| BackgroundPulmonary cryptococcosis(Pulmonary cryptococcosis,PC)is a serious fungal infection that can be acute,subacute or chronic onset.It is common in patients with impaired immune function,such as AIDS,organ transplantation,and malignant tumor patients.It has a low incidence and was once regarded as a rare opportunistic fungal infection.However,in recent years,the global incidence of PC has increased,and there are more and more reports in the literature.However,PC usually has an insidious onset with varying severity.The clinical symptoms are mostly common respiratory system symptoms such as cough,sputum expectoration,and chest tightness;laboratory tests such as white blood cell count,procalcitonin and C-reactive protein have no obvious abnormalities;images There are many kinds of studies,which are easy to be confused with respiratory diseases such as bacterial pneumonia,tuberculosis,bronchial lung cancer,etc.,and the rate of misdiagnosis and missed diagnosis is high,and the best time for treatment is often missed,resulting in serious adverse prognosis.The diagnosis mainly depends on the pathogenic examination of lung tissue.When the patient refuses to perform an invasive operation or is unable to perform an invasive operation due to poor tolerance and lacks pathological support,the development of this diagnostic method is restricted.Therefore,how to diagnose pulmonary cryptococcosis using non-invasive methods has become an urgent problem that needs to be resolved.The cryptococcal capsular polysaccharide antigen test that has emerged in recent years is a method that can quickly detect cryptococcus.It is not only a non-invasive test,but also has high sensitivity and specificity.It has a high degree of sensitivity and specificity in the early stages of cryptococcal infection.Diagnostic application value.However,related researches are mostly focused on human acquired immunodeficiency virus(Human acquired immunodeficiency virus,HIV)antibody-positive populations,and research on HIV antibody-negative or immune-normal hosts is rare.Therefore,this article takes lung histopathological examination as the gold standard for diagnosis,and discusses the detection of cryptococcal capsular polysaccharide antigen(cryptococcalcapsularpolys accharideantigen,CrAg)in HIV-negative PCs by the serum enzyme-linked immunosorbent assay(ELISA).The diagnostic value provides more evidence for the early diagnosis of PC.AimTo explore the sensitivity,accuracy and specificity of ELISA CrAg detection in serum samples;evaluate the clinical application value of serum ELISA CrAg detection in the early diagnosis of HIV-negative pulmonary cryptococcosis,and provide an important reference for the early clinical diagnosis of PC.At the same time,this study analyzes the general information,clinical symptoms,imaging examinations,laboratory examinations,etc.of HIV-negative PC patients,summarizes the clinical characteristics of HIV-negative PC,deepens clinicians’ understanding of pulmonary cryptococcosis,and realizes early stage Identify and diagnose to improve the prognosis of patients and reduce the rate of misdiagnosis and missed diagnosis.MethodsCollect inpatient information through Jiahe Medical Record Management System,and retrieve all suspected PC cases admitted to the hospital from May 2010 to May 2019 that underwent serum ELISA CrAg detection.The included cases were screened according to the inclusion and exclusion criteria,and a total of 107 cases were included.According to pathological diagnostic criteria,107 patients were divided into PC group and non-PC group,of which 46 cases were in PC group and 61 cases were in non-PC group.The serum ELISA CrAg test results of the two groups of patients were collected retrospectively and the accuracy,sensitivity and specificity of the ELISA test were calculated.The general data,clinical symptoms,imaging characteristics and laboratory examination results of the PC group were collected retrospectively.According to the serum CrAg test results,the patients were divided into ELISA positive group and ELISA negative group,and the clinical characteristics of the two groups of patients were analyzed and compared.The data was analyzed using SPSS26.0 statistical software.The sensitivity,specificity and accuracy of the serum ELISA method were calculated using four grid data,and the receiver operating characteristic(ROC)curve was made.The measurement data is analyzed for normality and homogeneity of variance.If the normal distribution and homogeneity of variance are satisfied,two independent sample t-tests are used,expressed as mean±standard deviation.If the normal distribution is not satisfied,the Wilcoxon rank sum test is used,which is expressed as the median(M).Chi-square test was used for counting data.P<0.05 is statistically significant,and the test level is all α=0.05.Results1.All 107 cases were tested for CrAg by serum ELISA,25 were positive,including 24 PCs and 1 non-PC;82 negatives,including 22 PCs and 60 non-PCs.The accuracy of serum ELISA in the diagnosis of HIV-negative PCs was 79%(84/107),the sensitivity was 52%(24/46),and the specificity was 98%(60/61).2.General situation:Among the 46 patients,19 were females(41.3%),27 were males(58.7%),the ratio of males to females was 27/19;the age distribution(16-73)varied,and the average age was(49.41±10.559)Years old;3 patients had a history of exposure to humid environments;16 of 46 patients(34.8%)had underlying diseases,including 8 cases of hypertension,2 cases of diabetes,5 cases of malignant tumors,and 2 cases each of long-term use of hormones and immunosuppressants There were 2 cases of viral hepatitis,and the remaining 30 cases(65.2%)denied the existence of underlying diseases.Clinical symptoms:37 cases(80.4%)of 46 cases showed different clinical symptoms,including 31 cases of cough,27 cases of sputum,10 cases of chest tightness,12 cases of fever,8 cases of chest pain,and 6 cases of hemoptysis;imaging findings:46 Cases showed mass and patchy soft tissue shadows in 26 cases,single or multiple nodular shadows in 26 cases,mixed lesions in 7 cases,with cavitation in 7 cases,pleural effusion in 8 cases,lymphadenopathy in 10 cases,thin There were 5 cases of burr sign and 2 cases of shallow leaf sign.Diagnosis:44 cases were confirmed by CT-guided percutaneous lung biopsy,and the remaining 2 cases were confirmed by bronchoscopy lung biopsy.Pathological findings:Most pathological examinations showed chronic granulomatous inflammation.3.There was no statistically significant difference between the ELISA positive group and the negative group in the combination of underlying diseases and clinical symptoms(p<0.05).Conclusion1.Serum ELISA CrAg has high specificity(98%),and has high diagnostic and differential diagnosis value for HIV-negative pulmonary cryptococcosis.It can be used as a screening and rule-out diagnostic method for cryptococcal infection.2.HIV-negative pulmonary cryptococcosis tends to occur in young and middle-aged men;malignant tumors,long-term use of hormones or immunosuppressants are common susceptibility factors;most have no underlying diseases;clinical symptoms,imaging findings and laboratory tests are not specific;easy Misdiagnosed as other pathogens,pneumonia,tuberculosis,lung cancer,etc. |
PDF Full Text Request