Clinical Analysis Of 89 Patients With Pulmonary Fungal Disease

Purpose:Due to the differences between the various regions of the country reported a spectrum of pulmonary fungal disease, and it has less reports about pulmonary fungal disease samples confirmed cases in Guangxi area. So this paper will focus on researching the relationship among the spectrum of pulmonary fungal disease, diagnostic techniques, and radiologic features of the diseases, to improve the clinical diagnoses and treatment about fungal.Methods:By ICD-10 number checking the hospitalized patients with various pulmonary fungal diseases in the People’s Hospital of Guangxi Zhuang Autonomous Region from January 2004 to December 2013, these medical records such as "pulmonary aspergillosis,pulmonary cryptococcosis,pulmonary candidiasis,pulmonary Nocardia bacterial disease,pulmonary penicilliosis marneffei,pulmonary mucormycosis,Lung spore bacterium disease", at the same time, by reading these patients’medical records, medical orders for treatment drugs, radiographic images and laboratory test results to look into these diseases. All the diagnosis of pulmonary fungal diseases were re-diagonised base on "Pulmonary fungal infection diagnose is and treatment expert consensus" from Respiratory Disease Branch of Chinese Medical Association published in 2007.Results:Eighty-nine patients with pulmonary fungal disease were included 51male(57.3%) and 38 female (42.7%).The most common disease was the pulmonary aspergillosis(37,41.57%), followed by pulmoanry cryptococcosis (32,36.59%),pulmonary candidasis (6,6.74%), pulmoanry nocardiosis (5,5.62%), pulmonary penicillium marneffei (5,5.62%), pulmonary mucormycosis (3, 3.37%),pneumocystis jirovecii pneumonia(1,1.12%). Sixty-seven patients (75.28%) had risk factor, among them,23 (25.84%) patients had 2 or more. The most common symptom was cough that found in 62 cases (69.66%), other symptoms included expectoration (59,66.29%), fever (14,15.73%), hemoptysis (13,14.61%), chest pain and dyspnea (both 9,10.11%), The medical signs of lungs comprised crakles (30,33.71%), dry rales (19,21.35%)and wheeze(6, 6.74%).Both lungs were involved in 48 (53.93%) patients showed by the chest radiologic imaging(X-ray film or CT film),22 (24.72%) in right lung and 19 (21.35%) in left lung. The main lesions were multi- node (39,43.82%), the other included mass shadow (28,31.46%), opacities (17,19.10%), patchy shadow (5, 5.62%). In the cases of fringe of multi-node or mass shadow, smooth edge (25, 37.31%), lobes (18,26.87%), burr shape (24,35.82%). Besides, halo sign (26, 29.21%), cave mural nodules (8,31.46%), meniscus sign (11,12.36%), fluid level (9,10.11%), the pleural indentation (3,3.37%), calcification (2,2.25%).These diseases (19,21.35%) were diagnosed by two or more diagnostic techniques, there some diseases (14,15.73%) were diagnosed by two diagnostic technique,5 cases (5.62%) were diagnosed by three. Most cases of histologically confirmed, the main form were TBLB (38,42.70%), CT guided percutaneous lung biopsy had 37 cases (41.57%), surgery (22,24.72%), the others were thoracoscopy (9,10.11%), sterile specimen fungal culture positive cases had 7, that including pleural effusion (5,5.62%) and blood culture (2, 2.25%).Conclusion:Pulmonary aspergillosis and pulmonary cryptococcosis is the most common pulmonary fungal diseases, and most of the patients with high risk factors, which have no specific clinical features. The main imaging features is pulmonary nodules, which the main diagnostic technologl are the micro invasive.