Driver J A, Saunders C A, Heinze-Lacey B, Sugar A M
Evans Memorial Department of Clinical Research, Boston University Medical Center Hospital, MA 02118, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Jun 1;9(2):168-71.
Identification of cryptococcal infection while it is still in its pulmonary phase might improve the prognosis for patients with AIDS who contract cryptococcosis. Since cryptococcal pneumonia is infrequently diagnosed in the AIDS patient, especially compared with the frequency of diagnosis of cryptococcal meningitis, this retrospective study was designed to investigate the frequency of pulmonary complaints in the months before diagnosis of cryptococcal meningitis. The medical records of 18 patients diagnosed with cryptococcal meningitis were analyzed. Of 18 patients, 14 (78%) had respiratory symptoms during the 4-month period before meningitis appeared, as compared with nine of 18 (50%) at the time of diagnosis and four of 16 (25%) in the 4 months following diagnosis. Seven of the 14 cases of pulmonary disease prediagnosis were of unknown etiology; three were eventually diagnosed as cryptococcal infections during evaluation of the meningitis. The remaining eight infections were attributed to bacteria, respiratory viruses, or Pneumocystis carinii, although three of these cultures also contained yeast, presumed to be Candida species, which were not further examined. Our data suggest the importance of singling out AIDS patients who may have pulmonary cryptococcosis. Cryptocococcsis should be included in the differential diagnosis of pulmonary infection in HIV-positive patients with CD4+ lymphocyte counts < 200/mm3, and full identification of yeasts recovered from sputum or bronchoalveolar lavage fluid cultures should be done. A larger study should be undertaken to better define the incidence of clinically recognizable pulmonary cryptococcosis in AIDS patients.
在隐球菌感染仍处于肺部阶段时进行识别，可能会改善感染隐球菌病的艾滋病患者的预后。由于艾滋病患者中隐球菌肺炎的诊断并不常见，尤其是与隐球菌性脑膜炎的诊断频率相比，因此本回顾性研究旨在调查隐球菌性脑膜炎诊断前几个月肺部症状的出现频率。对18例诊断为隐球菌性脑膜炎的患者的病历进行了分析。18例患者中，14例（78%）在脑膜炎出现前的4个月内有呼吸道症状，而在诊断时18例中有9例（50%）出现呼吸道症状，诊断后4个月内16例中有4例（25%）出现呼吸道症状。预诊断时14例肺部疾病中有7例病因不明；其中3例在脑膜炎评估过程中最终被诊断为隐球菌感染。其余8例感染归因于细菌、呼吸道病毒或卡氏肺孢子虫，尽管其中3份培养物中也含有酵母，推测为念珠菌属，但未进一步检查。我们的数据表明识别可能患有肺部隐球菌病的艾滋病患者的重要性。对于CD4 +淋巴细胞计数<200/mm3的HIV阳性患者，肺部感染的鉴别诊断应包括隐球菌病，并且应全面鉴定从痰液或支气管肺泡灌洗液培养物中分离出的酵母。应开展更大规模的研究，以更好地确定艾滋病患者中临床可识别的肺部隐球菌病的发病率。
