Shirley Rhett M, Baddley John W
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA.
Curr Opin Pulm Med. 2009 May;15(3):254-60. doi: 10.1097/MCP.0b013e328329268d.
Cryptococcosis is an important opportunistic fungal infection, especially in the immunocompromised patient. Meningitis is the most common manifestation of cryptococcosis; however, cryptococcal lung disease is probably underdiagnosed, and knowledge of epidemiology, diagnosis, and treatment is necessary.
Cryptococcal lung disease ranges from asymptomatic colonization or infection to severe pneumonia with respiratory failure. Clinical presentation of pulmonary cryptococcosis is highly variable and often is related to the immune status of the patient. There have been many important clinical trials outlining treatment of cryptococcal meningitis in patients with AIDS, but there is a lack of treatment data available for patients with cryptococcal lung disease. Treatment recommendations for cryptococcal lung disease are made on the basis of host immune status and severity of clinical illness. For less severe disease, fluconazole therapy is recommended. In immunocompromised patients, or those with severe disease, induction therapy with an amphotericin B preparation and flucytosine, followed by fluconazole as consolidation and maintenance therapy, is recommended.
Cryptococcal lung disease is an important and probably underdiagnosed infection. Knowledge of the epidemiology, diagnostic methodologies, and treatment is needed to ensure good patient outcomes.
隐球菌病是一种重要的机会性真菌感染，尤其在免疫功能低下的患者中。脑膜炎是隐球菌病最常见的表现；然而，隐球菌性肺病可能未得到充分诊断，因此有必要了解其流行病学、诊断和治疗方法。
隐球菌性肺病的范围从无症状定植或感染到伴有呼吸衰竭的严重肺炎。肺隐球菌病的临床表现高度多变，且通常与患者的免疫状态有关。已经有许多重要的临床试验概述了艾滋病患者隐球菌性脑膜炎的治疗方法，但对于隐球菌性肺病患者，缺乏可用的治疗数据。隐球菌性肺病的治疗建议是根据宿主免疫状态和临床疾病的严重程度做出的。对于病情较轻的患者，建议使用氟康唑治疗。对于免疫功能低下的患者或病情严重的患者，建议先用两性霉素B制剂和氟胞嘧啶进行诱导治疗，随后用氟康唑进行巩固和维持治疗。
隐球菌性肺病是一种重要且可能未得到充分诊断的感染。需要了解其流行病学、诊断方法和治疗方法，以确保患者获得良好的治疗效果。
