:ﻪﺒﺗﺎﮑﻣ سردآ*
،ﺖﺷر نﻼﯿﮔ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
، قوﺮﻋ و ﺐﻠﻗ تﺎﻘﯿﻘﺤﺗ ﺰﮐﺮﻣ ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد
.
ﺖﻧﻮﻔﻋ زا يدﻮﺒﻬﺑ زا ﺪﻌﺑ ﺲﻨﻣرﻮﻓﻮﺌﻧ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ زا ﯽﺷﺎﻧ ﺖﯾﮋﻨﻨﻣ درﻮﻣ ﮏﯾ شراﺰﮔ
COVID-19
رد
يﺪﻧﻮﯿﭘ ﻪﯿﻠﮐ ي هﺪﻧﺮﯿﮔ رﺎﻤﯿﺑ
هداز نﺎﻀﻣر مﺎﻬﻟا ،
1مﺎﺟﺮﻓ ﮏﯿﻧ نﺎﻤﻠﺳ
2
*
1 - ،رﺎﯾدﺎﺘﺳا نﻼﯿﮔ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،يزار نﺎﺘﺳرﺎﻤﯿﺑ ،ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد ،يزار ﯽﻨﯿﻟﺎﺑ تﺎﻘﯿﻘﺤﺗ ﺪﺷر ﺰﮐﺮﻣ ﺮﯾا ،ﺖﺷر ،
نا
2 - ،رﺎﯾدﺎﺘﺳا وﺮﮔ ،ﯽﻗوﺮﻋ ﯽﺒﻠﻗ يﺎﻬﯾرﺎﻤﯿﺑ تﺎﻘﯿﻘﺤﺗ ﺰﮐﺮﻣ اد ،ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد ،ﺖﻤﺸﺣ نﺎﺘﺳرﺎﻤﯿﺑ ،قوﺮﻋ و ﺐﻠﻗ ه
مﻮﻠﻋ هﺎﮕﺸﻧ ﻼﯿﮔ ﯽﮑﺷﺰﭘ
،ن
ناﺮﯾا ،ﺖﺷر
هرود / ﻪﺘﻓﺎﯾ 23
هرﺎﻤﺷ / 5
ز / نﺎﺘﺴﻣ 1400
/ ﻞﺴﻠﺴﻣ 90
:ﻪﻟﺎﻘﻣ ﺖﻓﺎﯾرد 7
/1 / 1400 :ﻪﻟﺎﻘﻣ شﺮﯾﺬﭘ 1/
9 / 1400
ﻪﻣﺪﻘﻣ :
ﺎﻫ ﺖﻧﻮﻔﻋ هﺪﻧﺮﯿﮔ نارﺎﻤﯿﺑ رد ﯽﭼرﺎﻗ ي ﻟد ﻪﺑ يﺪﻧﻮﯿﭘ ﻮﻀﻋ ي
و گﺮﻣ ﯽﻠﺻا ﻞﻣاﻮﻋ زا ﯽﮑﯾ ﯽﻨﻤﯾا ﻢﺘﺴﯿﺳ بﻮﮐﺮﺳ ﻞﯿ و ﺮﯿﻣ
ﺑ ﻦﯾا رد نﺎﻣرد ﻞﺑﺎﻗ و ﻢﻬﻣ ﻞﻣاﻮﻋ زا ﯽﮑﯾ ﯽﭼرﺎﻗ يﺎﻫ ﺖﻧﻮﻔﻋ زا ﯽﺷﺎﻧ يﺰﮐﺮﻣ ﯽﺒﺼﻋ ﻢﺘﺴﯿﺳ يﺮﯿﮔرد ،ﺪﻨﺷﺎﺑ ﯽﻣ ﯽﻧاﻮﺗﺎﻧ نارﺎﻤﯿ
رﺎﻤﯿﺑ درﻮﻣ ﮏﯾ ﯽﺳرﺮﺑ ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا .ﺖﺳا 58
ﻪﺑ ﻼﺘﺒﻣ ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ ﻪﻘﺑﺎﺳ ﺎﺑ ﯽﺘﺑﺎﯾد ﻪﻟﺎﺳ ﺖﯾﮋﻨﻨﻣ
ﺘﭙﯾﺮﮐ ﯽﮐﻮﮐﻮ 3 ﺎﻣ يدﻮﺒﻬﺑ زا ﺪﻌﺑ ه
ﺪﯾوﻮﮐ ﺖﻧﻮﻔﻋ زا 19
.دزادﺮﭘ ﯽﻣ
رﺎﻤﯿﺑ يﺎﻗآ 58 ي هﺪﻧﺮﯿﮔ درﻮﻣ ﯽﺘﺑﺎﯾد ﻪﻟﺎﺳ ﺪﻧﻮﯿﭘ
رﺎﻤﯿﺑ ﻪﺑ غاﺮﻔﺘﺳا و عﻮﻬﺗ و ﺐﺗ ،هﺪﯿﺸﮐ لﻮﻃ دردﺮﺳ ﺖﯾﺎﮑﺷ ﺎﺑ ﻪﯿﻠﮐ ﺟاﺮﻣ نﺎﺘﺳ
ﻪﻌ
رﺎﻤﯿﺑ .ﺪﻨﮐ ﯽﻣ 3
ﺪﯾوﻮﮐ ﺖﻧﻮﻔﻋ ﺺﯿﺨﺸﺗ ﺎﺑ ﺰﯿﻧ ﻞﺒﻗ هﺎﻣ 19
ﺑ رد .ددﻮﺑ هﺪﺷ يﺮﺘﺴﺑ ﺰﮐﺮﻣ ﻦﯿﻤﻫ رد هﺪﺷ مﺎﺠﻧا يﺎﻫ ﯽﺳرﺮ
ﭘ ﻪﻧﻮﻤﻧ زا ﺲ
يﺰﻐﻣ ﻊﯾﺎﻣ يﺮﯿﮔ -ﻧ
ﺶﻫﺎﮐ يدوﺪﺣ ﺎﺗ رﺎﻤﯿﺑ ﮏﯾژﻮﻟورﻮﻧ ﻢﯾﻼﻋ ﯽﻋﺎﺨ ﭘﯿ
اﺪ ﻣ ﻊﯾﺎﻣ ﺰﯿﻟﺎﻧآ رد و دﺮﮐ يﺰﻐ
- ﻔﺘﺳا و ﯽﻋﺎﺨﻧ ﺖﺸﮐ زا هدﺎ
و
ﺮﻫﻮﺟ ﯽﭼرﺎﻗ ﺖﻧﻮﻔﻋ ﺪﻫاﻮﺷ ،يﺪﻨﻫ ﺖﺑﺎﺛ
ﺪﺷ . ﯽﻣﻮﻤﻋ لﺎﺣ ﺎﺑ رﺎﻤﯿﺑ ﻦﯾزﻮﺘﯿﺳﻮﻠﻓ و ﻦﯿﺴﯾﺮﺗﻮﻔﻣآ يﺎﻫوراد ﺎﺑ نﺎﻣرد زا ﺲﭘ ﺧ
زا بﻮ
ﺑ ﺺﺧﺮﻣ نﺎﺘﺳرﺎﻤﯿ ﺪﺷ
.
هژاو ﺪﯿﻠﮐ يﺎﻫ :ي
ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ ،ﺖﯾﮋﻨﻨﻣ ،ﺲﻨﻣرﻮﻓﻮﺌﻧ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ .
هﺪﯿﮑﭼ
ﻪﻣﺪﻘﻣ
ﻔﻋ هﺪﻧﺮﯿﮔ نارﺎﻤﯿﺑ رد ﯽﭼرﺎﻗ يﺎﻫ ﺖﻧﻮ يﺪﻧﻮﯿﭘ ﻮﻀﻋ ي
گﺮﻣ ﯽﻠﺻا ﻞﻣاﻮﻋ زا ﯽﮑﯾ ﯽﻨﻤﯾا ﻢﺘﺴﯿﺳ بﻮﮐﺮﺳ ﻞﯿﻟد ﻪﺑ ﯽﻧاﻮﺗﺎﻧ و ﺮﯿﻣ و ﺪﻨﺘﺴﻫ
آ ﻪﺑ ﻼﺘﺑا ناﺰﯿﻣ ﻪﮐ ﺪﻨﭼﺮﻫ ، د ﺎﻬﻧ
ر
يﺎﻫ ﺖﻧﻮﻔﻋ ﺎﺑ ﻪﺴﯾﺎﻘﻣ هﺪﺷ شراﺰﮔ ﺮﺘﻤﮐ لﺎﯾﺮﺘﮐﺎﺑ
ﺖﺳا .ا ز
ﯽﻤﺟﺎﻬﺗ ﯽﭼرﺎﻗ ﺖﻧﻮﻔﻋ ﻦﯿﻣﻮﺳ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ ،عﻮﯿﺷ ﺮﻈﻧ ﺖﺳا نارﺎﻤﯿﺑ ﻪﻧﻮﮕﻨﯾا رد )
1،2 (.
رﻮﻃ ﻪﺑ لﻮﻤﻌﻣ
،
ﺮﮐ ﯾ ﻮﮐﻮﮐﻮﺘﭙ س و ﺖﻧﻮﻔﻋ ﺎﺑ ﺐﻠﻏا ﯾ
سوﺮ ا ﺺﻘﻧ ﯾ ﻨﻤ ﯽ ﻧﺎﺴﻧا ﯽ
) (HIV ا ﺎﺑ .ﺖﺳا طﺎﺒﺗرا رد ﯾ
ﻦ لﺎﺣ نﺎﻣرد رﻮﻬﻇ ﺎﺑ ،
وﺪﺿ ﯾ ﺳوﺮ ﯽ ﻣ ﺆ ﺮﺛ ﺎﻫرﻮﺸﮐ رد دراﻮﻣ ﺮﺜﮐا ، ي
ﭘ ﯿ ﻪﺘﻓﺮﺸ رد
ﻣﯿ نﺎ ﺑﯿ نارﺎﻤ ﻏ ﯿﺮ ﻪﺑ هدﻮﻟآ و ﻪﺑ ،HIV
ﯾ هﮋ ﮔ ﯿ نﺎﮔﺪﻧﺮ ﭘ ﯿ ﺪﻧﻮ
ﻣ خر ﺎﻀﻋا ﯽ
ﻫد ﺪ ) 5 (.
ﻣ ﯿ ناﺰ زوﺮﺑ ﺮﮐ ﯾ ﻮﮐﻮﮐﻮﺘﭙ س وﺮﮔ رد ه
ﺎﻫ ي ﮔ ﻒﻠﺘﺨﻣ ﯿ هﺪﻧﺮ ﺎﻫ ي يﺪﻧﻮﯿﭘ ﻮﻀﻋ اﺪﻧا عﻮﻧ ﻪﺑ ﻪﺘﺴﺑ
م
ﭘﯿ ﺪﻧﻮ ي ﭘ نﺎﻣز تﺪﻣ و ﯿ
ﮕ ﯿﺮ ي زا 2/
0 ﺪﺻرد ﺎﺗ ﺪﺻرد ¼
ا هﺪﻧﺎﻣ ﺖﺑﺎﺛ ﺎﻬﻟﺎﺳ لﻮﻃ رد و ﺖﺳ ﺖﺳا
. ﻦﯿﻨﭽﻤﻫ ﻣﯿ
ناﺰ
ﻣ و گﺮﻣ ﯿﺮ
ﺑ رد ﯿ ﻦ عاﻮﻧا نارﺎﻤﯿﺑ ﮔ ﯿ هﺪﻧﺮ يﺪﻧﻮﯿﭘ ﻮﻀﻋ
ﺮﮐ ﻪﺑ ﻼﺘﺒﻣ ﯾ
زﻮﮐﻮﮐﻮﺘﭙ ﯾ ﺲ زا 14 ﺪﺻرد ﺎﺗ 6/
19 ﺪﺻرد
ﺮﯿﻐﺘﻣ رد رد ﺖﺳا ﻦﮑﻤﻣ و ﺖﺳا ﯾ
ﺖﻓﺎ نﺎﮔﺪﻨﻨﮐ ﻪﮐ يﺪﻧﻮﯿﭘ
ﺑﻪ ﮋﻨﻨﻣ ﯾ ﺖ ﺪﻧﻮﺷ ﯽﻣ ﻼﺘﺒﻣ ﻪﺑ
50 ﺪﺻرد ﻢﻫ دﺰﻧ ﯾ ﮏ دﻮﺷ
) 5،10 .(
ﯿﭘ نارﺎﻤﯿﺑ ،ﻮﻀﻋ ﺪﻧﻮﯿﭘ ﺖﺤﺗ نارﺎﻤﯿﺑ ﻦﯿﺑ رد ﺪﻧﻮ
ﮐ ﻪﯿﻠﮐ ناﺰﯿﻣ ﻦﯾﺮﺘﻤ ﺮﻄﺧ
ﻔﻋ ﻪﺑ ﻼﺘﺑا ﯽﻤﺟﺎﻬﺗ يﺎﻫ ﺖﻧﻮ
ﯽﻣ ﻞﻣﺎﺷ ار ﯽﭼرﺎﻗ ﺪﻧﻮﺷ
) 2 ( . ﺲﻨﻣرﻮﻓﻮﺌﻧ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ
راد ﺶﺷﻮﭘ چرﺎﻗ ﯽﻋﻮﻧ ﺖﺳا
ﺎﺸﻨﻣ و ء ﺮﺜﮐا رد نآ نارﺎﻤﯿﺑ
رﺎﻤﯿﺑ ﻦﯾا ﻪﮐ هﺪﺷ ﻪﺘﻔﮔ ﻊﻄﻗ رﻮﻃ ﻪﺑ ﺎﻣا ﺖﺳا مﻮﻠﻌﻣﺎﻧ ي
ﺎﺑ ﻂﯿﺤﻣ زا دﺮﻓ و دراﺪﻧ يدﺮﻓ لﺎﻘﺘﻧا چرﺎﻗ قﺎﺸﻨﺘﺳا
ﻣ ﻼﺘﺒ
ﯽﻣ ر يﺮﯿﮔرد ﺎﺑ اﺮﺜﮐا چرﺎﻗ ﻦﯾا زا ﯽﺷﺎﻧ ﺖﻧﻮﻔﻋ .دﻮﺷ و ﻪﯾ
ﺨﺸﺗ مﺎﮕﻨﻫ رد نارﺎﻤﯿﺑ ﺖﯾﺮﺜﮐا و ﺪﺑﺎﯾ ﯽﻣ ﺮﻫﺎﻈﺗ ﮋﻨﻨﻣ ﺺﯿ
ﻼﺘﺒﻣ ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ ﺖﯾﺰﻨﻨﻣ ﻪﺑ ﺪﻨﺘﺴﻫ
) 3،4 (.
ﻦﯾا رد
ﮏﯾ ﻪﻌﻟﺎﻄﻣ دﺮﻓ درﻮﻣ
58 ﻪﻟﺎﺳ هﺪﻧﺮﯿﮔ ي ﺪﻧﻮﯿﭘ ﻪﯿﻠﮐ ي
ي
ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ ﺖﯾﮋﻨﻨﻣ ﻪﺑ ﻼﺘﺒﻣ 3
ﺑ يﺮﯿﮔرد زا ﺪﻌﺑ هﺎﻣ ﺎ
ﺪﯾوﻮﮐ ﺖﻧﻮﻔﻋ 19
ﯽﻓﺮﻌﻣ دﻮﺷ ﯽﻣ . :رﺎﻤﯿﺑ ﯽﻓﺮﻌﻣ
يﺎﻗآ رﺎﻤﯿﺑ 58
ﻪﻘﺑﺎﺳ ﺎﺑ ﻪﻟﺎﺳ ﮐ ﯽﺘﺑﺎﯾد ﯽﺗﺎﭘوﺮﻔﻧ ي
ﻪﺑ ﻪ
تﺪﻣ 4 لﺎﺳ هﺎﻣ يد رد و هدﻮﺑ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﺖﺤﺗ لﺎﺳ 1398
ﺤﺗ هﺪﻨﻫد دﺮﻓ زا ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ ﯽﺣاﺮﺟ ﺖ راﺮﻗ هﺪﺷ تﻮﻓ ي
،ﺖﻓﺮﮔ ﺣ زا ﻪﮐ غاﺮﻔﺘﺳا و عﻮﻬﺗ و ﺐﺗ ،دردﺮﺳ ﺖﯾﺎﮑﺷ ﺎﺑ دوﺪ
2 ﺦﯾرﺎﺗ رد دﻮﺑ هﺪﺷ عوﺮﺷ ﻞﺒﻗ هﺎﻣ 6
لﺎﺳ دادﺮﺧ 1399
ﺑ ﻪ
يﺮﺘﺴﺑ و هدﺮﮐ ﻪﻌﺟاﺮﻣ نﺎﺘﺳرﺎﻤﯿﺑ ﺲﻧاژروا ﺪﺷ
.
ﻦﯿﻨﭽﻤﻫ رﺎﻤﯿﺑ 3
ﺖﯾﺎﮑﺷ ﺎﺑ ﺰﮐﺮﻣ ﻦﯿﻤﻫ رد ﻞﺒﻗ هﺎﻣ
ﺐﺗ
، زﺮﻟ ﻧ ﯽﮕﻨﺗ و هﺪﺷ يﺮﺘﺴﺑ ﺲﻔ دﻮﺑ
رد ﺎﻫ ﯽﺳرﺮﺑ رد ﻪﮐ
و ﻢﮐاﺮﺘﻣ ﯽﺣاﻮﻧ ﻪﻨﯿﺳ ﻪﺴﻔﻗ HRCT يﺎﻤﻧ
(Ground-
Glass Opacification) GGO هﺪﻫﺎﺸﻣ ﻪﯾر ود ﺮﻫ رد
سوﺮﯾو ﺎﺑ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ ﺺﯿﺨﺸﺗ ﺖﯾﺎﻬﻧ رد ﻪﮐ ﺪﺷ SARS-COV-2 ﺪﺷ ﻪﺘﺷاﺬﮔ يو ياﺮﺑ
رﺎﻤﯿﺑ ، ﺖﺤﺗ
ﻦﯿﮐوﺮﻠﮐ ﯽﺴﮐورﺪﯿﻫ ﺎﺑ نﺎﻣرد ﯿﯾوﺮﺘﺳا ﻮﮑﯿﺗرﻮﮐ ،
و ﺪ
نﺎﻣرد زا ﺪﻌﺑ و ﺖﻓﺮﮔ راﺮﻗ ﯽﺘﯾﺎﻤﺣ و هﺪﻧراﺪﻬﮕﻧ يﺎﻫ 3
ﻪﮐ ﺪﺷ ﺺﺧﺮﻣ بﻮﺧ ﯽﻣﻮﻤﻋ لﺎﺣ ﺎﺑ نﺎﺘﺳرﺎﻤﯿﺑ زا ﻪﺘﻔﻫ يدﺎﺑ ﯽﺘﻧآ ﺮﺿﺎﺣ لﺎﺣ يﺮﺘﺴﺑ رد ﺖﺒﺜﻣIgG
ﺪﯾﻮﮐ ﻪﯿﻠﻋ -
19 .ﺪﺷ شراﺰﮔ يو ياﺮﺑ
ﻪﭽﺨﯾرﺎﺗ وراد رﺎﻤﯿﺑ ﯽﻓﺮﺼﻣ ﯽﯾوراد ي يﺎﻫ
سﻮﻤﯿﻟوﺮﮐﺎﺗ 1
زور رد رﺎﺑ ود مﺮﮔ نﻮﻟوﺰﯿﻧدﺮﭘ ،
5 ﻧازور مﺮﮔ ﯽﻠﯿﻣ ،ﻪ
ﻞﯿﺘﻓﻮﻣ تﻻﻮﻨﻓﻮﮑﯾﺎﻣ 360
ﺮﻫ 8 ،ﺖﻋﺎﺳ ﺗآ وﺮ ﻦﯿﺗﺎﺘﺳو 40
ﻦﯿﺘﻧﺎﮐوﺮﺘﯿﻧ ،ﻦﯿﻟﻮﺴﻧا ،ﺎﻫ ﺐﺷ مﺮﮔ ﯽﻠﯿﻣ 6/
2 ﻫ مﺮﮔ ﯽﻠﯿﻣ ﺮ
12 ﺪﯾﺎﻣزرﻮﻓ ،ﺖﻋﺎﺳ 40
ﺮﻫ صﺮﻗ ﻒﺼﻧ مﺮﮔ ﯽﻠﯿﻣ 12
ﺖﻋﺎﺳ
ﻦﯾﺮﭙﺳآ و 80
دﺪﻋ ﮏﯾ يزور مﺮﮔ ﯽﻠﯿﻣ
، ﯽﻣ ﻞﻣﺎﺷ .ﺪﺷ
ﻪﻨﯾﺎﻌﻣ رد
، رﺎﻤﯿﺑ ﯽﺑ تﻻاﻮﺳ ﻪﺑ و دﻮﺑ رﺎﯿﺷﻮﻫ ﯽﻟو لﺎﺣ
ﻮﺧ ﻪﺑ ﮑﯾﺰﯿﻓ ﻪﻨﯾﺎﻌﻣ ﻢﻬﻣ تﺎﮑﻧ ،داد ﯽﻣ ﺦﺳﺎﭘ ﯽﺑ راﺮﻗ ﻪﺑ ﯽ
ﺐﺗ :دﻮﺑ ﺮﯾز 3/
38 ﻪﺟرد ﯽﺘﻧﺎﺳ ي ﯽﻧﺎﻫد ترﻮﺻ ﻪﺑ ﻪﮐ داﺮﮔ
نﻮﺧرﺎﺸﻓ ،ﺪﺷ يﺮﯿﮔ هزاﺪﻧا 95
/ 145 ،دﻮﺑ هﻮﯿﺟ ﺮﺘﻣ ﯽﻠﯿﻣ
ﺎﻫ ﻪﻤﺤﺘﻠﻣ ﮓﻧﺮﯿﺑ
و ﺪﻧدﻮﺑ ﺰﯾو ﺰﯾو ياﺪﺻ ﻊﻤﺳ رد هﺪﻨﮐاﺮﭘ
تﺎﻨﯾﺎﻌﻣ ﻪﻠﻤﺟ زا تﺎﻨﯾﺎﻌﻣ ﺮﯾﺎﺳ .ﺪﺷ هﺪﯿﻨﺷ ﻪﯾر ود ﺮﻫ ﻮﻟورﻮﻧ
،رﻮﻧ ﻪﺑ ﮏﻣدﺮﻣ ﺦﺳﺎﭘ ،ﺎﻫ ﻢﺸﭼ تﺎﮐﺮﺣ ﻞﻣﺎﺷ ﮏﯾژ
ﺮﮔ ﯽﺘﻔﺳ ﯽﺳرﺮﺑ ﺲﮑﻠﻓر و ﯽﻧﻼﻀﻋ نﻮﺗ و ترﺪﻗ ،ﯽﻧد
يﺎﻫ
ﯽﮕﻤﻫ ﯽﻘﻤﻋ ﯽﻌﯿﺒﻃ
.ﺪﻧدﻮﺑ
رﺎﻤﯿﺑ ياﺮﺑ يﺰﻐﻣ ﻦﮑﺳاCT
، ﯾﺎﻣ زا يﺮﯿﮔ ﻪﻧﻮﻤﻧ وMRI ﻊ
ﯽﻋﺎﺨﻧ لﺎﺒﻧد ﻪﺑ .ﺪﺷ مﺎﺠﻧا (LP)
LP يﺰﻐﻣ ﻊﯾﺎﻣ جوﺮﺧ و
ﯽﻋﺎﺨﻧ ﺪﺷ جرﺎﺧ ﻻﺎﺑ رﺎﺸﻓ ﺎﺑ ﻪﮐ ( CSF)
، دردﺮﺳ ﺑ رﺎﻤﯿﺑ ﻪ
.دﺮﮐ اﺪﯿﭘ ﺶﻫﺎﮐ ﯽﻬﺟﻮﺗ ﻞﺑﺎﻗ ناﺰﯿﻣ ﻫﺎﮕﺸﯾﺎﻣزآ ﯽﺳرﺮﺑ رد
،ﯽ
يﺰﻐﻣ ﻊﯾﺎﻣ ﺰﯿﻟﺎﻧآ -ﻧ
:ﺪﺷ شراﺰﮔ ﺮﯾز راﺮﻗ ﻪﺑ ﯽﻋﺎﺨ Color: clear
WBC:107 /mm2 Neutrophil: 2%
Lymphocyte:98%
RBC: 2 /mm2 Glucose: 14 mg/dl Protein: 129 mg/dl
Volume: 6cc
HSV PCR: Neg CMV PCR: Neg MTB PCR: Neg
Fungi general PCR: Positive for Cryptococcus neoformans
ﺮﯿﻤﺳا ﯽﺳرﺮﺑ رد
،CSF ﺮﯿﻤﺳا رد يﺮﺘﮐﺎﺑ ﭻﯿﻫ
) يﺪﻨﻫ ﺮﻫﻮﺟ يﺰﯿﻣآ ﮓﻧر رد و ﺪﺸﻧ هﺪﻫﺎﺸﻣ Indian
Ink test (
يﻻﺎﺑ ﮏﺷ ﺎﺑ ﻢﺴﯿﻧﺎﮔراوﺮﮑﯿﻣ يداﺪﻌﺗ
سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ .ﺪﺷ هﺪﻫﺎﺸﻣ ﺲﻨﻣﺮﻓﻮﺌﻧ
ًﺎﻌﯾﺮﺳ رﺎﻤﯿﺑ ﻦﯿﺴﯾﺮﺗﻮﻔﻣآ ﺎﺑ نﺎﻣرد ﺖﺤﺗ
ب و
بﻮﺧ ﯽﻣﻮﻤﻋ لﺎﺣ ﺎﺑ ﺖﯾﺎﻬﻧ رد و ﺖﻓﺮﮔ راﺮﻗ ﻦﯾزﻮﺘﯿﺳﻮﻠﻓ .ﺪﺷ ﺺﺧﺮﻣ
A
ﺮﯾﻮﺼﺗ ﻪﻧﻮﻤﻧ ﺮﯿﻤﺳا :A رﺎﻤﯿﺑCSF
ﺮﯾﻮﺼﺗ ﺖﺸﮐ ﺮﯾﻮﺼﺗ :B Indian Ink
و ﺚﺤﺑ يﺮﯿﮔ ﻪﺠﯿﺘﻧ
ﺮﮐ ﺖﻧﻮﻔﻋ ﻪﻧﻮﮔ ود زا هﺪﻤﻋ رﻮﻃ ﻪﺑ ﯽﮐﻮﮐﻮﺘﭙﯾ
ﯽﭼرﺎﻗ ي
ﺑ مﺎﻧ ﻪ و ﺲﻨﻣﺮﻓﻮﺌﻧ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ يﺎﻫ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ
ﻊﯾﺎﺷ ﻞﻣﺎﻋ ﻦﯿﻣﻮﺳ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ .دﻮﺷ ﯽﻣ دﺎﺠﯾا ﯽﯿﺗﺎﮔ ﺎﻬﺗ ﯽﭼرﺎﻗ ﺖﻧﻮﻔﻋ ﻮﻀﻋ ﺪﻧﻮﯿﭘ ﺖﺤﺗ نارﺎﻤﯿﺑ رد ﯽﻤﺟ
ﯽﻣ ﻦﯾا رد ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ ﺖﻧﻮﻔﻋ عﻮﯿﺷ ﻞﮐ رﻮﻃ ﻪﺑ و ﺪﺷﺎﺑ
رﺎﻤﯿﺑ نا 2 /0 ﺎﺗ 5 ﺖﺳا هﺪﺷ شراﺰﮔ ﺪﺻرد )
5،6 (.
ناﺰﯿﻣ
زا ﯽﺷﺎﻧ ﺮﯿﻣ و گﺮﻣ ﻮﻀﻋ نﺎﮔﺪﻧﺮﯿﮔ رد يرﺎﻤﯿﺑ ﻦﯾا
يﺪﻧﻮﯿﭘ 14 ﺎﺗ 6/
19 رد ﻪﮐ هﺪﺷ هدز ﻦﯿﻤﺨﺗ ﺪﺻرد
يﺮﯿﮔرد ﺎﺑ نارﺎﻤﯿﺑ ﺎﺗ ناﺰﯿﻣ ﻦﯾا ﮋﻨﻨﻣ
50 ﻢﻫ ﺪﺻرد
ﻪﻠﻀﻓ زا و دراد دﻮﺟو نﺎﮔﺪﻧﺮﭘ ي قﺎﺸﻨﺘﺳا و ﺲﻔﻨﺗ هار
يرﺎﻤﯿﺑ ﺚﻋﺎﺑ مﺎﺠﻧا تﺎﻌﻟﺎﻄﻣ ﻖﺒﻃ .دﻮﺷ ﯽﻣ نﺎﺴﻧا ﯽﯾاز
دراﺪﻧ دﺮﻓ ﻪﺑ دﺮﻓ لﺎﻘﺘﻧا ﺖﻧﻮﻔﻋ ﻦﯾا هﺪﺷ )
3 ، 5 ، 7 (.
رﻮﺘﮐﺎﻓ ﻦﯾﺮﺘﻤﻬﻣ زا يﺎﻫ
رد ﺮﻄﺧ ﻧﻮﻔﻋ ﻦﯾا ﻪﺑ ﻼﺘﺑا
ﺖ
بﻮﮐﺮﺳ ﻒﻠﺘﺨﻣ عاﻮﻧا ﺘﺴﯿﺳ
ﯽﻨﻤﯾا ﻢ ﻢﺘﺴﯿﺳ لﻼﺘﺧا و
ﺴﻧا ﯽﻨﻤﯾا ﺺﻘﻧ سوﺮﯾو ﺖﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺑا ﻪﻠﻤﺟ زا ﯽﻨﻤﯾا نﺎ
ﯽﻤﯿﺧﺪﺑ ،ﻮﻀﻋ ﺪﻧﻮﯿﭘ ،(HIV) وﺮﯿﺳ و ﺖﺑﺎﯾد يرﺎﻤﯿﺑ ،ﺎﻫ
ز
ﯽﻣ يﺪﺒﮐ ﺪﻨﺷﺎﺑ
. فﺮﺼﻣ وﺮﺘﺳاﻮﮑﯿﺗرﻮﮐ ﺋ
ﺪﯿ ﺗ دﺮﻓ ﺰﯿﻧ ﺎﻫ ﺖﺤ
ﺪﻨﻨﮐ ﯽﻣ ﺖﻧﻮﻔﻋ ﻦﯾا ﻪﺑ ﻼﺘﺑا ﺪﻌﺘﺴﻣ ﺮﺘﺸﯿﺑ ار ﺪﻧﻮﯿﭘ .
ﯽﻓﺮﺼﻣ ﻪﻧازور زود ناﺰﯿﻣ ﻪﮐ ﺪﻨﭼﺮﻫ ﻦﯾا ﺶﯾاﺰﻓا ياﺮﺑ
ًاﺮﯿﺧا ﻪﻌﻟﺎﻄﻣ ﮏﯾ رد George et al.
ﯽﺳرﺮﺑ ﻪﺑ
يﺎﻫرﻮﺘﮐﺎﻓ رد ﺮﻄﺧ
ﻮﮐﻮﺘﭙﯾﺮﮐ ﺖﻧﻮﻔﻋ رد ﯽﮐ
42634 رﺎﻤﯿﺑ
هﺪﻧﺮﯿﮔ ﺺﺨﺸﻣ ﺎﻫ ﯽﺳرﺮﺑ رد ﻪﮐ ﺪﻨﺘﺧادﺮﭘ يﺪﻧﻮﯿﭘ ﻮﻀﻋ ي
ارﺎﻤﯿﺑ و ﯽﺘﺑﺎﯾد نارﺎﻤﯿﺑ ،ﺮﺗﻻﺎﺑ ﻦﺳ ﺎﺑ نارﺎﻤﯿﺑ ﺪﺷ ﺎﺑ ن
ﻊﺿو
ﺖﻧﻮﻔﻋ ﻦﯾا ﻪﺑ ﻼﺘﺑا ياﺮﺑ يﺮﺘﺸﯿﺑ ﺮﻄﺧ ﺮﺗﺪﺑ يدﺎﺼﺘﻗا ﻫ
ﺎ
ﮔرا ﺮﯾﺎﺳ ﺎﺑ ﻪﺴﯾﺎﻘﻣ رد ﻪﯾر ﺪﻧﻮﯿﭘ رد ﻦﯿﻨﭽﻤﻫ .ﺪﻧراد ﻫ نﺎ
ﺎ
ﺪﺷ شراﺰﮔ ﺮﺘﺸﯿﺑ ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ ﺖﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺑا ﮏﺴﯾر )
7 (.
ﺖﻣﻼﻋ نوﺪﺑ زا ﺪﻧاﻮﺗ ﯽﻣ ﺖﻧﻮﻔﻋ ﻦﯾا ﯽﻨﯿﻟﺎﺑ ﻢﯾﻼﻋ ﺗ ﺎ
ﻮﻤﻌﻣ ﻢﯾﻼﻋ يﺰﻐﻣ يﺮﯿﮔرد رد ،ﺪﺷﺎﺑ ﺮﯿﻐﺘﻣ ﺪﯾﺪﺷ ﻢﯾﻼﻋ ًﻻ
دردﺮﺳ ترﻮﺻ ﻪﺑ تﺪﻣ ﯽﻧﻻﻮﻃ
نﺪﺑ ،يرﺎﯿﺷﻮﻫ ﺮﯿﯿﻐﺗ ،ﺐﺗ ،
ﻊﯾﺎﺷ ﺮﺘﻤﮐ رﻮﻃ ﻪﺑ و درد
، و ندﺮﮔ ﯽﺘﻔﺳ رﻮﻧ زا سﺮﺗ
ﺪﺑﺎﯾ ﯽﻣ ﺮﻫﺎﻈﺗ )
4،5 ( ﺷ ناﻮﻨﻋ ترﻮﻫﻮﮐ ﻪﻌﻟﺎﻄﻣ ﮏﯾ رد . ﺪ
ﻋ دﻮﺟو ﻪﮐ ﺖﯾﮋﻨﻨﻣ ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﯿﺑ رد دردﺮﺳ ﺖﻣﻼ
ﮐ هﺪﻨﻨﮐ ﯽﻨﯿﺑ ﺶﯿﭘ رﻮﺘﮐﺎﻓ ﯽﮐﻮﮐﻮﺘﭙﯾﺮ ﺮﯿﺳ رد ﯽﺑﻮﺧ ي
ﯽﻣ ﺮﻈﻧ ﻪﺑ داﺮﻓا ﻦﯾا يرﺎﻤﯿﺑ ﺪﺳر
) 9 ( درﻮﻣ رﺎﻤﯿﺑ ﻪﮐ
ﮐ غاﺮﻔﺘﺳا و عﻮﻬﺗ و ﺐﺗ و دردﺮﺳ ﺖﯾﺎﮑﺷ ﺎﺑ ﺰﯿﻧ ﯽﺳرﺮﺑ ﻪ
2
.ﺪﻧدﺮﮐ ﻪﻌﺟاﺮﻣ نﺎﺘﺳرﺎﻤﯿﺑ ﻪﺑ دﻮﺑ هﺪﯿﺸﮐ لﻮﻃ هﺎﻣ ﺗ يﻮﯾر يﺮﯿﮔرد رد ﯽﺑ زا تاﺮﻫﺎﻈ
ﯽﻧﻮﻣﻮﻨﭘ ﺎﺗ ﯽﺘﻣﻼﻋ
ﻧﻮﯿﭘ ﺖﺤﺗ نارﺎﻤﯿﺑ .ﺖﺳا ﺮﯿﻐﺘﻣ ﯽﺴﻔﻨﺗ ﯽﯾﺎﺳرﺎﻧ و ﺪﯾﺪﺷ ﺪ
ًﻻﻮﻤﻌﻣ يﺰﻐﻣ و يﻮﯾر يﺮﯿﮔرد رﺎﭼد ﺺﯿﺨﺸﺗ نﺎﻣز رد
ﺪﻨﺘﺴﻫ . نﺎﮔرا ﺮﯾﺎﺳ زا ﯽﻣ ﻪﮐ ﯽﯾﺎﻫ
ﻔﻋ ﻦﯾا ﺎﺑ ﺪﻨﻧاﻮﺗ ﺖﻧﻮ
اﻮﺗ ﯽﻣ ﺪﻧﻮﺷ ﺮﯿﮔرد مﺮﻧ ﺖﻓﺎﺑ ،نﻮﺧ ،ﺖﺳﻮﭘ ن
، ناﻮﺨﺘﺳا ﻫ ﺎ
يﺮﯿﮔرد .دﺮﺑ مﺎﻧ ار ﻞﺻﺎﻔﻣ و ﺎﺗ (ﯽﻤﮕﻧﺎﻓ) ﯽﻧﻮﺧ
33 د ﺪﺻر
دﻮﺷ دﺎﺠﯾا ﺪﻧاﻮﺗ ﯽﻣ ﻮﻀﻋ ﺪﻧﻮﯿﭘ ﺖﺤﺗ نارﺎﻤﯿﺑ رد .
ﯾ رد ﮏ
ﻢﺘﺴﯿﺳ يﺮﯿﮔرد رﺎﭼد نارﺎﻤﯿﺑ ﻪﮐ ﺪﺷ ناﻮﻨﻋ ﯽﺳرﺮﺑ ﺪﻌﺘﺴﻣ ﺮﺘﺸﯿﺑ ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ ﺖﻧﻮﻔﻋ زا ﯽﺷﺎﻧ يﺰﮐﺮﻣ ﯽﺒﺼﻋ نارﺎﻤﯿﺑ ﺮﯾﺎﺳ ﻪﺑ ﺖﺒﺴﻧ ﯽﻧﻮﺧ يﺮﯿﮔرد و ﯽﻤﮕﻧﺎﻓ زوﺮﺑ ﺪﻨﺘﺴﻫ ) 5 (.
ﻦﺘﻓﺎﯾ يرﺎﻤﯿﺑ ﻦﯾا ﺺﯿﺨﺸﺗ رد ﻞﺋﺎﺴﻣ ﻦﯾﺮﺘﻤﻬﻣ زا يﺮﯿﮔرد ﺖﻌﺳو و ﻮﻀﻋ ،ﻞﺤﻣ .ﺖﺳا
لﻮﻃ و عﻮﻧ ﻪﮐ اﺮﭼ
ﺘﻧا سﺎﺳا ﻦﯾا ﺮﺑ نﺎﻣرد تﺪﻣ نارﺎﻤﯿﺑ مﺎﻤﺗ .دﻮﺷ ﯽﻣ بﺎﺨ
هﺪﻧﺮﯿﮔ ﺖﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺑا ﻪﺑ كﻮﮑﺸﻣ ﻪﮐ يﺪﻧﻮﯿﭘ ﻮﻀﻋ ي زا ﯽﺼﯿﺨﺸﺗ ﻞﻣﺎﮐ ﯽﺳرﺮﺑ ﺖﺤﺗ ﺪﯾﺎﺑ ﺪﻨﺘﺴﻫ ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ
ﺎﻣ ﺰﯿﻟﺎﻧآ و نﻮﺧ ﺖﺸﮐ ﻪﻠﻤﺟ يﺰﻐﻣ ﻊﯾ
- .ﺪﻧﺮﯿﮕﺑ راﺮﻗ ﯽﻋﺎﺨﻧ
ﺎﺗ نﻮﺧ ﺖﺸﮐ 45
ﺖﯾﺰﻨﻨﻣ ﻪﺑ ﻼﺘﺑا دراﻮﻣ ﺪﺻرد
و يﻮﯾر يﺮﯿﮔرد ﺎﻬﻨﺗ ﺮﮔا .دﻮﺷ ﯽﻣ ﺖﺒﺜﻣ ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ ﮋﻨﻨﻣ يﺮﯿﮔرد در زا ﺲﭘ ،ﺪﺷﺎﺑ ﻪﺘﺷاد دﻮﺟو يﻮﯾر تﺎﻌﯾﺎﺿ ﮋﻨﻨﻣ يﺮﯿﮔرد نوﺪﺑ ﺎﯾ ﺎﺑ رﻻﻮﺋﻮﻟآﻮﮑﻧوﺮﺑ ژاوﻻ ﮏﯾ مﺎﺠﻧا ﺪﯾﺎﺑ يﺮﯿﮔرد ﯽﺳرﺮﺑ رد .دﻮﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد ﺪﯾﺎﺑ ﯽﺒﺼﻋ ﻢﺘﺴﯿﺳ
يﺰﻐﻣ ﻊﯾﺎﻣ زا يرادﺮﺑ ﻪﻧﻮﻤﻧ -
،ﺰﯿﻟﺎﻧآ ياﺮﺑ و مﺎﺠﻧا ﯽﻋﺎﺨﻧ
دﻮﺷ هدﺎﺘﺳﺮﻓ ﺖﺸﮐ و يﺰﯿﻣآ ﮓﻧر .
ﻦﯾا ﯽﻌﻄﻗ ﺺﯿﺨﺸﺗ
ﺖﺸﮐ سﺎﺳا ﺮﺑ ﺖﻧﻮﻔﻋ ﻢﺴﯿﻧﺎﮔراوﺮﮑﯿﻣ نﺪﯾد و CSF
ﺖﺳا ﻤﻫ ، ﻪﻧﻮﮔ ﺺﯿﺨﺸﺗ رد ﻢﺴﯿﻧﺎﮔرا ﺖﺸﮐ ﻦﯿﻨﭽ ي
ﯽﺳرﺮﺑ رد ﻪﮐ ﺖﺳا ﺪﻨﻤﺷزرا ﯽﭼرﺎﻗ رد هﺪﺷ مﺎﺠﻧا يﺎﻫ
ﻦﯾا رﺎﻤﯿﺑ ﻬﻧ رد ،ﻪﻌﻟﺎﻄﻣ
يﺰﻐﻣ ﻊﯾﺎﻣ ﺖﺸﮐ رد ﺖﯾﺎ -
ﯽﻋﺎﺨﻧ
ﻪﻧﻮﮔ ﺮﮕﯾد زا .ﺪﺷ هﺪﻫﺎﺸﻣ ﺲﻨﻣرﻮﻓﻮﺌﻧ سﻮﮐﻮﮐﻮﺘﭙﯾﺮﮐ ي
ﯽﺼﯿﺨﺸﺗ يﺎﻫ راﺰﺑا زا ﻞﺒﻗ ﺪﯾﺎﺑ ﻪﮐ ﺖﺳا يﺰﻐﻣ ﻦﮑﺳاCT
هدﻮﺗ تﺎﻌﯾﺎﺿ در ﺖﻬﺟLP طﻮﺑﺮﻣ ﯽﻟﺎﻔﺳورﺪﯿﻫ و هﻮﻘﻟﺎﺑ يا
ﺶﯾاﺰﻓا ﻪﺑ دﻮﺷ مﺎﺠﻧاICP
) 4،5 (.
مﺎﺠﻧا زا ﺲﭘ ﻣ ﻪﻌﻟﺎﻄﻣ درﻮﻣ رﺎﻤﯿﺑ رد LP
يﺰﻐﻣ ﻊﯾﺎ
ﻞﺑﺎﻗ رﻮﻃ ﻪﺑ رﺎﻤﯿﺑ دردﺮﺳ و هﺪﺷ جرﺎﺧ رﺎﺸﻓ ﺎﺑ ﯽﻋﺎﺨﻧ ﻪﮐ ﺖﺳا هﺪﺷ ناﻮﻨﻋ تﺎﻌﻟﺎﻄﻣ رد ،دﺮﮐ اﺪﯿﭘ ﺶﻫﺎﮐ ﯽﻬﺟﻮﺗ ﻞﮐ رﻮﻃ ﻪﺑ 50
ﺎﺗ 70 د ﮋﻨﻨﻣ يﺮﯿﮔرد ﺎﺑ نارﺎﻤﯿﺑ ﺪﺻرد رﺎﭼ
ﺪﻨﺘﺴﻫ يا ﻪﻤﺠﻤﺟ ﻞﺧاد رﺎﺸﻓ ﺶﯾاﺰﻓا )
( ICP ) 5 (.
ﺰﮔ ﯾ ﻪﻨ ﻧﺎﻣرد ﯽ اﺮﺑ ي ﺮﮐ ﯾ ﻮﮐﻮﮐﻮﺘﭙ س سﺎﺳاﺮﺑ ﻞﺤﻣ
ﮔرد ﯿﺮ ي ﺑ تﺪﺷ ، ﯿ رﺎﻤ ي ﻌﺿو و ﯿ ﺖ اﯾ ﻨﻤ ﯽ ﻣز ﯿ ﻪﻨ ا ي ﺑﯿ رﺎﻤ
.دﻮﺷ ﯽﻣ بﺎﺨﺘﻧا اﺮﺑ
ي ﺑﯿ نارﺎﻤ ﺒﻣ ﻪﺑ ﻼﺘ يﺮﯿﮔرد ،CNS
ﻧﺎﻣرد فاﺪﻫا ﯽ
ر ﯾ ﻪﺸ ندﺮﮐ ﻦﮐ ﯾﺎ
ﺖﻧﻮﻔﻋ لﺮﺘﻨﮐ ﺪﻣ ،
ﯾﺮ ﯾ ﺖ
ﻓﺎﮐ ﯽ ﮔﻮﻠﺟ و ﻻﺎﺑ ICP ﯿﺮ
ي ﺒﺼﻋ ضراﻮﻋ زا ﯽ
ﻧﻻﻮﻃ ﯽ تﺪﻣ
ﺖﺳا و اﺮﺑ ي ﺑﯿ نارﺎﻤ ﻪﺑ ﻼﺘﺒﻣ يﺮﯿﮔرد ر ﯾﻮ ي رد فاﺪﻫا ، نﺎﻣ
رﯾ ﻪﺸ ﺑ ندﺮﮐ ﻦﮐ ﯿ
رﺎﻤ ي ﮔﻮﻠﺟ و ﯿﺮ ي رد رﺎﺸﺘﻧا زا CNS
.ﺪﺷﺎﺑ ﯽﻣ ﺑ مﺎﻤﺗ رد ﯿ
نارﺎﻤ ﻪﺑ ﻼﺘﺒﻣ ﯿﮔرد
يﺮ ﯾﺎCNS ﺑﯿ رﺎﻤ ي
ﺮﺸﺘﻨﻣ نﺎﻣرد ، ﺪﺿ چرﺎﻗ ﺳﻻﻮﻣﺮﻓ ﺎﺑ ﯿ
نﻮ ﺮﺗﻮﻔﻣآ ﯾ ﺴ ﯿ ﻦ و B
5 - ﺳﻮﻠﻓ ﯿ زﻮﺘ ﯾ ﻦ دﺎﻬﻨﺸﯿﭘ ﻣ ﯽ دﻮﺷ ) 4-6 ( وراد ود ﻦﯾا ﻪﮐ
تﺪﻣ ﻪﺑ ﻞﻗاﺪﺣ 2
ﺎﺑ نﺎﻣرد نآ زا ﺲﭘ و هﺪﺷ ﺰﯾﻮﺠﺗ ﻪﺘﻔﻫ
تﺪﻣ ﻪﺑ ﻞﻗاﺪﺣ لوزﺎﻧﻮﮐﻮﻠﻓ 8
ﺎﺗ 10 ﺪﺑﺎﯾ ﻪﻣادا ﻪﺘﻔﻫ )
3 ( .
ﺳﻻﻮﻣﺮﻓ زا هدﺎﻔﺘﺳا ﯿ
نﻮ ﻟﯿ ﭙﯿ ﺪ ي ﺮﺗﻮﻔﻣآ ﯾ ﺴ ﯿ ﻦ ﻪﺑ B ﻟد ﯿ ﻞ
ﻤﺳ ﺶﻫﺎﮐ ﯿ
ﺖ يﻮﯿﻠﮐ ﺮﺗﻮﻔﻣآ ﻪﺑ ﯾ
ﺴ ﯿ ﻦ تﻻﻮﮑﯿﺴﮐﻮﺋد B
ﺟﺮﺗ ﯿ ﺢ ﻣ هداد ﯽ ا ﺮﺑ هوﻼﻋ .دﻮﺷ ﯾ
ﻦ ﻣ و گﺮﻣ ، ﯿﺮ
رد
ﮔﯿ نﺎﮔﺪﻧﺮ ﺪﻧﻮﯿﭘ ﺮﮐ ﻪﺑ ﻼﺘﺒﻣ ﯾ
زﻮﮐﻮﮐﻮﺘﭙ زا هدﺎﻔﺘﺳا ﺎﺑCNS
ﺳﻻﻮﻣﺮﻓ ﯿ نﻮ ﻟﯿ ﭙﯿ ﺪ ي ﺮﺗﻮﻔﻣآ ﯾ ﺴ ﯿ ﻦ 90 B زور زا ﺮﺘﻤﮐ
ﺮﺗﻮﻔﻣآ ﯾ ﺴ ﯿ ﻦ ﺴﮐﻮﺋد ﯽ دﻮﺑ تﻻﻮﮐ ﺖﺳا ه
) 5 (.
و ﻦﯿﺴﯾﺮﺗﻮﻔﻣآ ﺎﺑ نﺎﻣرد ﺖﺤﺗ ﺎﻣ رﺎﻤﯿﺑ ﺖﯾﺎﻬﻧ رد تﺪﻣ ﻪﺑ ﻦﯾزﻮﺘﯿﺳﻮﻠﻓ 14
ﻮﺒﻬﺑ زا ﺲﭘ ﻪﮐ ﺪﺘﻓﺮﮔ راﺮﻗ زور يد
.ﺪﻧﺪﺷ ﺺﺧﺮﻣ نﺎﺘﺳرﺎﻤﯿﺑ زا بﻮﺧ ﯽﻣﻮﻤﻋ لﺎﺣ ﺎﺑ ﯽﺒﺴﻧ ﺎﺑ
ﻪﻘﺑﺎﺳ ﻪﺑ ﻪﺟﻮﺗ درﻮﻣ رﺎﻤﯿﺑ رد ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ و ﺖﺑﺎﯾد ي
ﺮﻫ ﻪﮐ ﻪﻌﻟﺎﻄﻣ و ﯽﻨﻤﯾا ﻢﺘﺴﯿﺳ ﻒﻌﺿ ﻞﻠﻋ زا ﻞﻣﺎﻋ ود
يﺎﻫرﻮﺘﮐﺎﻓ رد ﺮﻄﺧ
ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ ﺖﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺑا .ﺪﻨﺘﺴﻫ
ﺖﻧﻮﻔﻋ ﻪﺑ كﻮﮑﺸﻣ ﻢﯾﻼﻋ عوﺮﺷ ﻪﺟﻮﺗ ﺐﻟﺎﺟ ﻪﺘﮑﻧ سوﺮﯾو ﻪﺑ ﻼﺘﺑا زا ﺲﭘ هﺎﻣ ﮏﯾ ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ COVID-
ﺑ ار ﻪﻧﺎﻤﮔ ﻦﯾا ﻪﮐ دﻮﺑ 19 ﺮ
ﯽﻣ ﻪﮐ دﺰﯿﮕﻧا ﻪﺑ ﻼﺘﺑا
COVID-19 ﺖﺳا ﻦﮑﻤﻣ ﺰﯿﻧ
ﯽﻨﻤﯾا ﻢﺘﺴﯿﺳ ﺮﺑ ﺮﺛا ﺎﺑ
ﺖﻧﻮﻔﻋ نﻮﭽﻤﻫ يﺪﻌﺑ يﺎﻫ ﺖﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺑا ياﺮﺑ ار ﻪﻨﯿﻣز .ﺪﻨﮐ ﻢﻫاﺮﻓ ﯽﮐﻮﮐﻮﺘﭙﯾﺮﮐ
ﺮﮑﺸﺗ ﯽﻧادرﺪﻗ و
ﻪﻌﻟﺎﻄﻣ مﻮﻠﻋ هﺎﮕﺸﻧاد قﻼﺧا ﻪﺘﯿﻤﮐ ﻂﺳﻮﺗ ﺮﺿﺎﺣ لﺎﺣ ي
قﻼﺧا ﺪﮐ ﺎﺑ نﻼﯿﮔ ﯽﮑﺷﺰﭘ IR.GUMS.REC.1399.196
درﻮﻣ ﺗﺄ ﺪﯿﯾ .ﺖﺳا ﻪﺘﻓﺮﮔ راﺮﻗ
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A case report of Cryptococcus neoformans meningitis after recovery from COVID-19 infection in a kidney transplant recipient patient
Ramezanzadeh E1, Nikfarjam S2*
1. Assistant Professor, Razi Clinical Research Development Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
2. Assistant Professor, Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran, [email protected]
Received: 27 March 2021 Accepted: 22 Nov 2021
Abstract
Background: Fungal infections in transplant recipient patients are among the main causes of mortality and disability due to immunosuppression. Involvement of the central nervous system because of fungal infections is one of the important and treatable factors in such patients. This study investigated a case of a 58-year-old diabetic patient with a history of kidney transplantation infected by cryptococcal meningitis 3 months after recovery from coronavirus disease 2019 (COVID-19) infection. A 58-year-old diabetic patient with a history of kidney transplantation presented with a complaint of prolonged headache, fever, nausea, and vomiting. The patient was admitted to the same center 3 months before with a diagnosis of COVID-19 infection. The examinations performed after cerebrospinal fluid sampling showed a slight reduction in the patient's neurological symptoms, and the analysis of cerebrospinal fluid and the use of Indian culture and ink demonstrated evidence of fungal infection. After treatment with Amphotericin and Flowocytosine, the patient was discharged from the hospital in a good general condition.
Keywords: Cryptococcus neoformans, Kidney transplantation, Meningitis.
*Citation: Ramezanzadeh E, Nikfarjam S. A case report of Cryptococcus neoformans meningitis after recovery from COVID-19 infection in a kidney transplant recipient patient. Yafte. 2022; 23(5):80-86.