Clinical analysis of pulmonary cryptococcosis in 110 immunocompetent patients

Abstract

Objective To describe the clinical mainfestations,imaging,diagnosis,and management of pulmonary cryptococcosis in patients.Methods 110 cases of pulmonary cryptococcosis diagnosed from January 1995 to June 2012 were reviewed.The clinical features were analyzed.Results Sixty-two cases (56.4%) out of 110 patients were under 50 years old and 80 cases (72.7%) were male.The main clinical mainfestations included cough (67 cases, 60.9%),expectoration (43 cases, 39.1%), fever (21 cases, 19.1%), chest pain (21 cases, 19.1%), dyspnea (21 cases, 19.1%), emaciation (11 cases,10.0%),and twenty-eight patients of entirely symptom free were hospitalized because of noticing shadows of the lung found by chest X film. The imaging features included solitary pulmonary mass opacity (26 cases, 23.6%), nodular shadows (20 cases, 18.2%),patchy consolidation opacity (33 cases,30.0%), combined patchy and nodular shadows (31 cases, 28.2%).Lesion was found more in the lower than in the upper lung (60.0% vs 18.2%), and more in the right than in the left lung (39.1% vs 32.7%),and bilateral lung had lesion in 31 cases. The presence of cryptococcus was assessed in 45 patients using serum latex agglutination test against a cryptococcal antigen in serum. Twenty-nine patients were positive,two cases were weakly positive, and 14 cases were negative.All cases were diagnosed pathologically by lung resection or biopsy via fiberoptic bronchoscopy.Succeessful outcomes were achieved in the patients with lesion resection or venously administrated fluconazole and other antifungal agents.Conclusions Pulmonary cryptococcosis is found mainly in immunocompetent patients aged ＜50 years old without preexisting lung disease, its clinical manifestation is not specific,the image is diverse,and it is often misdiagnosed or underdiagnosed.The suspected patients should be diagnozed by serum latex agglutination test,fibre bronchoscopy or percutaneous lung biopsy.Surgical removal of lesions or antifungal treatment for complete courses can lead to favorable outcomes for most patients. Key words: Pulmonary cryptococcosis; Cryptococcus neoformans; Antifungal drugs