Aberg J A, Mundy L M, Powderly W G
AIDS Clinical Trials Unit, San Francisco General Hospital AIDS Program, University of California 94110, USA.
Chest. 1999 Mar;115(3):734-40. doi: 10.1378/chest.115.3.734.
To further elucidate the diagnostic and therapeutic approaches to patients with pulmonary cryptococcosis who are not HIV-infected.
All of the patients without HIV infection who received care at two Midwest hospitals between January 1986 and February 1996 and had a respiratory isolate of Cryptococcus neoformans.
The medical records of the study patients were reviewed for demographic data, host immune status, respiratory symptoms, diagnostic studies, treatment, and follow-up.
Forty-two patient presentations comprised the overall study group. Thirty-six patients (85.7%) had no evidence of dissemination, and six patients (14.3%) had disseminated disease. Seven of the 36 patient presentations were definitive pulmonary cryptococcosis, 15 were presumptive disease, and 14 were colonization with C neoformans. Neither the baseline demographic parameters nor the immune status appeared to discriminate the patients with disease from the patients with colonization. A serum cryptococcal antigen (sCRAG) was positive for 7 of 18 patients, 3 of whom were proven by culture to have a disseminated infection. A negative sCRAG was observed in 11 patients, one of whom had proven dissemination. Fifteen patients underwent a lumbar puncture as part of their evaluation, and cryptococcal meningitis was diagnosed in three of these patients, all of whom had positive blood cultures for C neoformans. The majority of the patients did not receive antifungal therapy.
In the majority of the patients, the lung appeared to be the sole organ involved, and a workup for systemic infection was rarely helpful. A positive sCRAG was not specific for dissemination. Antifungal therapy should be reserved for symptomatic patients, for patients with a positive sCRAG, and for patients with underlying immunosuppression.
进一步阐明非HIV感染的肺隐球菌病患者的诊断和治疗方法。
1986年1月至1996年2月期间在中西部两家医院接受治疗且呼吸道分离出新型隐球菌的所有非HIV感染患者。
查阅研究患者的病历，获取人口统计学数据、宿主免疫状态、呼吸道症状、诊断检查、治疗及随访信息。
42例患者构成了整个研究组。36例患者（85.7%）无播散证据，6例患者（14.3%）有播散性疾病。36例患者中，7例为确诊的肺隐球菌病，15例为疑似病例，14例为新型隐球菌定植。基线人口统计学参数和免疫状态均无法区分患病患者和定植患者。18例患者中有7例血清隐球菌抗原（sCRAG）呈阳性，其中3例经培养证实有播散性感染。11例患者sCRAG呈阴性，其中1例经证实有播散。15例患者在评估过程中接受了腰椎穿刺，其中3例被诊断为隐球菌性脑膜炎，所有这些患者的血培养新型隐球菌均呈阳性。大多数患者未接受抗真菌治疗。
在大多数患者中，肺似乎是唯一受累器官，对全身感染的检查很少有帮助。sCRAG阳性并非播散的特异性指标。抗真菌治疗应保留给有症状的患者、sCRAG阳性的患者以及有潜在免疫抑制的患者。
