侵及肺的播散性隐球菌病7例临床分析

The disseminated cryptococcosis involving lungs:report of 7 cases

目的了解累及肺部的播散性隐球菌病的临床特征和处理原则。方法回顾性分析7例累及肺部的播散性隐球菌病的临床表现和治疗结果。结果 7例患者中,呼吸系统为首发症状2例,中枢神经系统为首发症状4例,发热为首发症状1例。3例患者具有基础疾病史,1例患者有鸽粪接触史。2例无基础疾病者表现为隐球菌脑膜炎的症状,而无呼吸系统症状,常规影像学检查发现孤立性肺结节;3例有基础疾病者肺部影像学呈肺炎样表现,均有呼吸系统症状;2例学龄前儿童肺部影像学呈弥漫性改变,但亦无明显的呼吸系统症状。6例接受抗真菌治疗的患者中,5例痊愈,1例死亡。结论累及肺部的播散性隐球菌病的临床表现复杂,缺乏特异性,容易误诊和漏诊,一旦确诊应及时给予两性霉素B等抗真菌药治疗。

Objective To analyze the clinical features of disseminated eryptococeosis involving lungs. Methods Seven confirmed cases of disseminated cryptococcosis involving pulmonary infection were reviewed. Results Of the 7 patients, the first manifestation was respiratory symptoms in 2 patients, central nervous system symptoms in 4 patients, and fever in 1 patient. Underlying disease was only seen in 3 patients. Another one patient had the history of exposure to pigeon feces. Of the six patients treated with antifungal treatment, 5 recovered, only 1 died. Two patients with clinical manifestation of cryptococcal meningitis only showed pulmonary nodule by chest X-ray without respiratory symptom. Pneumonia was seen in 3 cases with respiratory symptoms. Conclusions The clinical manifestation of pulmonary involvement in patients with disseminated cryptococcosis was complicated and unspecific. It is very likely to misdiagnose this disease. Once the diagnosis was made, amphotericin B should be administrated immediately as the first choice.