85g / L (85mg%), smear examination found a huge capsule of cocci. Garlic injection 80ml daily, erythromycin 140mg intravenous infusion, three months after healed. The patient died of poor response to acute leukemia. Example 2 weeks, male, 45 years old. Cirrhotic ascites with fever, liver treatment two months later, the same as in Example 1 appeared meningeal irritation. Laboratory tests showed that the intracerebral pressure of 1.13 × 10 ~ 5 cells / L (144 cells / mm ~ 3) sugar 0.555mmol / L (10mg%) and protein 0.6g / L Piece of ink staining, microscopy found in Example 1 and the same bacteria. Allicin 180mg daily intravenous infusion, 10 days after the condition deteriorated, the rescue died. Autopsy, spinal fluid still found a large number of large capsular cocci. Example 3 Chengmou, male, 50 years old, due to headache, vomiting, diplopia, high fever admitted to hospital, gradually aggravated, coma, diagnosed as knot brain. Antihypertensive treatment was ineffective. Further examination showed that intracerebral pressure was 4.116 kPa (420 mm H 2 O), 1.4 × 10 5 / L (140 cells / mm 3), 0.84 g / L (84 mg% / L (20mg%), smear staining microscope seen the same as the above two cases, with amphotericin B, 50mg daily for six months, the symptoms disappeared, spinal fluid examination turned negative, the patient recovered, 4 years Follow-up, the patient is healthy, normal life. Inspection and identification