Kohno Shigeru, Kakeya Hiroshi, Izumikawa Koichi, Miyazaki Taiga, Yamamoto Yoshihiro, Yanagihara Katsunori, Mitsutake Kotaro, Miyazaki Yoshitsugu, Maesaki Shigefumi, Yasuoka Akira, Tashiro Takayoshi, Mine Mariko, Uetani Masataka, Ashizawa Kazuto
Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan.
J Infect Chemother. 2015 Jan;21(1):23-30. doi: 10.1016/j.jiac.2014.08.025. Epub 2014 Oct 29.
To clarify the clinical features of pulmonary cryptococcosis in Japanese non-HIV population.
Retrospective investigation of 151 pulmonary cryptococcosis cases between 1977 and 2012 was executed. The underlying disease (UDs), aggravating factors, radiological characteristics, and treatment were examined.
Sixty-seven patients (44.4%) had no UDs. The common UDs were diabetes (32.1%) followed by hematologic disease (22.6%), and collagen disease (22.6%). Peripherally distributed pulmonary nodules/masses were most commonly seen. Lesions in the right middle lobe (p = 0.01) and air bronchogram (P = 0.05) were significantly more frequent, respectively, in patients with UDs than patients without them. Azoles were mainly selected for the patients without meningoencephalitis. Mean treatment duration for patients with and without UDs was 6.64 and 2.87 months, respectively. Patients whose pulmonary nodules improved after treatment continued to experience gradual reduction of cryptococcosis antigen titers, even if antigen titers were positive at the time of treatment cessation. The average time for antigen titers to become negative after treatment cessation was 13.1 and 10.7 months for patients with and without UDs, respectively. When groups were compared according to the presence of meningoencephalitis complications, deaths, and survivals, factors contributing to cryptococcosis prognosis included higher age, hypoproteinemia, hypoalbuminemia, steroid use, high C-reactive protein levels, and meningoencephalitis complications.
It is crucial to consider the presence of UDs and meningoencephalitis for the choice of antifungals and treatment duration for cryptococcosis in non-HIV patients. Three- and six months-administration of azoles for pulmonary cryptococcosis with or without UDs, respectively is reasonable.
明确日本非HIV人群肺隐球菌病的临床特征。
对1977年至2012年间的151例肺隐球菌病病例进行回顾性调查。检查基础疾病（UDs）、加重因素、放射学特征及治疗情况。
67例患者（44.4%）无基础疾病。常见的基础疾病依次为糖尿病（32.1%）、血液系统疾病（22.6%）和结缔组织病（22.6%）。最常见的表现为外周分布的肺结节/肿块。基础疾病患者右中叶病变（p = 0.01）及空气支气管征（P = 0.05）分别显著多于无基础疾病患者。对于无脑膜脑炎的患者，主要选用唑类药物。有基础疾病和无基础疾病患者的平均治疗时长分别为6.64个月和2.87个月。治疗后肺部结节改善的患者，即使在停药时隐球菌抗原滴度为阳性，其抗原滴度仍会持续逐渐降低。停药后抗原滴度转阴的平均时间，有基础疾病患者为13.1个月，无基础疾病患者为10.7个月。根据是否合并脑膜脑炎并发症、死亡及生存情况对各组进行比较时，影响隐球菌病预后的因素包括高龄、低蛋白血症、低白蛋白血症、使用类固醇、高C反应蛋白水平及脑膜脑炎并发症。
对于非HIV患者隐球菌病抗真菌药物的选择及治疗时长，考虑基础疾病和脑膜脑炎的存在至关重要。对于有或无基础疾病的肺隐球菌病患者，分别给予3个月和6个月的唑类药物治疗是合理的。
