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肺隐球菌病。

Pulmonary cryptococcosis.

机构信息

Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.

出版信息

Semin Respir Crit Care Med. 2011 Dec;32(6):727-34. doi: 10.1055/s-0031-1295720. Epub 2011 Dec 13.

Abstract

Cryptococcosis is an invasive fungal infection (IFI), caused predominantly by Cryptococcus neoformans or Cryptococcus gattii, that affects both immunocompromised (IC) and non-IC patients. Although the most serious disease manifestation is meningoencephalitis, cryptococcal pneumonia is underdiagnosed and may disseminate to the central nervous system (CNS) and other sites depending upon host defenses and administration of appropriate antifungal therapy. The clinical presentation of pulmonary cryptococcosis varies along a spectrum from asymptomatic infection to severe pneumonia and respiratory failure, and the radiological presentation can be characterized by an array of findings, including nodules, consolidation, cavitary lesions, and a diffuse interstitial pattern. Diagnosis most often relies upon isolation of Cryptococcus from a pulmonary specimen in the appropriate clinical and radiological context. Treatment recommendations include induction therapy with an amphotericin B preparation and flucytosine for IC patients and those with severe disease and fluconazole for mild-to-moderate, localized disease. Knowledge of the pathophysiology, epidemiology, clinical presentation, and treatment of pulmonary cryptococcosis may lead to greater recognition of this underdiagnosed IFI and improved outcomes.

摘要

隐球菌病是一种侵袭性真菌感染(IFI),主要由新型隐球菌或格特隐球菌引起,影响免疫功能低下(IC)和非免疫功能低下的患者。虽然最严重的疾病表现是脑膜脑炎,但隐球菌性肺炎诊断不足,并且根据宿主防御和适当的抗真菌治疗,可能会播散到中枢神经系统(CNS)和其他部位。肺部隐球菌病的临床表现从无症状感染到严重肺炎和呼吸衰竭不等,影像学表现可表现为多种表现,包括结节、实变、空洞病变和弥漫性间质模式。诊断通常依赖于在适当的临床和影像学背景下从肺部标本中分离出隐球菌。治疗建议包括诱导治疗,对于 IC 患者和严重疾病患者以及轻度至中度、局限性疾病患者,使用两性霉素 B 制剂和氟胞嘧啶;对于轻度至中度、局限性疾病患者,使用氟康唑。了解肺部隐球菌病的病理生理学、流行病学、临床表现和治疗方法可能会导致更多地认识到这种诊断不足的 IFI,并改善预后。

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