社区感染肺隐球菌病临床特点分析

Clinical analysis of community acquired pulmonary cryptococcosis

目的研究社区感染肺隐球菌病的特点。方法回顾性分析2003年1月～2007年12月在复旦大学中山医院住院的30例肺隐球菌病患者的临床资料。结果30例患者中,男19例,女11例;年龄16～70岁,平均(44±12.64)岁。66.7%无明显基础疾病,HIV抗体均阴性。30%无症状,70%有以下表现:干咳(16.7%)、咳痰(46.7%)、发热(23.3%)、胸痛(13.3%)、胸闷(13.3%)。症状轻,体征不明显,有一定自限性。影像学表现:53.3%表现为单发或多发的结节、团块影,40%以渗出、实变为主,余为弥漫性混合病灶。病理学改变:96.7%见肉芽肿性病变,其中93.1%多核巨细胞胞浆内外见透亮空泡样隐球菌孢子,过碘酸雪夫(PAS)和Grocott六胺银(GMS)染色阳性率皆为89.7%;3.3%为慢性炎症。活检肺组织涂片或痰涂片找到新生隐球菌孢子各1例(3.3%),活检组织培养或痰培养新生隐球菌阳性率分别为16.7%和3.3%。15例行隐球菌乳胶凝集试验,阳性率93.3%。结论社区感染肺隐球菌病多发生于健康状况较好的人群,临床表现轻微,影像学表现多样,病理学及相应病原学、血清学检查有较高的诊断价值。

Objective To investigate the clinical characteristics of community acquired pulmonary cryptocoecosis（PC）. Methods A total of 30 cases of PC diagnosed at Zhongshan Hospital Affiliated to Fudan University from Jan 2003 to Dec 2007 were retrospectively analyzed. 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 diseases 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 muhiple（ 53. 3% ）, infiltrates and consolidation （40%） or diffused and mixed lesions. Non-caseous granuloma was the main character in pathological study （96. 7% ） , in which 93.1% with muhinueleated giant cells containing abundant vacuolus yeast forms with the periodic acid schiff（PAS） reaction and/or Grocott Gomori＇s methenamine silver（GMS） staining positive. Only one case was 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 eryptococcosis, and 93.3% were positive. Conclusions Some immunocompetent healthy people may be 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.