Objective To analyze the clinical characteristics and diagnostic methods of primary pulmonary cryptococcosis. Methods The medical records of adult HIV-negative patients diagnosed with primary pulmonary cryptococcosis between 2006 and March 2011 were reviewed retrospectively. Results 90 patients were enrolled in the study. The mean( ±SD) age was ( 46. 3 ±12. 42) years( range 19 to 71 years) . The clinical manifestations of pulmonary cryptococcosis were mild without obvious physical signs. The imaging features can be classified into 3 types. Nodule or mass type was common. The right lung and lower lobe were most commonly involved. There was no significant difference of the lesion type between the groups with or without underlying diseases ( P gt;0. 05) . Sputum or BALF culture for Cryptococcus neoformans yield no positive result. The main diagnostic methods were video-assisted thoracic surgery( VATS, 42 cases) , transbronchial lung biopsy( TBLB, 28 cases) and transthoracic needle aspiration biopsy( TNAB, 14 cases) . The latex agglutination( LA) test yield positive results in 31 patients out of 48 patients( 64. 58% ) . The LA test positive group often used TBLB as diagnostic method( 64. 52% ) .Meanwhile the LA test negative group and the group without LA test often used thoracoscope as diagnostic method( 47. 06% and 76. 19% ) . There was significant difference in diagnostic method between the three groups( P lt;0. 05) . Conclusions It is not impossible to acquire pulmonary cryptococcosis in immunocompetent patients. The clinical manifestations and imaging features of pulmonary cryptococcosis were lack of characteristics. The diagnosis level can be improved by invasive examination such as TBLB and TNAB. The LA test for Cryptococcus neoformans can be used as an early noninvasive diagnostic method.
肺隐球菌病（PC）是一种由隐球菌感染引起的急性或亚急性肺部真菌病。好发于免疫功能低下者。在HIV感染者中，PC的发生率为5%~10%。非HIV感染者，PC发病的危险因素包括：结节病、关节炎、Crohn’s病、结缔组织病、肾小球肾炎、糖尿病、肿瘤、实体器官移植受者、接受抗肿瘤坏死因子α治疗、接受激素治疗或免疫抑制剂治疗等。约15%的PC患者没有基础疾病，属于免疫功能健全者。有研究发现免疫功能健全的PC发病与患者吸烟史、既往激素治疗史和曾有肿瘤史相关[1]，这可能与这类患者存在自然免疫缺陷有关[2]。患者没有任何肺原发病症和肺结构异常而形成PC感染称为原发性隐球菌型肺炎，约50%是发生在免疫功能健全的患者中，大多数患者肺为单一受累器官。
Cryptococcosis, mainly caused by Cryptococcus neoformans/gattii species complexes, is a lethal infection in both immunosuppressive and immunocompetent populations. With the upgrade of detection methods and the increase of clinical knowledge, the incidence rate of cryptococcosis is increasing, and it has become one of the most important fungi threatening human health. In recent years, great progress has been made in this field, including the taxonomy and nomenclature of Cryptococcus spp., laboratory diagnostic methods and antifungal susceptibility tests, as well as the characteristics and treatments of cryptococcosis. This article reviews the above contents, in order to improve the clinical and laboratory understanding of the Cryptococcus spp., and realize the timely diagnosis and early treatment of cryptococcosis.
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.
In 2024, the European Confederation of Medical Mycology, the International Society for Human and Animal Mycology, and the American Society for Microbiology jointly published the first global clinical guideline for cryptococcosis in The Lancet Infectious Diseases, which systematically established differentiated diagnostic and treatment strategies tailored to distinct host types and infection sites. This article provides an in-depth interpretation of the guideline, focusing on critical clinical aspects including diagnosis and screening of cryptococcal infection, management of central nervous system (CNS) infections, pulmonary infections, non-CNS/non-pulmonary infections, intervention strategies for complications such as immune reconstitution syndrome, and individualized treatment recommendations for special populations (pregnant women and children). The article aims to deliver standardized and actionable clinical guidance for healthcare providers, facilitating optimized comprehensive management of cryptococcosis across multi-tier healthcare institutions.
In recent years, due to the extensive usage of immunosuppressant and the rise of patients with cancers and organ transplantation, the incidence rate of invasive fungal infection, especially invasive pulmonary fungal infection, has increased. Besides the clinical manifestations, medical history and imaging, the diagnosis of pulmonary mycosis mainly depends on pathogen detection methods in clinical microbiology laboratory. However, due to the difficulty in fungi culturing and the low sensitivity of smear microscopy, better molecular biology methods are needed. To date, the emergence of metagenomic next-generation sequencing (mNGS) has improved the identification rate of pulmonary fungal infections. mNGS is significantly superior to traditional detection methods in rapid, accurate, and comprehensive determination of fungi from various clinical specimens, especially atypical fungi. However, some problems in mNGS method have to be addressed including sample collection, report interpretation, and its combination with traditional microbiology methods. With the in-depth discussion and solution of the above problems, mNGS will be indispensable to the etiological diagnosis of pulmonary invasive fungal infection.
Objective To investigate clinical characteristics of community acquired pulmonary crypyococcosis（PC）.Methods A total of 30 cases of PC diagnosed at Zhongshan Hospital of Fudan University from Jan 2003 to Dec 2007 were retrospectively analysed.All cases were identified by pathological study.Results The patients consisted of 19 males and 11 females，with median age of 44 years（16 to 70 years），66.7% of whom without underlying deseases and with normal immune function.9 patients（30%） were asymptomatic，and 21 patients（70%） had respiratory and/or constitutional symptoms.The most common symptoms were dry cough（16.7%），expectoration（46.7%），fever（23.3%），chest pain（13.3%） and dyspnea on exertion（13.3%）.All symptoms were mild and often showed a self-limiting trend.The common imaging features were nodule and mass，either solitary or multiple（53.3%），infiltrates and consolidation（40%） or diffused and mixed lesions.Non-caseous granulomas was the main character of patholgical study（96.7%），in which 93.1% with multinucleated giant cells containing abundant vacuolus yeast forms with the periodic acid schiff（PAS） reaction and/or Grocott Gomori’s methenamine silver（GMS） staining postive.Only one case found Cryptococcus neoformans spores in biopsy tissue smear and another in sputum smear.16.7% of the patients had positive biopsy tissue cultures for Cryptococcus neoformans，and 3.3% were positive of sputum cultures.15 patients underwent latex agglutination test for pulmonary cryptococcosis，and 93.3% were positive.Conclusions Some immunocompetent healthy people may compromised with community acquired PC with mild symptoms or even not at all and heterogeneous imaging appearance.Pathology，etiology，and serology were valuable diagnostic tools.
ObjectiveTo investigate the diagnostic value of lateral chromatography for cryptococcal capsular polysaccharide antigen in cryptococcal infection.MethodsThe data of patients who detected cryptococcal capsular polysaccharide antigen in West China Hospital of Sichuan University in 2018 were collected. The sensitivity, specificity, positive predictive value and negative predictive value of cryptococcal capsular polysaccharide antigen detected by lateral chromatography were analyzed. The samples with positive lateral chromatography and definite clinical diagnosis were compared with the results of ink staining and fungal culture.ResultsA total of 721 cases were detected. The sensitivity, specificity, positive predictive value and negative predictive value of lateral chromatography detection were 100.00%, 99.39%, 93.93%, 100.00%, respectively. The positive rates of ink staining, fungal culture and cryptococcal capsular polysaccharide antigen for cryptococcal infection were 63.46%, 48.00% and 100.00%, respectively. Sixty-two patients were clinically diagnosed, including 45 cases of cryptococcal meningitis (72.58%), 16 cases of cryptococcal pneumonia (25.81%), and 1 case of bone cryptococcal infection (1.61%).ConclusionsLateral chromatography detection for cryptococcal capsular polysaccharide antigen shows well performing sensitivity and specificity in the diagnosis of cryptococcal infection. Considering its rapid and simple pre-operation, cryptococcal capsular polysaccharide antigen detection with lateral chromatography has good application value for early diagosis of cryptococcal infection.