Chen Meiyan, Chen Shuyang, Wang Meng, Wang Huijuan, Zeng Shengyuan, Zhuang Liying, Lai Guoxiang, Yu Zongyang, You Yanjing, Xie Baosong, Yao Xiujuan, Chen Xiangqi, Lin Lan, Lin Qunying, Hu Yuxiong, Xu Liyu, Li Xiaohua, Chen Xiaohong, Wu Danmei, Chen Gongping, Liu Kaixiong, She Hui, Lin Li, Yu Guoqing, Wen Wen
Department of Pulmonary and Critical Care Medicine, Fuzong Clinical Medical College of Fujian Medical University, Dongfang Hospital of Xiamen University, School of Medicine, Xiamen University, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, 350001, People's Republic of China.
Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
Respir Res. 2025 Jun 13;26(1):216. doi: 10.1186/s12931-025-03283-w.
This study investigates the clinical presentations, diagnostic approaches, and treatment outcomes of pulmonary cryptococcosis (PC) in non-HIV patients in Fujian Province, and explores the correlation between immunological status and clinical features.
A prospective, multicenter cohort study was conducted from April 2017 to March 2022, involving 234 PC patients from 47 hospitals in nine prefecture-level cities in southeastern China's Fujian Province.
The study included 145 male and 89 female PC patients, average age 50.66 ± 14.11 years. Immunological status varied: 115 immunocompetent, 17 with potential immunodeficiency due to certain comorbidities, 69 with mild-to-moderate immunodeficiency, and 33 with severe immunodeficiency. Diabetes mellitus was the most common comorbidity. The prevalence of PC is higher in Eastern Fujian (51.7%). 18.4% of patients were exposed to birds/pigeons droppings prior to admission. 37.6% of patients were asymptomatic. Cough and expectoration were common symptoms. Radiologically, multiple lesions with subpleural and lower lobe involvement were typical. The Cryptococcus capsular antigen (CrAg) test showed a sensitivity of 94.9%. Fluconazole was the primary treatment (87.0%), followed by voriconazole. At final follow-up, 85.4% of patients had recovered or improved.
PC incidence in non-HIV-infected adults in Fujian is higher in males. Most patients were immunocompetent and from eastern Fujian, with few significant environmental exposures. Clinical and radiological findings were non-specific, highlighting diagnostic challenges. The CrAg test is a valuable diagnostic tool. Treatment with fluconazole and voriconazole resulted in favorable outcomes.
本研究调查福建省非艾滋病患者肺隐球菌病（PC）的临床表现、诊断方法和治疗结果，并探讨免疫状态与临床特征之间的相关性。
2017年4月至2022年3月进行了一项前瞻性、多中心队列研究，纳入了中国东南部福建省9个地级市47家医院的234例PC患者。
该研究纳入145例男性和89例女性PC患者，平均年龄50.66±14.11岁。免疫状态各不相同：115例免疫功能正常，17例因某些合并症存在潜在免疫缺陷，69例有轻至中度免疫缺陷，33例有严重免疫缺陷。糖尿病是最常见的合并症。PC在福建东部的患病率较高（51.7%）。18.4%的患者在入院前接触过鸟类/鸽粪。37.6%的患者无症状。咳嗽和咳痰是常见症状。影像学上，典型表现为胸膜下和下叶受累的多发病变。隐球菌荚膜抗原（CrAg）检测的敏感性为94.9%。氟康唑是主要治疗药物（87.0%），其次是伏立康唑。在最后随访时，85.4%的患者已康复或病情改善。
福建省非艾滋病感染成年人中PC发病率男性较高。大多数患者免疫功能正常，来自福建东部，很少有明显的环境暴露。临床和影像学表现不具特异性，突出了诊断挑战。CrAg检测是一种有价值的诊断工具。氟康唑和伏立康唑治疗取得了良好效果。
