Pulmonary Cryptococcosis:2 Cases Report And A Review Of Literature

Objective: To recognize the clinical characteristics and features of Chest CT of pulmonary cryptococcosis(PC),and improve the the early diagnosis rate of PC.Methods: Report the data of 2 cases of patients with pulmonary cryptococcosis diagnosed in Respiratory Medicine of our hospital from 2011 to 2016,a retrospective analysis of these 2 cases and 432 cases of domestic patients with pulmonary cryptococcosis were collected from CNKI in the past 10 years.To summary the incidence,susceptibility factors,clinical manifestations,chest CT imaging features,diagnostic methods,misdiagnosis type and misdiagnosis causes of pulmonary cryptococcal disease.Results:(1)A total of 98 reports have been selected,and Combined with 2 cases o f clinical data diagnosed by our department,434 patients with PC were reported,and the ratio of male to female was 1.95:1;80.6%(204/253)patients had no contact history of birds,poultry and soil etc;10.8%(244/371)patients had no underlying diseases;26.0%(113/434)patients without any symptoms,the other patients went to hospital because of cough,expectoration,chest pain,fever and other non-specific symptoms.(2)As to Chest CT performance,nodular lump shadows accounted for 73.7%,patchy infiltration or consolidation shadow accounted for 15.0%,mixed lesions accounted for 10.1%,5 cases are diffuse millet shadow,accounted for 1.2%.(3)The Common misdiagnosis included 147 cases(49.4%)of common lung cancer or lung metastases,68 cases(23.0%)of common bacterial pneumonia and 55 cases(18.6%)of pulmonary tuberculosis.(4)97.9% of patients(426/434)were diagnosed by histopathology of percutaneous pulmonary puncture,thoracotomy,bronchoscopy biopsy,thoracoscopic lobectomy or biopsy specimens,and a few were diagnosed by etiology such as respiratory secretions or blood,cerebrospinal fluid and other body specimens.Conclusion: 1.In this retrospective analysis of literature in the last decade,PC is not uncommon in immunocompetent persons,especially young men,most of them without obvious contact factors.2.There are regional differences in the distribution of PC,The incidence of PC in the south is higher than in the north.3.The clinical manifestations of PC patients lack specificity,lung lesions occur mostly in the outer lung fields and lower lobe,varying in shape,nodular lung masses were relatively common in people with normal immune functions.4.Percutaneous lung biopsy occupies an important position in the diagnosis of PC,cryptococcal latex agglutination test has a high specificity and sensitivity,can be used as a preliminary check of PC and efficacy evaluation index.