| Objective:To explore the clinical characteristics of pulmonary cryptococcosis and enhance the knowledge of this disease,in order to reduce misdiagnosis and missed diagnosis.Methods:The medical records were reviewed retrospectively,collected during Aug.2013 to Feb.2019 in the First Affiliated Hospital of Soochow University of the 69 cases diagnosed as pulmonary cryptococcosis,including clinical characteristics,imaging features,laboratory findings,diagnosis methods,therapy,prognosis of antifungal drugs,and other clinical data.Results:There were 69 pulmonary cryptococcosis patients collected,including 50 male patients and 19 female patients,aged from 21 to 76 years,[average:(51.47±12.56)years].In the study,36.3%patients had clinical symptoms.The most common symptoms were cough(34.8%,24/69),expectoration(20.3%,14/69),fever(15.9%,11/69),chest pain(8.7%,6/69),chest tightness(4.3%,4/69),and headache(4.3%,3/69).However,63.7%(44/69)of the patients were admitted to hospital for further differential diagnosis due to lung lesions found in routine physical examination,and confirmed by surgical operation later.Compared with the immunocompetent patients,the immunocompromised patients were more likely to have moist rale(p=0.002).Radiological(computed tomography)findings showed predominantly findings including a single nodule or masses(20 cases),multiple nodules or masses(34 cases),pneumonic infiltrates(8 cases)and mixed type(7 cases).The immunocompromised patients easily merger pleural effusion(p=0.017).The LFA and(or)the LAT and(or)Quantitative test for latex agglutination were detected in18 patients and all of them were positive for it.At the same time,5 of these patients improved after diagnostic antifungal therapy based on this result.Cerebrospinal fluid was examined in 10 patients,and cryptococcus neoformans was cultured in 3 of them.The percentage of peripheral blood white blood cells or neutrophils in patients with immune deficiency increased significantly(p=0.013).In this study,60 patients were diagnosed according to pathological results,including 49 cases confirmed by surgery,6 cases confirmed by PCNB,3 cases confirmed by TBLB,1 case confirmed by medical thoracoscopy,one case found cryptococcus neoformans in hemoculture and the rest were diagnosed clinically.For the treatment of this disease,the 49 cases were treated by surgical resection,and in median 10 months' follow-up,2 lost to the follow.And 20 cases were treated with antifungal therapy,and in median 18 months' follow-up,5 lost to the follow.There were no recurrence cases,either.Conclusion:There were no specific clinical symptoms and signs for pulmonary cryptococcosis.Diagnosis of pulmonary cryptococcosis depends on pathology.Cryptoeoccal capsular polysaccharide antigen detection had a high sensitivity for the clinical diagnosis.Due to the distribution of lung lesions of the disease have certain characteristics,timely detection of cryptococcus serum antigen for patients highly suspected of clinical diagnosis is conducive to the diagnosis of the disease,thus reducing the surgical treatment.Antifungal drug therapy was the major therapy,and the most patients had favorable prognosis. |
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