| Objective: To deepen the understanding of pulmonary cryptococcosis,we retrospectively analyzed the data of patients with pulmonary cryptococcosis diagnosed by pathology in our hospital in recent 3 years.Methods: Clinical data of 83 patients with pulmonary cryptococcosis diagnosed by lung histopathology in the first affiliated hospital of guangxi medical university from January 2016 to December 2018 were retrospectively analyzed.A total of 40 patients underwent cryptococcal latex agglutination test(38 serum samples,18 alveolar lavage samples).The clinical manifestations,laboratory examination results and imaging characteristics of the two groups were compared.Results :(1)83 patients were included,with an average age of 49.93 ±12.13 years old,and a male-female ratio of 1.37: 1,50 patients(69.2%)had no underlying disease.(2)There was no specific clinical symptoms,mainly cough/expectoration(45/83,54.22%),chest pain(23/83,27.71%),and 28.91% of the patients had no symptoms.Blood routine examination and c-reactive protein were normal inmost patients.Nodules/masses were seen in 66.21% of patients.The most common concomitent signs were bronchopneumatic sign(36.49%),halo sign(29.73%),and vacuole/cavity sign(30.14%),and the lesion was closely related to the pleura.The positive rate of sputum smear,sputum culture and alveolar lavage was lower,and the positive rate of lung tissue culture was higher(5/7).The success rates of percutaneous lung biopsy and TBLB tissue acquisition under b-ultrasound guidance were 95.65% and 75%,respectively(P >0.05).45% of the patients were misdiagnosed as lung cancer,and a total of 46patients(55.42%)in this group received thoracoscopic surgery,among which fluconazole had a good therapeutic effect and the overall prognosis of the patients was good.One of the surgical patients developed cryptococcal meningitis without antifungal therapy.(3)There was no significant difference between the two groups in clinical symptoms,increased white blood cell count and c-reactive protein,imaging characteristics,and positive rate of serum cryptococcal latex agglutination test(P > 0.05).In terms of imaging,the incidence of cavities/vacuoles in patients with basic diseases was higher than that in patients without basic diseases(38.7% vs.18.6%),but the difference was not statistically significant(P=0.067>0.05).(4)The detection rates of serum and alveolar lavage were 45.78% and21.69%,respectively.The positive rates of serum and alveolar lavage were65.79% and 50%,respectively.Serum cryptococcus latex agglutination test positive group of central Africa accounted for the proportion of patients with nodular tumor type is higher,nodular mass type patients are more prone to cryptococcus latex agglutination test negative serum(P<0.05),serum cryptococcus latex agglutination test positive group and negative group in thenumber of lesions and lung involvement image characteristic difference has no statistical significance(P>0.05).Compared with patients without basic diseases,the positive rate of serum cryptococcal latex agglutination test in patients with basic diseases was higher(78.57% vs.58.33%),but there was no statistical difference between the two groups.There was no significant difference between the positive group and the negative group in terms of inflammatory index,number of lesions and ratio of lung involvement.There was no significant difference between the positive group and the negative group in the number of lesions,vacuolar cavitation sign and the occurrence rate of bronchial inflation sign(P > 0.05).(5)In this group,47 patients(56.63%)did not submit serum for cryptococcal latex agglutgation test,among which 33 patients were confirmed by thoracoscopic surgery,among which 31 patients(93.9%)presented nodular mass lesion,and 31 patients(93.9%)presented single lung involvement lesion.Among the patients with serum LAT not submitted for examination,80%(36/45)were confirmed by surgery,and among the patients with serum LAT submitted for examination,28.95% were confirmed by surgery(11/38),with statistical difference between the two groups(P <0.05).Conclusion:(1)Cryptococcosis of the lung was mostly seen in middle-aged men,with atypical clinical manifestations.There was no significant difference in clinical symptoms,laboratory examination and imaging features between the group with basic diseases and the group without basic diseases.(2)The serum and alveolar lavage liquid have better specificity and sensitivity,and the serum cryptococcus latex agglutination test can be negative in patients with nodular mass type.The negative results of cryptococcal latexagglutination test could not exclude the occurrence of pulmonary cryptococcosis.There was no significant relationship between the positive rate of cryptococcus latex agglutination test of alveolar lavage fluid and the imaging characteristics of the lesion.(3)Clinical doctors pay insufficient attention to cryptococcal latex agglutentation test,and the examination rate is low,especially in the form of nodular tumor with single lung involvement,leading to the possibility of misdiagnosis of lung cancer and surgery.(4)Surgical treatment has the risk of disease spread.Patients with negative serum cryptococcal latex agglutination test but suspected pulmonary cryptococcal disease should try to obtain the pathology through minimally invasive method.Lung biopsy guided by b-ultrasound and lung biopsy via bronchi have a high success rate of sampling,which can be combined if necessary.Sometimes small lesions are difficult to be obtained by percutaneous lung puncture or TBLB,and surgery is required,but postoperative antifungal therapyshould be routinely given. |
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