Wang Lifang, Shi Yi, Ding Yuan, Wang Qin, Su Xin
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China.
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Zhonghua Jie He He Hu Xi Za Zhi. 2014 Oct;37(10):764-8.
To improve understanding of the clinical manifestations and imaging features of pulmonary cryptococcosis.
The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 65 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Nanjing General Hospital , Suqian Municipal People's Hospital and People's Liberation Army 81 Hospital from January 2001 to March 2013.
There were 65 proven cases diagnosed with pulmonary cryptococcosis, including 44 males and 21 females, aged from 12 to 73 years [average (44 ± 13) years]. The most common clinical symptoms included cough (n = 32), expectoration(n = 20) , fever (n = 16), and chest pain (n = 14), while some patients(n = 18) had no symptoms. Common chest imaging findings included single or multiple masses or nodules (n = 36), patchy infiltrates (n = 19, and mixed lesions (n = 10). Among the 21 cases with cryptococcal capsular polysaccharide antigen detection, 14 were positive. The antigen titre ( ≥ 1: 8 for positivity) was positively correlated with disease severity and lesion extent. The diagnosis of 45 cases was proven by percutaneous lung biopsy and 3 were diagnosed by bronchoscopic biopsy, while 17 were confirmed by surgery. Among 65 patients, 53 underwent Acute Physiology and Chronic Health EvaluationII (APACHEII) scoring, and 45 had a score of less than 10. Among them, 38 cases acquired complete or partial recovery, 4 were progressive and 3 died. Eight cases had a score of 10 or more, of whom 3 acquired complete or partial recovery, 1 was progressive and 4 died.
The most common clinical manifestations of pulmonary cryptococcosis were cough and expectoration and the most common chest imaging features were masses or nodular shadows. Percutaneous lung biopsy was a commonly used method to diagnose this disease. Cryptococcal capsular polysaccharide antigen detection was helpful for the diagnosis and management with a relatively high sensitivity. Antifungal drug therapy was the major treatment and a few patients may need surgery. The prognosis was better in patients with mild disease.
提高对肺隐球菌病临床表现及影像学特征的认识。
回顾性分析65例肺隐球菌病患者的临床特征、影像学特点、实验室检查、治疗及预后情况。数据收集自南京总医院、宿迁市人民医院及解放军第八一医院2001年1月至2013年3月期间的病例。
确诊肺隐球菌病65例，其中男性44例，女性21例，年龄12～73岁，平均（44±13）岁。最常见的临床症状包括咳嗽（32例）、咳痰（20例）、发热（16例）及胸痛（14例），部分患者（18例）无症状。胸部常见影像学表现为单发或多发肿块或结节（36例）、斑片状浸润影（19例）及混合性病变（10例）。21例行隐球菌荚膜多糖抗原检测的患者中，14例阳性。抗原滴度（阳性标准≥1:8）与疾病严重程度及病变范围呈正相关。45例经皮肺穿刺活检确诊，3例经支气管镜活检确诊，17例经手术确诊。65例患者中，53例行急性生理与慢性健康状况评分II（APACHEII），45例评分小于10分。其中38例获得完全或部分缓解，4例病情进展，3例死亡。8例评分大于或等于10分，其中3例获得完全或部分缓解，1例病情进展，4例死亡。
肺隐球菌病最常见的临床表现为咳嗽、咳痰，胸部影像学最常见表现为肿块或结节影。经皮肺穿刺活检是诊断该病的常用方法。隐球菌荚膜多糖抗原检测有助于诊断及病情监测，敏感性较高。抗真菌药物治疗是主要治疗方法，少数患者可能需要手术治疗。病情较轻患者预后较好。
