Clinical analysis of pulmonary cryptococcosis with varied immune status: 32 cases review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Yanxiang ,  DONG Lixia , CAO Jie

Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P. R. China;

Corresponding author：

DONG Lixia, Email: luckydonglixia@163.com

Keywords：

Pulmonary cryptococcosis; Immune state; Imaging findings; Treatment

DOI：

10.7507/1671-6205.201712023

Video：

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Objective To discuss the correlation between immune status and clinical characteristics in pulmonary cryptococcosis. Methods The clinical data of 32 non-AIDS patients with pulmonary cryptococcosis, diagnosed from August 2001 to October 2017 in Tianjin Medical University General Hospital, were retrospectively analyzed. The enrolled patients were divided into an immune-competent group with 13 cases and an immune-suppressed group with 19 cases. The clinical characteristics were compared between the two groups with different immune status. Results All 32 patients were treated for clinical symptoms. The main symptoms were cough, expectoration, fever, chest tightness, chest pain, and hemoptysis. There were no statistical differences between the two groups. The computed tomography of chest showed that there were 2 patients (6.3%) involving upper lung in the immune-competent group, and 5 patients (15.6%) in the immune-suppressed group. There were 9 patients (28.1%) involving lower lung in the immune-competent group, and 12 patients (37.5%) in the immune-suppressed group. There were 10 patients (31.3%) with nodular masses of lesions in the immune-competent group and none in the immune-suppressed group. There was 1 patient with infiltrating in the immune-competent group and 8 patients in the immune-suppressed group. There were 2 patients with mixed types of lesions in the immune-competent group and 11 patients in the immune-suppressed group. Five patients were complicated with cryptococcal meningitis, and 2 patients with eosinophilia. Conclusions The clinical characteristics of the patients with pulmonary cryptococcosis are not specific in difference immune status. The chest CT shows that the lesions of immune-competent patients are mainly nodular masses type, while lesions of immune-suppressed patients are mainly infiltrating shadow and mixed shadow. The treatment should be chose according to immune status.

Citation： ZHANG Yanxiang, DONG Lixia, CAO Jie. Clinical analysis of pulmonary cryptococcosis with varied immune status: 32 cases review. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(4): 354-358. doi: 10.7507/1671-6205.201712023 Copy

1.	中国侵袭性肺部真菌感染工作组. 侵袭性肺部真菌感染的诊断标准与治疗原则 (草案). 中国实用内科杂志, 2006, 21(26): 1748-1751.
2.	邵长周, 瞿介明, 何礼贤. 免疫受损与非免疫受损患者并发肺结核的临床对照研究. 中国防痨杂志, 2002, 24(z1): 2-8.
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4.	Brizendine KD, Baddley JW, Pappas PG. Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status. PLoS One, 2013, 8(3): e60431.
5.	Hsu LY, Ng ES, Koh LP. Common and emerging fungal pulmonary infections. Infect Dis Clin North Am, 2010, 24(3): 557-577.
6.	梁丽玲, 梁志欣, 陈良安. 肺隐球菌病临床诊治进展. 中华医院感染学杂志, 2017, 27(6): 1437-1440.
7.	姚秀娟, 陈愉生. 29 例不同免疫状态肺隐球菌病临床分析. 临床肺科杂志, 2012, 17(3): 415-417.
8.	Chang CC, Sorrell TC, Chen SC. Pulmonary cryptococcosis. Semin Respir Crit Care Med, 2015, 36(5): 681-691.
9.	Kim DY, Kim Y, Baek SY, et al. Simultaneous thoracic and abdominal presentation of disseminated cryptococcosis in two patients without HIV infection. Am J Roentgenol, 2003, 181(4): 1055-1057.
10.	朱敏, 毕意辉, 武景波, 等. 肺隐球菌病临床误诊讨论. 临床误诊误治, 2015, 28(2): 43-46.
11.	赵宇, 蔡绍曦, 汪金林, 等. 90 例人类免疫缺陷病毒阴性宿主原发性肺隐球菌病的诊断分析. 中国呼吸与危重监护杂志, 2012, 11(6): 541-544.
12.	Chang WC, Tzao C, Hsu HH, et al. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest, 2006, 129(2): 333-340.
13.	Zhang Y, Li N, Zhang Y, et al. Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis. Eur Respir J, 2012, 40(5): 1191-1200.
14.	Xie LX, Chen YS, Liu SY, et al. Pulmonary cryptococcosis: comparison of CT findings in immunocompetent and immunocompromised patients. Acta Radiol, 2015, 56(4): 447-453.
15.	Yamakawa H, Yoshida M, Yabe M, et al. Correlation between clinical characteristics and chest computed tomography findings of pulmonary cryptococcosis. Pulm Med, 2015, 2015: 703407.
16.	Kerkering TM, Duma RJ, Shadomy S. The evolution of pulmonary cryptococcosis: clinical implications from a study of 41 patients with and without compromising host factors. Ann Intern Med, 1981, 94(5): 611-616.
17.	Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care, 2003, 7(1): 1-2.
18.	Pongmekin P, Chongtrakool P, Santanirand P, et al. Clinical characteristics and mortality risk factors of cryptococcal infection among HIV-negative patients. J Med Assoc Thai, 2014, 97(1): 36-43.
19.	Mahabeer Y, Chang CC, Naidu D, et al. Comparison of Etests and Vitek 2^® to broth microdilution for the susceptibility testing of Cryptococcus neoformans. Diagn Microbiol Infect Dis, 2014, 80(4): 294-298.
20.	Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis, 2010, 50(3): 291-322.

1. 中国侵袭性肺部真菌感染工作组. 侵袭性肺部真菌感染的诊断标准与治疗原则 (草案). 中国实用内科杂志, 2006, 21(26): 1748-1751.
2. 邵长周, 瞿介明, 何礼贤. 免疫受损与非免疫受损患者并发肺结核的临床对照研究. 中国防痨杂志, 2002, 24(z1): 2-8.
3. Liu K, Ding H, Xu B, et al. Clinical analysis of non-AIDS patients pathologically diagnosed with pulmonary cryptococcosis. J Thorac Dis, 2016, 8(10): 2813-2821.
4. Brizendine KD, Baddley JW, Pappas PG. Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status. PLoS One, 2013, 8(3): e60431.
5. Hsu LY, Ng ES, Koh LP. Common and emerging fungal pulmonary infections. Infect Dis Clin North Am, 2010, 24(3): 557-577.
6. 梁丽玲, 梁志欣, 陈良安. 肺隐球菌病临床诊治进展. 中华医院感染学杂志, 2017, 27(6): 1437-1440.
7. 姚秀娟, 陈愉生. 29 例不同免疫状态肺隐球菌病临床分析. 临床肺科杂志, 2012, 17(3): 415-417.
8. Chang CC, Sorrell TC, Chen SC. Pulmonary cryptococcosis. Semin Respir Crit Care Med, 2015, 36(5): 681-691.
9. Kim DY, Kim Y, Baek SY, et al. Simultaneous thoracic and abdominal presentation of disseminated cryptococcosis in two patients without HIV infection. Am J Roentgenol, 2003, 181(4): 1055-1057.
10. 朱敏, 毕意辉, 武景波, 等. 肺隐球菌病临床误诊讨论. 临床误诊误治, 2015, 28(2): 43-46.
11. 赵宇, 蔡绍曦, 汪金林, 等. 90 例人类免疫缺陷病毒阴性宿主原发性肺隐球菌病的诊断分析. 中国呼吸与危重监护杂志, 2012, 11(6): 541-544.
12. Chang WC, Tzao C, Hsu HH, et al. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest, 2006, 129(2): 333-340.
13. Zhang Y, Li N, Zhang Y, et al. Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis. Eur Respir J, 2012, 40(5): 1191-1200.
14. Xie LX, Chen YS, Liu SY, et al. Pulmonary cryptococcosis: comparison of CT findings in immunocompetent and immunocompromised patients. Acta Radiol, 2015, 56(4): 447-453.
15. Yamakawa H, Yoshida M, Yabe M, et al. Correlation between clinical characteristics and chest computed tomography findings of pulmonary cryptococcosis. Pulm Med, 2015, 2015: 703407.
16. Kerkering TM, Duma RJ, Shadomy S. The evolution of pulmonary cryptococcosis: clinical implications from a study of 41 patients with and without compromising host factors. Ann Intern Med, 1981, 94(5): 611-616.
17. Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care, 2003, 7(1): 1-2.
18. Pongmekin P, Chongtrakool P, Santanirand P, et al. Clinical characteristics and mortality risk factors of cryptococcal infection among HIV-negative patients. J Med Assoc Thai, 2014, 97(1): 36-43.
19. Mahabeer Y, Chang CC, Naidu D, et al. Comparison of Etests and Vitek 2^® to broth microdilution for the susceptibility testing of Cryptococcus neoformans. Diagn Microbiol Infect Dis, 2014, 80(4): 294-298.
20. Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis, 2010, 50(3): 291-322.

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