Clinical Analysis of 34 Cases of Pulmonary Cryptococcosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZONG Xiaofu ¹ , BAI Chong ² ,  WNAG Changhui ² , CHEN Jianghan ³ , LI Qiang ² , WANG Qing ¹ , ZHANG Ying ¹ , LIU Yunxia ¹

Department of Respiratory Medicine, The 81st Hospital of Chinese PLA. Nanjing, Jiangsu, 210002, China;

Corresponding author：

WNAG Changhui, Email: Wangch63@yahoo.com.cn

Keywords：

Pulmonary cryptococcosis; Imageology; Diagnosis; Treatment

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Objective To invesitgate the clinical characteristics, radiology, diagnosis and treatment of pulmonary cryptococcosis ( PC) . Methods The patients with PC diagnosed form January 2000 to January 2009 from three hospitals of Shanghai and Nanjing were retrospectively analyzed. Results A total of 34 patients were diagnosed, with 24 males and 10 females, and an average age of ( 40. 6 ±13. 5) years old ( ranged from 3 to 72 years) . Twelve patients had underlying diseases and 28 patients had symptoms. The main symptoms were pyrexia ( 20 cases) , cough and expectoration ( 22 cases) , chest pain ( 8 cases) , chest tightness ( 5 cases) , and hemoptysis ( 4 cases) . Seven cases were diagnosed as systemic pulmonary cryptococcosis, in which 3 cases were complicated with cryptococcal meningitis ( CM) , and 3 cases with CM and cryptococcal septicemia, and 1 cases with third dorsal vertebra Busse-Buschke disease. Radiologic manifestations showed multiformand nonspecific lesion such as nodus or nodules in 17 cases, pneumonia in 10 cases, mixed appearance in 6 cases, and diffused military nodes in 1 case. The diagnosis was confirmed by pathological study in 27 cases, including 12 cases by thoracotomy, 10 cases by percutaneous lung biopsy, 1 cases by thoracic vertebra biopsy, and 4 cases by bronchoscope. Ten cases were confirmed with culture positive or smear positive. Six cases were treated by surgery alone, 21 cases by antimycotic drug therapy alone, and 6 cases by drug therapy after surgery. One case quitted after the diagnosis. The duration of treatment varied from 2 weeks to 2 years. One case died in the hospital, 25 cases recovered after discharge, and 8 cases were lost to follow-up. Conclusions PC is likely to be misdiagnosed due to atypical clinical and image manifestations. The diagnosis is always comfirmed on the pathological and microbiological study.

Citation： ZONG Xiaofu,BAI Chong,WNAG Changhui,CHEN Jianghan,LI Qiang,WANG Qing,ZHANG Ying,LIU Yunxia. Clinical Analysis of 34 Cases of Pulmonary Cryptococcosis. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(5): 425-428. doi: Copy

1.	江森, 朱晓华, 孙兮文, 等. 肺隐球菌病临床和影像学分析. 上海医学影像, 2005, 14: 209-212.
2.	赖国祥, 张玉华, 林庆安, 等. 国内22 年肺隐球菌病回顾性分析. 中国实用内科杂志, 2005, 25: 176-178.
3.	熊维宁, 熊盛道, 徐永健, 等. 原发性肺隐球菌病一例报告并文献复习. 中国呼吸与危重监护杂志, 2006, 5: 459-460.
4.	刘莉, 胡莉娟, 周营营, 等. 社区感染隐球菌病临床特点分析. 中国呼吸与危重监护杂志, 2008, 7: 363-366.
5.	Visnegarwala F, Graviss EA, Lacke CE, et al. Acute respiratory failure associated with cryptococcosis in patients with AIDS: analysis of predictive factors. Clin Infect Dis, 1998, 27: 1231-1237.
6.	易祥华, 张容轩, 高文, 等. 临床酷似肺癌的肺隐球菌病12 例临床病理分析. 诊断病理学杂志, 2001, 8: 330-333.
7.	Vilchez RA, Linden P, Lacomis J, et al. Acute respiratory failure associated with pulmonary cryptococcosis in non-aids patients. Chest, 2001, 119: 1865-1869.
8.	陈中华. 肺隐球菌病的临床分析. 临床肺科杂志, 2006, 11 : 753 - 754.
9.	颜召文, 吴平平, 蔡军, 等. 急性肺隐球菌病合并肺出血尸检一例报道. 上海交通大学学报( 医学版) , 2007, 27: 1039-1040.
10.	Francis AB. Differential diagnosis in conventional radiology: pulmonary nodules and mass lesions. New York: Thieme-Stratton Inc, 1985, 380.
11.	梁荣光, 赖清, 陈永富, 等. 亚临床症状肺隐球菌病的影像学表现. 影像诊断与介入放射学, 2005, 14: 158-160.
12.	余秉翔, 刘又宁, 姬淑君. 国内隐球菌病17 例分析. 中华结核和呼吸杂志, 1997, 20: 172-173.
13.	Chechani V, Kamholz SL. Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS. Chest, 1990, 98: 1060-1066.
14.	Nunez M, Peacock JE, Chin R. Pulmonary Cryptococcosis in the Immunocompetent Host Therapy With Oral Fluconazole: A Report of Four Cases and a Review of the Literature. Chest, 2000, 118: 527- 534.
15.	Saag MS, Graybill RJ, Larsen RA, et al. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis, 2000, 30: 710- 718.

1. 江森, 朱晓华, 孙兮文, 等. 肺隐球菌病临床和影像学分析. 上海医学影像, 2005, 14: 209-212.
2. 赖国祥, 张玉华, 林庆安, 等. 国内22 年肺隐球菌病回顾性分析. 中国实用内科杂志, 2005, 25: 176-178.
3. 熊维宁, 熊盛道, 徐永健, 等. 原发性肺隐球菌病一例报告并文献复习. 中国呼吸与危重监护杂志, 2006, 5: 459-460.
4. 刘莉, 胡莉娟, 周营营, 等. 社区感染隐球菌病临床特点分析. 中国呼吸与危重监护杂志, 2008, 7: 363-366.
5. Visnegarwala F, Graviss EA, Lacke CE, et al. Acute respiratory failure associated with cryptococcosis in patients with AIDS: analysis of predictive factors. Clin Infect Dis, 1998, 27: 1231-1237.
6. 易祥华, 张容轩, 高文, 等. 临床酷似肺癌的肺隐球菌病12 例临床病理分析. 诊断病理学杂志, 2001, 8: 330-333.
7. Vilchez RA, Linden P, Lacomis J, et al. Acute respiratory failure associated with pulmonary cryptococcosis in non-aids patients. Chest, 2001, 119: 1865-1869.
8. 陈中华. 肺隐球菌病的临床分析. 临床肺科杂志, 2006, 11 : 753 - 754.
9. 颜召文, 吴平平, 蔡军, 等. 急性肺隐球菌病合并肺出血尸检一例报道. 上海交通大学学报( 医学版) , 2007, 27: 1039-1040.
10. Francis AB. Differential diagnosis in conventional radiology: pulmonary nodules and mass lesions. New York: Thieme-Stratton Inc, 1985, 380.
11. 梁荣光, 赖清, 陈永富, 等. 亚临床症状肺隐球菌病的影像学表现. 影像诊断与介入放射学, 2005, 14: 158-160.
12. 余秉翔, 刘又宁, 姬淑君. 国内隐球菌病17 例分析. 中华结核和呼吸杂志, 1997, 20: 172-173.
13. Chechani V, Kamholz SL. Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS. Chest, 1990, 98: 1060-1066.
14. Nunez M, Peacock JE, Chin R. Pulmonary Cryptococcosis in the Immunocompetent Host Therapy With Oral Fluconazole: A Report of Four Cases and a Review of the Literature. Chest, 2000, 118: 527- 534.
15. Saag MS, Graybill RJ, Larsen RA, et al. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis, 2000, 30: 710- 718.

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