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.	中國侵襲性肺部真菌感染工作組. 侵襲性肺部真菌感染的診斷標準與治療原則 (草案). 中國實用內科雜志, 2006, 21(26): 1748-1751.
2.	邵長周, 瞿介明, 何禮賢. 免疫受損與非免疫受損患者并發肺結核的臨床對照研究. 中國防癆雜志, 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.	梁麗玲, 梁志欣, 陳良安. 肺隱球菌病臨床診治進展. 中華醫院感染學雜志, 2017, 27(6): 1437-1440.
7.	姚秀娟, 陳愉生. 29 例不同免疫狀態肺隱球菌病臨床分析. 臨床肺科雜志, 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, 畢意輝, 武景波, 等. 肺隱球菌病臨床誤診討論. 臨床誤診誤治, 2015, 28(2): 43-46.
11.	趙宇, 蔡紹曦, 汪金林, 等. 90 例人類免疫缺陷病毒陰性宿主原發性肺隱球菌病的診斷分析. 中國呼吸與危重監護雜志, 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. 中國侵襲性肺部真菌感染工作組. 侵襲性肺部真菌感染的診斷標準與治療原則 (草案). 中國實用內科雜志, 2006, 21(26): 1748-1751.
2. 邵長周, 瞿介明, 何禮賢. 免疫受損與非免疫受損患者并發肺結核的臨床對照研究. 中國防癆雜志, 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. 梁麗玲, 梁志欣, 陳良安. 肺隱球菌病臨床診治進展. 中華醫院感染學雜志, 2017, 27(6): 1437-1440.
7. 姚秀娟, 陳愉生. 29 例不同免疫狀態肺隱球菌病臨床分析. 臨床肺科雜志, 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, 畢意輝, 武景波, 等. 肺隱球菌病臨床誤診討論. 臨床誤診誤治, 2015, 28(2): 43-46.
11. 趙宇, 蔡紹曦, 汪金林, 等. 90 例人類免疫缺陷病毒陰性宿主原發性肺隱球菌病的診斷分析. 中國呼吸與危重監護雜志, 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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