隐球菌病容易与哪些疾病混淆？

　　新形隐球菌较其他病原微生物容易被发现，脑脊液的墨汁涂片及真菌培养极为重要。鉴于结核性脑膜炎、脑脓肿、部分治疗的化脓性脑膜炎、颅内肿瘤、其他真菌体脑膜炎的脑脊液改变均与隐球菌脑膜炎相似，故是鉴别诊断的重点。隐球菌脑膜炎和结核性脑膜炎及脑肿瘤的鉴别见表1。

　　表1　隐球菌脑膜炎与结核性脑膜炎及脑肿瘤的鉴别

              
                            
                                          病?名
                                          隐球菌脑膜炎
                                          结核性脑膜炎
                                          脑肿瘤
                            
                            
                                          起病
                                          多缓慢，可呈亚急性
                                          多呈亚急性
                                          慢性
                            
                            
                                          发热
                                          早期不明显，以后多不规则
                                          病程中较早出现发热
                                          多无发热
                            
                            
                                          颅神经受累
                                          视神经病变及乳头水肿多见
                                          视神经乳头水肿少见外展神经受累多见，脉络膜上可见结核结节
                                          以外展神经为多
                            
                            
                                          脑脊液细胞数
                                          轻、中度增多，200／mm3以下多见
                                          中度增多，200～500／mm3
                                          正常或轻度增多
                            
                            
                                          糖
                                          明显减低
                                          多数在20～40mg/dl
                                          正常
                            
                            
                                          蛋白质
                                          轻、中度增加
                                          明显增加
                                          稍有增高，有蛋白细胞分离现象
                            
                            
                                          氯化物
                                          减低
                                          减低
                                          正常
                            
                            
                                          涂片查菌
                                          新形隐球菌
                                          结核杆菌
                                          无
                            
                            
                                          隐球菌抗原检测
                                          阳性
                                          阴性
                                          阴性
                            
                            
                                          脑电图
                                          弥漫性异常
                                          弥漫性异常
                                          多有定位性改变
                            
                            
                                          头颅CT及脑血管造影
                                          无特殊改变
                                          无特殊改变
                                          可有特殊改变
                            
              

　　皮肤隐球菌病借损害特征、病理及真菌培养而与粉刺、传染性软疣、皮肤结核、孢子丝菌病或恶性肿瘤相鉴别。

　　2.肺部隐球菌病?应与肺炎双球菌引起的大叶性肺炎、肺结核及肺念珠菌病、肺曲霉病等肺部感染疾病相鉴别。

　　3.其他隐球菌病?皮肤隐球菌病应与孢子丝菌病、着色芽生菌病及各种慢性溃疡相鉴别，骨隐球菌病应与骨肿瘤相鉴别。隐球菌性败血症应与细菌性败血症相鉴别。