Balloul E, Couderc L J, Molina J M, Cahite I, Wolff M, Saimot A G, Caubarrère I
Service de Pneumologie, Hôpital Foch, Suresnes.
Rev Mal Respir. 1997 Nov;14(5):365-70.
We reviewed the records of 15 Human Immunodeficiency Virus (HIV) infected patients with pulmonary cryptococcosis (PC). PC was the first AIDS-defining manifestation in nine patients. HIV infection was identified simultaneously with the onset of PC in 4 patients. The CD4+ lymphocyte count was low in all cases (median, 24/m3). Chest radiography showed interstitial infiltrates in 13 instances, associated with pleural effusion in 5 cases and hilar adenopathy in 2 cases. In one case, chest-X-ray showed isolated pleural effusion and was normal in one patient. For 11 of 12 patients, bronchoalveolar lavage fluid culture was positive for Cryptococcus neoformans. Seven of 15 patients had evidence of extrapulmonary cryptococcal disease with positive cerebrospinal fluid culture. Serum cryptococcal antigen was detected in all 15 patients. Concomitant lung infection with Pneumocystis carinii was diagnosed in 4 patients. First-line regimen was fluconazole in 10 patients and amphotericin B in 4 patients. Fluconazole has been prescribed in 7 patients as a permanent suppressive therapy and should be continued indefinitely.
我们回顾了15例感染人类免疫缺陷病毒（HIV）并患有肺隐球菌病（PC）患者的病历。PC是9例患者的首个艾滋病界定指征。4例患者在PC发病时同时确诊HIV感染。所有病例的CD4 +淋巴细胞计数均较低（中位数为24/m³）。胸部X线检查显示13例有间质浸润，5例伴有胸腔积液，2例有肺门淋巴结肿大。1例胸部X线显示孤立性胸腔积液，1例患者正常。12例患者中有11例支气管肺泡灌洗 fluid培养新型隐球菌呈阳性。15例患者中有7例有肺外隐球菌病证据，脑脊液培养呈阳性。所有15例患者均检测到血清隐球菌抗原。4例患者同时诊断为卡氏肺孢子虫肺部感染。10例患者的一线治疗方案为氟康唑，4例为两性霉素B。7例患者已使用氟康唑作为长期抑制治疗，应无限期持续使用。
