| BackgroundPulmonary cryptococcosis(PC)is a subacute or chronic pulmonary fungal disease caused by cryptococcosis infection,which is common among patients with immunodeficiency,malignant tumors,or receive immunosuppressive agents and cytotoxic drugs.In recent years,studies at home and abroad have shown that Aspergillus is the most common pathogen causing fungal infection in the lungs.Cryptococcus and Candida are ranked second and third.In addition,the number of patients without basic diseases and exposure history increased,and the number of patients with normal immune function increased.The onset of the disease is concealed,the symptoms are different.The clinical manifestations are cough,cough,fever,chest tightness and other common respiratory symptoms,lack of specificity.There is no abnormalities in laboratory tests,sputum culture,alveolar lavage fluid examination etiology The positive rate is low,and the imaging features can be characterized as single adenoids,multiple nodules,lung consolidation,mediastinal lymphadenopathy or even miliary nodules.It is easy to be misdiagnosed as bacterial pneumonia,tuberculosis and diseases such as lung malignant tumors.Therefore,there are insufficient clinical diagnostic clues and evidences relying solely on clinical symptoms,laboratory tests,and imaging examinations,and it is clear that the diagnosis still requires surgical resection of the lesion tissue or CT-guided percutaneous lesion site biopsy and other invasive examinations to obtain pathological examination results.Or we can use sputum,secretions,blood and sterile cavity fluid through multiple routes to obtain pathogenic examination results.The former is traumatic and difficult to be widely accepted and recognized by patients;the latter is not highly positive or has false negatives or false positive and other conditions,the diagnostic value is not high.Therefore,improving the clinician's understanding of pulmonary cryptococcosis can help the early diagnosis and early treatment of the disease,and avoid delaying the disease;and how to use non-invasive examination to confirm pulmonary cryptococcosis has become an urgent problem to be further solved.ObjectiveThrough retrospective analysis of the clinical characteristics,imaging examination and diagnosis and treatment of patients with pulmonary cryptococcosis diagnosed in the First Affiliated Hospital of Zhengzhou University from January2011 to June 2018,to improve the awareness and diagnosis level of the disease.To analyze whether there are differences in clinical symptoms and imaging findings in patients with pulmonary cryptococcosis with normal immune function and immunodeficiency.Observe the diagnostic significance of multiple laboratory tests in patients with pulmonary cryptococcosis,and observe multiple invasive methods in cryptococcus diagnostic value in patients with pulmonary cryptococcosis.MethodsRetrospectively analysis 44 patients with pulmonary cryptococcosis diagnosed in the First Affiliated Hospital of Zhengzhou University from January 2011 to June2018.According to the International Consensus of the European Organization for the Study of Cancer/Fungal Infection(EORTC/MSG),the diagnostic criteria and the clinical diagnostic criteria set by the Chinese Medical Association Respiratory Diseases Society 2007“Association of Experts in the Diagnosis and Treatment of Pulmonary Fungal Diseases”,all cases are clearly diagnosed by pathology or pathogens and related examinations.All case data include the following:1.General information:gender,age,smoking history,drinking history,initial diagnosis;2.Host factors:history of environmental exposure,underlying diseases and related treatment,medication;3.Clinical symptoms and physical examination,laboratory findings,chest imaging studies;laboratory tests including white blood cells,neutrophil count,erythrocyte sedimentation rate,C-reactive protein,procalcitonin,tumor markers,G test,GM test,sputum or secretion smear and culture results.4.Diagnosis method:confirmed by pathological examination or pathogenic examination;5.Treatment,disease outcome and prognosis.The relevant data were classified and compared according to the presence or absence of underlying diseases and imaging findings.Statistical analysis was performed using SPSS 22.0 software.The measurement data that conforms to the normal distribution is expressed as X±s and two independent sample t-tests are performed.The count data is described in terms of the composition ratio n(%),using the?~2 test.Results1.Gender and age:Of the 44 patients with pulmonary cryptococcosis,24 were male(54.55%),20 were female(45.45%),aged 24~81 years,and the median age was 48 years.2.History of basic diseases and environmental exposure:27 cases(61.36%)had underlying diseases,including 14 cases of diabetes(31.82%),10 cases of hypertension(22.72%),and 5 cases of malignant tumors(11.36%)(respectively myelodysplastic syndrome,papillary thyroid carcinoma,gastric cardia adenocarcinoma,testicular seminoma,4 cases of viral hepatitis B(9.09%),3 cases of systemic lupus erythematosus(6.82%),2 cases of coronary heart disease(4.54%),rheumatoid arthritis in 2 cases(4.54%),tuberculosis in 2 cases(4.54%),nephrotic syndrome in 1 case(2.27%),and IgA nephropathy in 1 case(2.27%).At the same time,oral administration of glucocorticoids and cytotoxic drugs in 5 cases(11.36%),oral glucocorticoids in 3 cases(6.82%),and chemotherapy in 2 cases(4.54%).One patient(2.27%)had a history of bird droppings,and one patient(2.27%)had neighbors feeding pigeons.3.Clinical symptoms:asymptomatic in 17 cases(38.64%),symptomatic in 27cases(61.36%),mainly cough,cough in 19 cases(43.18%),fever in 11 cases(25.00%),chest tightness in 5 cases(11.36%)),hemoptysis 4 cases(9.09%),chest pain 2 cases(4.54%).4.Imaging findings:diverse and lack of specificity,divided into multiple nodules in 19 cases(43.18%),single nodules in 16 cases(36.36%),lung consolidation in 8 cases(18.18%),miliary nodules 1 Example(2.27%).The distribution of lesions was more common on the right side than on the left side,and the lower leaves were more common than the upper and middle leaves.The lesion morphology and accompanying signs were diverse,including 26 cases(59.09%)with burr marks,20 cases(45.45%)with pleural traction,and 14 cases(31.82%)with vascular bundle signs.Seven patients who underwent PET-CT examination showed high FDG intake status.5.Laboratory examination:30 patients(68.18%)had normal white blood cells,9patients(20.46%)had higher white blood cells than normal reference values,5patients(11.36%)had lower white blood cells than normal reference values;36patients had erythrocyte sedimentation rate(ESR)Among the patients,20(55.56%)patients were normal,and 16(44.44%)patients were higher than the normal reference value;among 35 patients with C-reactive protein(CRP),22(62.86%)were normal.Thirteen patients(37.14%)were higher than the normal reference value;among the34 patients who received procalcitonin(PCT),12(35.29%)were normal and 22(65.71%)were higher than the normal reference;For example,5 patients were positive for tumor markers,accounting for 17.86%;21 patients were examined by peripheral venous blood G test,and 12 patients were given alveolar lavage fluid for G test.A total of 6 positive cases accounted for 18.18%;20 patients underwent GM test for peripheral venous blood,12 patients received alveolar lavage fluid for GM test,2patients were positive,accounting for 6.25%;12 patients underwent fiberoptic bronchoscopy,aspiration sputum Or take alveolar lavage fluid or brush for local lesions culture or smear examination,no positive findings were found in the culture.Among the 9 patients who underwent smear examination,3(33.33%)were stained with ink staining and found to be cryptococcus neoformans,and 1 case of hexammine silver staining found yeast-like spores.Cocci;9 patients underwent immunological tests and 3(33.33%)were abnormal.6.Diagnosis methods:1 case(2.27%)showed blood culture to suggest cryptococcus,3 case(6.82%)underwent fiberoptic bronchoscopy,alveolar lavage ink staining microscopic examination revealed cryptococcus,and another 42 cases(95.45%)were organized.Biopsy confirmed,32 cases(72.73%)pathologically suggest granulomatous inflammation,10 cases(22.73%)suggest a large number of fungal hyphae and spores in fibrous connective tissue,including hexammine silver staining and PAS staining double positive 40 cases(90.91%)),hexammine silver staining positive,PAS staining negative in 2 cases(4.54%).7.Treatment:surgery+postoperative oral fluconazole treatment in 3 cases(6.82%),41 cases of drug antifungal therapy alone(93.18%),of which 2 cases(4.54%)Cryptococcus,Mycobacterium tuberculosis mixed infection patients Both received fluconazole and anti-tuberculosis drugs;another 39 patients had fluconazole in 31 cases(70.45%),voriconazole in 4 cases(9.09%),itraconazole in 2 cases(4.54%),amphotericin B and Fluconazole 2 cases(4.54%).8.Disease outcome and prognosis:43 patients(97.73%)received symptoms after treatment,and the chest CT lesions were reviewed beforehand.One patient(2.27%)was hospitalized for puncture and waited for pathological results.Disseminated to the central nervous system,the symptoms improved significantly after treatment,the chest CT was slightly absorbed before the re-examination,but repeated infections after discharge,and eventually died.Conclusions1.Pulmonary cryptococcosis can also occur in patients with normal immune function.The disease is mainly caused by young and middle-aged people,and males are slightly more than females.2.Few patients have a clear history of exposure to poultry and pigeon droppings.3.The clinical manifestations and imaging features of pulmonary cryptococcosis patients lack specificity,and it is easy to initially diagnose bacterial pneumonia,tuberculosis or lung malignant tumors.4.The chest imaging of patients with pulmonary cryptococcosis without basic diseases is more common in single nodules.The lesion morphology and accompanying signs are variable.The lung cancer signs are the main features.Combined with tumor markers,it is helpful for differential diagnosis of lung cancer.5.Definite diagnosis depends on histopathological examination or pathogenic examination.Invasive examination such as CT-guided biopsy of lesion tissue has obvious advantages due to less trauma and high positive rate.Multiple routes to obtain sputum,secretion,blood and sterility.The introduction of pathogens into the cavity helps the early diagnosis of the disease. |
PDF Full Text Request