Clinical Analysis Of 100 Cases Of Pulmonary Cryptococcosis Diagnosed By Pathology

Objective In order to sum up experience and improve the level of diagnosis and treatment of pulmonary cryptococcosis,the clinical data which come from 100 cases of pulmonary cryptococcosis diagnosed by pathology was analyzed.Research object and method Patients definitely diagnosed with pulmonary cryptococcosis at the department of respiration and thoracic surgery in FUJIAN Medical University union Hospital between January 2012 and September 2015 were selected.The clinical data of all patients with pulmonary cryptococcosis was reviewed,then the questionnaire was made, data was processed,at last,statistical analysis was performed according to the state of immune function.The paper studies the general information,predisposing factors,clinical manifestations,radiological findings,diagnostic methods,treatments and prognosis.SPSS 16 statistical software was used for analysis.Result 1.100 patients were enrolled in the research,including 57 males and 43 females.The age ranged from 30 to 75 years old. The mean(±SD)age of them was 51.32±11.02 years,the high incidence of ages were 40 to 60 years old. 2.99 patients had no clear contact history:such as guano,bad soil and so on, and 1 patient had history of exposure to birds. 33 cases had no any basic diseases, and 67 cases accompanied by one or more underlying disease,among the underlying disease,malignant tumor,hypertension and diabetes were seen more.5 patients used immunosuppressive agents or corticosteroids. 3.67 patients were asymptomatic, the rest 33 patients had one or more of the following symptoms: cough, expectoration, hemoptysis, chest pain, shortness of breath, fever, fatigue, night sweats, emaciation. 4.Imaging performance:98 cases presented nodule / mass shadow, including 32 cases of single nodules or masses,66 cases of multiple nodules or masses,the remaining two cases presented widespread and mixed patterns. The lesions were mainly located in the peripheral region(61.00%),subpleural area(52.00%),and both lower lung(50.00%),the most common concomitant signs of the lesions were lobulation and speculation.There were no significant deviations of the involved lung lobe distribution and the number of lesions between the sex, so were the immunocompetent group and the immunocompromised group. 5.19 patients had serum latex agglutination test for cryptococcus, 5 cases were positive, 14 cases were negative. 6.Pulmonary wedge resection by video-assisted thoracoscope was done for 98 patients,transbronchial lung biopsy was done for 2 patients,and percutaneous needle biopsy guided by CT was done for 1 patients. 7. The pathology of 100 patients showed inflammatory granuloma,fungal spores can be seen inside and outside the multinucleated giant cells or epithelioid cells,10 cases accompanied by necrosis, 1 case accompanied by calcification.The positive rate of PAS staining was 99%,the positive rate of methenamine silver staining was 99%, the positive rate of Mayer's dyeing was 76%. All tissues' acid fast staining were negative,according to the above,all patients were diagnosed as cryptococcosis. 8. For 100 patients,the main treatment was surgery + antifungal drug therapy after operation,of which 72 cases received antifungal treatment,the majority of medication way was single agent sequence,the course of treatment ranged from 3 months to 12 months, the average course of treatment was 6.39±2.15 months.80 cases in 100 cases were followed up for 3 months to 1 years, of which: 29 cases were cured, 51 cases improved better, 0 cases reappeared and 0 cases died.Conclusion The pulmonary cryptococcosis mainly involves middle-aged,it can be found in the immunocompetent and the immunocompromised people.The clinical symptoms and imaging findings are lack of specificity,the definite diagnosis is primarily dependent on lung histopathology, the test of serum cryptococcal capsular antigen can be used as a non-invasive method to assist diagnosis.The curative effect of antifungal drug therapy was significant.