Ni L F, Wang H, Li H, Zhang Z G, Liu X M
Department of Geriatrics, Peking University First Hospital, Beijing 100034, China.
Department of Radiology, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Oct 18;50(5):855-860.
To improve the understanding of the clinical features of pulmonary cryptococcosis in non-human immunodeficiency virus (non-HIV) infection patients and reduce delay in diagnosis, or misdiagnosis.
The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 34 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Peking University First Hospital from June 1997 to June 2016.
There were 34 cases diagnosed with pulmonary cryptococcosis, including 22 males and 12 females, aged from 20 to 75 years [average: (50.1±15.0) years]. There were 16 cases with host factors and (or) underlying diseases named immunocompromised group. In the study, 67.6% patients had clinical symptoms while 32.4% patients had no symptoms. The most common symptoms included cough, fever, chest pain, shortness of breath, and hemoptysis in sequence. Common chest imaging findings were patchy infiltrates, consolidation, single or multiple nodular or masses shadows. Among the 20 cases with cryptococcal capsular polysaccharide antigen detection, 19 were positive. Eleven cases underwent routine cerebrospinal fluid examination, and 3 cases complicated with central nervous system cryptococcal infection. At first visit, 24 cases were misdiagnosed, among which, 11 cases were misdiagnosed as lung cancer. The diagnosis of 15 cases was proved by percutaneous lung biopsy and 11 were confirmed by surgery, while 8 were diagnosed clinically. Then 11 cases were treated by surgical resection, and in median 4 years' followp, there was 1 case of recurrence. And 23 cases were treated with antifungal therapy, and in median 8 years' follow-up, 3 cases lost to the follow-up and 1 case of recurrence. Compared with normal immune group, immunocompromised patients had higher ages (P=0.017), more crackles (P=0.006) and more percentage of increase of peripheral white blood cells or neutrophils (P=0.003), but no significant difference in symptoms, imaging characteristics or hospitalization time.
There were no specific clinical symptoms and signs for pulmonary cryptococcosis in non-HIV patients. Diagnosis of pulmonary cryptococcosis depends on pathology. Percutaneous lung biopsy was mostly recommended for clinical highly suspected patients. Cryptoeoccal capsular polysaccharide antigen detection had a high sensitivity for the clinical diagnosis. Antifungal drug therapy was the major treatment, and the prognosis of the most patients was good.
提高对非人类免疫缺陷病毒（非HIV）感染患者肺隐球菌病临床特征的认识，减少诊断延迟或误诊。
回顾性分析34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1997年6月至2016年6月北京大学第一医院。
共34例诊断为肺隐球菌病，其中男性22例，女性12例，年龄20～75岁[平均（50.1±15.0）岁]。有宿主因素和（或）基础疾病者16例，为免疫功能低下组。本研究中，67.6%的患者有临床症状，32.4%的患者无症状。最常见症状依次为咳嗽、发热、胸痛、气短和咯血。常见胸部影像学表现为斑片状浸润、实变、单发或多发结节或肿块影。20例行隐球菌荚膜多糖抗原检测的患者中，19例阳性。11例行常规脑脊液检查，3例合并中枢神经系统隐球菌感染。初诊时24例误诊，其中11例误诊为肺癌。15例经皮肺穿刺活检确诊，11例手术确诊，8例临床诊断。11例手术切除治疗，中位随访4年，复发1例。23例抗真菌治疗，中位随访8年，失访3例，复发1例。与免疫正常组相比，免疫功能低下患者年龄更大（P=0.017），啰音更多（P=0.006），外周血白细胞或中性粒细胞升高比例更高（P=0.003），但症状、影像学特点及住院时间差异无统计学意义。
非HIV患者肺隐球菌病无特异性临床症状和体征。肺隐球菌病的诊断依赖于病理检查。对于临床高度怀疑患者，大多推荐经皮肺穿刺活检。隐球菌荚膜多糖抗原检测对临床诊断有较高敏感性。抗真菌药物治疗为主要治疗方法，多数患者预后良好。
