Kontoyiannis D P, Peitsch W K, Reddy B T, Whimbey E E, Han X Y, Bodey G P, Rolston K V
Department of Internal Medicine Specialties, Section of Infectious Diseases, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Clin Infect Dis. 2001 Jun 1;32(11):E145-50. doi: 10.1086/320524. Epub 2001 May 4.
Records of 31 patients with cancer who did not have known human immunodeficiency virus infection and who developed culture-proven cryptococcosis during the period of 1989-1999 (incidence of 18 cases per 100,000 admissions) were retrospectively reviewed. Several presentations of cryptococcosis were seen, including pulmonary in 19 patients (13 of which were symptomatic), disseminated in 6, meningeal in 3, and other, less common manifestations in 3. Hematologic malignancy (in 20 patients [65%]) was the most common underlying disease. Lymphopenia was present in 19 patients (61%). Previous steroid use was noted in 16 patients (51%). The diagnosis of cryptococcosis was rarely suspected; lung and brain malignancy were frequent initial impressions. Cryptococcosis was diagnosed postmortem in only 2 cases (6%). In cases of both pulmonary and meningeal cryptococcosis, the yield of invasive diagnostic procedures was good. Antifungal treatment was heterogeneous, but only 18% of patients who received it had treatment failure. Fluconazole monotherapy was successful in 92% of patients. In conclusion, cryptococcosis is rare in patients with cancer and appears to have a relatively good diagnostic yield and therapeutic outcome.
对1989年至1999年期间31例未感染人类免疫缺陷病毒且发生经培养证实的隐球菌病的癌症患者的记录进行了回顾性分析（每100,000例入院患者中发病率为18例）。观察到隐球菌病有多种表现形式，包括19例肺部感染（其中13例有症状）、6例播散性感染、3例脑膜感染以及3例其他较罕见的表现形式。血液系统恶性肿瘤（20例患者[65%]）是最常见的基础疾病。19例患者（61%）存在淋巴细胞减少。16例患者（51%）曾使用过类固醇。隐球菌病很少被怀疑；肺部和脑部恶性肿瘤是常见的初步诊断印象。仅2例（6%）患者在死后诊断出隐球菌病。在肺部和脑膜隐球菌病病例中，侵入性诊断程序的阳性率较高。抗真菌治疗方法不一，但接受治疗的患者中只有18%治疗失败。氟康唑单药治疗在92%的患者中取得成功。总之，隐球菌病在癌症患者中较为罕见，似乎具有相对较好的诊断阳性率和治疗效果。
