Retrospective Analysis Of 42 Non-HIV Patients Pathologically Diagnosed With Pulmonary Cryptococcosis

Objective: The purpose of this study was to summarize the clinical features of non-HIV patients with pathologically confirmed pulmonary cryptococcosis,also aim at explore the early diagnosis methods of pulmonary cryptococcosis.Method: A retrospective analysis was made on the clinical data of 42 non-HIV patients with pathologically confirmed pulmonary cryptococcosis who were hospitalized in Zhongshan Hospital Affiliated to Xiamen University for 36 months from January 1,2016 to December 31,2018.Specific steps are as follows: inquiring patients with pathological diagnosis of pulmonary cryptococcosis in pathological reporting system from 2016 to 2018,combining with the data of electronic medical records system,pathological inquiries system,image access system and clinical laboratory management system,screening out cases that meet the inclusion criteria,eliminating criteria,and then collecting patients’ general information,occupational and contact history,disease history,clinical manifestations,imaging data,laboratory examination(immunology,etiology,pathological diagnosis),etc.Summarize and Statistical analysis the data in Excel.The measurement data of non-normal distribution are expressed as median,and the counting data are expressed as constituent ratio(%).Learn the significance for diagnostic by Comparing different examination methods for pulmonary cryptococcosis.Result: A total of 42 patients,including 23 males and 19 females,with an average age of 50.7 years and a median age of 48 years,were enrolled in this study.90% of the patients were concentrated in the 40-69 age group,with the most in the 40-49 age group.Long-term wet southeastern coastal areas and farmers are at high risk for acquiring PC.35.7% of the patients were physically healthy and 23.8% had a history of sinusitis.52.4% of PC patients were presented with cough and 31.0% of them had no symptoms.50% Thoracic CT showed nodules with no difference in the location of the lesions.More than 90% of the cases were misdiagnosed as bacterial pneumonia,tuberculosis or lung cancer.The sensitivity of serum cryptococcal capsular antigen lateral flow assay(CrAg-LFA)was 78.9%,and that of bronchoalveolar lavage fluid(BALF)CrAg-LFA was 95.8%.The sensitivity of traditional microscopy and culture was lower.42.9% of histopathological examinations were performed by CT scan-guided transthoracic core-needle biopsy(TTNB).Conclusion: Non-HIV PC’s clinical manifestations are non-characteristic and diverse.About 1/3 of the patients have no symptoms.The primary performonce of lung CT is nodules and masses in both lungs,which is easy to be misdiagnosed.Pathological diagnosis by invasive examination is essential to PC.The development of detection of CrAg in laboratory examination provides etiological evidence for early diagnosis.We found the sensitivity and diagnostic value of CrAg-LFA in bronchoalveolar lavage(BAL)was higher than CrAg-LFA in serum,but multicenter studies and more clinical trials were needed to confirm it.