Clinical characteristics and diagnostic strategies of pulmonary cryptococcosis: an analysis of 24 cases

Bingjing ZHU; Hu LUO; Xiaohan HUANG; Caixia DENG; Chunlan TANG

doi:10.16016/j.1000-5404.202004312

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Clinical characteristics and diagnostic strategies of pulmonary cryptococcosis: an analysis of 24 cases

Clinical Medicine | 更新时间：2026-01-09

- Clinical characteristics and diagnostic strategies of pulmonary cryptococcosis: an analysis of 24 cases
- Journal of Third Military Medical University Vol. 42, Issue 15, Pages: 1543-1547(2020)
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院呼吸与危重症医学科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202004312
  CLC： R181.32;R519.4;R563
- Received：30 April 2020，
  
  Revised：2020-06-05，
  
  Published：15 August 2020
- 稿件说明：
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Bingjing ZHU, Hu LUO, Xiaohan HUANG, et al. Clinical characteristics and diagnostic strategies of pulmonary cryptococcosis: an analysis of 24 cases[J]. Journal of Third Military Medical University, 2020, 42(15): 1543-1547.
DOI：

Bingjing ZHU, Hu LUO, Xiaohan HUANG, et al. Clinical characteristics and diagnostic strategies of pulmonary cryptococcosis: an analysis of 24 cases[J]. Journal of Third Military Medical University, 2020, 42(15): 1543-1547. DOI： 10.16016/j.1000-5404.202004312.

摘要

目的

分析肺隐球菌病的临床特征，探讨其诊断策略。

方法

收集2012年2月至2019年7月我院24例肺隐球菌病例，对其临床特征及诊断进行回顾性分析。

结果

24例肺隐球菌病中仅4例患者有免疫抑制相关疾病；常见临床症状有咳嗽、咳痰、胸痛等，有9例患者无症状；常见胸部影像学表现有结节影13例，团片影4例，混合病变7例，特征性胸部CT表现主要为混合型病变、晕征、胸膜下病灶、近端支气管通气征；21例行隐球菌抗原检测者有20例阳性(95.2%，20/21)；15例行病理组织学检查者12例阳性(80%，12/15)，其中1例组织培养病原学阳性；10例仅隐球菌抗原或病理组织学阳性者给予氟康唑诊断性治疗9例有效。

结论

无免疫功能抑制的肺隐球菌病常见且临床症状多无特异性；患者临床症状、影像学特征性表现结合隐球菌抗原及病理组织学阳性可临床诊断；隐球菌抗原和病理组织学仅有一项阳性时氟康唑诊断性治疗有助于诊断。

Abstract

Objective

To analyze the clinical features of pulmonary cryptococcosis and discuss its diagnostic strategies.

Methods

A total of 24 cases of pulmonary cryptococcosis admitted in our hospital from February 2012 to July 2019 were recruited

and their clinical data were collected. The clinical features and diagnosis were analyzed retrospectively.

Results

Only 4 of the 24 patients had immunosuppressive related diseases. Their common clinical symptoms included cough

expectoration

chest pain

etc.

and 9 of them had no symptoms. Common chest imaging manifestations were nodular shadow in 13 cases

mass shadow in 4 cases and mixed lesion in 7 cases. The characteristic chest CT manifestations were mainly mixed lesion

halo sign

subpleural lesion and proximal bronchial ventilation sign. Of the 21 cases tested for cryptococcus antigen

20 were positive (95.2%

20/21); Of the 15 patients who underwent histopathological examination

12 were positive (80%

12/15)

and 1 of them was positive in tissue culture etiology. For the 10 patients who were only positive to cryptococcus antigen or histopathologically

fluconazole treatment was effective to 9 of them.

Conclusion

Pulmonary cryptococcosis without immunosuppression is common and has nonspecific clinical symptoms mostly. Clinical diagnosis can be made based on clinical symptoms

imaging features

cryptococcal antigen and histopathological positivity of the patients. Fluconazole diagnostic therapy is helpful for diagnosis when there is only one positivity to cryptococcal antigen or histopathology.

关键词

Keywords

references

HUNG M S, TSAI Y H, LEE C H, et al . Pulmonary cryptococcosis: Clinical, radiographical and serological markers of dissemination[J ] . Respirology, 2008, 13(2): 247-251. DOI:10.1111/j.1440-1843.2007.01202.x.

GULLO F P, ROSSI S A, SARDI J D E C, et al . Cryptococcosis: epidemiology, fungal resistance, and new alternatives for treatment[J ] . Eur J Clin Microbiol Infect Dis, 2013, 32(11): 1377-1391. DOI:10.1007/s10096-013-1915-8.

YAMAKAWA H, YOSHIDA M, YABE M, et al . Correlation between clinical characteristics and chest computed tomography findings of pulmonary cryptococcosis[J ] . Pulm Med, 2015, 2015: 703407. DOI:10.1155/2015/703407.

PERFECT J R, DISMUKES W E, DROMER F, et al . Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of America[J ] . Clin Infect Dis, 2010, 50(3): 291-322. DOI:10.1086/649858.

浙江省医学会呼吸病学分会.肺隐球菌病诊治浙江省专家共识[J].中华临床感染病杂志, 2017, 10(5): 321-326. DOI:10.3760/cma.j.issn.1674-2397.2017.05.001.

Respiratory Branch of Zhejiang Medical Association. Expert consensus on diagnosis and treatment of pulmonary cryptococcosis[J]. Chin J Clin Infect Dis, 2017, 10(5): 321-326. DOI:10.3760/cma.j.issn.1674-2397.2017.05.001.

王芳, 马海畅, 王晓娟, 等.脑脊液宏基因组测序技术在隐球菌性脑膜炎中的应用分析[J].河南医学研究, 2019, 28(15): 2718-2720.

WANG F, MA H C, WANG X J, et al . Application analysis of CSF sequencing technology in cryptococcal meningitis[J ] . Henan Med Res, 2019, 28(15): 2718-2720.

邸小青, 甘思远, 叶瑞芳, 等.肺原发性隐球菌病患者临床病理及影像学特征分析[J].中国病原生物学杂志, 2019, 14(6): 639-642. DOI:10.13350/j.cjpb.190605.

DI X Q, GAN S Y, YE R F, et al . Clinicopathological and imaging features of patients with primary pulmonary cryptococcosis[J ] . J Parasit Biol, 2019, 14(6): 639-642. DOI:10.13350/j.cjpb.190605.

陈相猛, 段晓蓓, 郝以秀, 等.非艾滋病患者不同免疫状态肺隐球菌病临床和CT表现对比分析[J].放射学实践, 2016, 31(11): 1047-1051.

CHEN X M, DUANX B, HAO Y X, et al . Pulmonary crytococcosis in non-AIDS patients with different immunology conditions: comparison of clinical and CT characteristics[J ] . Radiol Pract, 2016, 31(11): 1047-1051.

谢长浓, 杨春阳, 梁健华, 等.肺隐球菌病的CT表现及临床分析[J].实用放射学杂志, 2017, 33(2): 203-205. DOI:10.3969/j.issn.1002-1671.2017.02.010.

XIE C N, YANG C Y, LIANG J H, et al . CT characteristics and clinical analysis of pulmonary cryptococcosis[J ] . J Pract Radiol, 2017, 33(2): 203-205. DOI:10.3969/j.issn.1002-1671.2017.02.010.

姚克林, 胡红杰, 夏瑞明, 等. HIV阴性患者肺隐球菌病的临床与CT影像分析[J].浙江临床医学, 2016, 18(5): 807-809.

YAO K L, HU H J, XIA R M, et al . The clinical and CT imaging performance characteristics of HIV negative patients of Pulmonary Cryptococcosis[J ] . Zhejiang Clin Med J, 2016, 18(5): 807-809.

周新.解读侵袭性肺部真菌感染的诊断标准与治疗原则(草案)[J].中华内科杂志, 2006, 45(9): 788-789. DOI:10.3760/j.issn:0578-1426.2006.09.035.

ZHOU X. Interpretation of diagnostic criteria and treatment principles for invasive pulmonary fungal infections (draft)[J]. Chin J Intern Med, 2006, 45(9): 788-789. DOI:10.3760/j.issn:0578-1426.2006.09.035.

黄佳斯, 石磊, 唐爱国, 等.胶体金免疫层析法检测血清隐球菌抗原在肺隐球菌病诊断中的应用价值[J].临床检验杂志, 2017, 35(7): 518-519.

HUANG J S, SHI L, TANG A G, et al . Application value of colloidal gold immunochromatography in detecting cryptococcal antigen in diagnosis of pulmonary cryptococcosis[J ] . Chin J Clin Lab Sci, 2017, 35(7): 518-51 9.

付成凤, 唐春兰, 罗虎.误诊为肺炎的青年肺隐球菌诊治1例并文献复习[J].临床肺科杂志, 2018, 23(8): 1541-1544.

FU C F, TANG C L, LUO H. Diagnosis and treatment of cryptococcal pneumonia in young people misdiagnosed as pneumonia and literature review[J]. J Clin Pulm Med, 2018, 23(8): 1541-1544.

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