Clinical Findings Of Invasive Pulmonary Mycosis And Its Diagnosis And Treatment Exploring: Report Of 62 Cases

ObjectiveTo discover the epidemiological and clinical characteristics of invasive pulmonary mycosis (IFM) on the basis of statisticsing clinical data of 62 proven cases, so as to elevate the level of diagnosis and treatment, and explore furtherly the clinical application value of a new therapy for IFM,by injecting drugs with indwelling catheter in bronchus which is inserted through fibrobronchoscope on patients with pulmonary cryptococcosis .MethodsAt first, the proven cases of IFM, between 2003/3 and 2008/2, were collected retrospectively from Department of Respiratory Medicine and Thoracic Surgery of Fuzhou General Hospital. Schedule table were made to record the detail information of each patient. Following the same table to record detail information of patients with IFM from 2008/3 to 2009/10 and following up them. The clinical efficacy in group that treated by injecting drugs with indwelling catheter in bronchus which was inserted through fibrobronchoscope(treatment group) was compared with that treated by conventional treatment(control group) to evaluate the clinical value of treating patient with pulmonary cryptococcosis by injecting drugs with indwelling catheter. statistical analysis was done by SPSSl3.0.Results1.Of the 62 cases, 57(91.9%) were community-acquired infection, 5 (8.1%) were hospital-acquired infection, and 38(61.3%) were pulmonary cryptococcosis, 18(29.0%) were pulmonary aspergillosis, 4(6.5%) were pulmonary mucormycosis, 1(1.62%) was pulmonary candidiasis and 1(1.62%) was not classified. No risk factors and underlying disease were reported 54.8%.2.Main symptoms included cough 62.9%, expectoration 48.4%, fever 12.9%, hemoptysis 24.2%, chest pain29%, chest distress 21%, breathlessness 19.4%, asymptomatic 21% and rales19.4%. Anemia 14(22.2%), High neutrophil14(22.2%), no neutropenia; the number of CD4 by flow cytometer were low in 13 patients. Lesions of 31(81.6%) pulmonary cryptococcosis distributed in the outskirt of lung, close to the pleura and often appeared in posterior basal segment of both lung(left 50.0%, right 42.1%). Multiple nodules or patches accounted for 50%. Pulmonary aspergillosis lesions more commonly appeared in upper-lung of both sides(27.8% in the upper left, upper right 55.6%), lesions were multiple, cavities were seen in the lesions of 55.6% patients, 33.3% with typical crescent sign. Diagnosis: misdiagnosed 71.%, awaiting to diagnose 24.2%, only 4.8% correctly diagnosed. Histopathology access: Percutaneous lung biopsy 41 cases, thoracic surgery 13 cases, thoracoscope surgery 6 cases, lymph node biopsy 1 case and bronchoscopy biopsy 1 case. Immunohistochemistry is the final diagnoses. Overall effect: cure 77.4%, marked 4.8%, advance3.2%, invalid 6.6%, death 3.2%, lost 4.8%.3.the therapeutic effect of pulmonary cryptococcosis of treatment group was significantly better than that of control group, and the difference appeared in own control patients as well(the tube side and the non-tube side). The new therapy shorten the time of therapy.ConclusionThe proven cases of IFM were almost community-acquired. The most frequently IFM encountered was pulmonary cryptococcosis, followed by pulmonary aspergillosis and pulmonary mucormycosis, Primary pulmonary candidiasis was rare. About half patients had no risk factors and underlying disease, all the clinical manifestations were not specific. Inflammatory indicators were generally normal or slightly elevated, and immunologic function was often normal. Lesions of most pulmonary cryptococcosis always distributed in the outskirt of lung, close to the pleura and often appeared in posterior basal segment of both lung. multiple nodules or patches were the predominant pattern of chest CT. Pulmonary aspergillosis lesions more commonly appeared in upper-lung of both sides, lesions were multiple, cavities were seen in most lesions, crescent sign was more specific. With a high misdiagnosis rate, CT guided percutaneous biopsy was safe and effective in confirming the diagnosis. immunohistochemical is the gold standard for diagnosis. Most patients had ideal prognosis, The new treatment for pulmonary cryptococcosis could significantly improve the cure rate and shorten the therapeutic time.