55例社区获得性肺隐球菌病病例分析

A clinical analysis of 55 cases of community-acquired pulmonary cryptococcosis

本文旨在通过研究社区获得性肺隐球菌病的临床特点,提高医务人员对肺隐球菌病的认识,做到早期诊断和治疗。采用回顾性病例分析研究,统计2003年1月~2009年12月入住复旦大学附属中山医院的55例确诊及临床诊断为肺隐球菌病患者的临床资料。55例患者中,男性34例,女性21例;年龄17~75岁,平均（44.8±13.4）岁。69.1%无明显基础疾病。38.2%无症状,因体检发现肺部阴影而就诊。61.8%有以下症状：咳嗽、咳痰,胸闷,发热,胸痛;症状轻,体征不明显,偶有肺部湿啰音。影像学表现：53.0%表现为单发和（或）多发结节肿块影,31.4%表现为渗出实变影,15.7%为混合病灶。实验室检查：25例患者行隐球菌乳胶凝集试验检查,阳性率100%。痰真菌培养、活检组织培养和气管镜吸出物培养分别见新生隐球菌1例、4例和2例。组织病理学检查：主要表现为肉芽肿性病变,多核巨细胞内、外见隐球菌孢子;过碘酸-雪夫染色细胞壁呈红色,阳性率为88.5%;Grocott六胺银染色细胞壁呈银黑色,阳性率为88.5%。结果提示,社区获得性肺隐球菌病多见于中年男性,临床症状轻微,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。

To investigate the clinical characteristics of community-acquired pulmonary cryptococcosis,a total of 55 cases of pulmonary cryptococcosis diagnosed at Zhongshan Hospital,Fudan University from 2003 to 2009 were retrospectively analyzed.The patients were consisted of 34 males and 21 females,with median age of 44.8±13.4（17 to 75） years,69.1% of whom had no underlying diseases.Among those patients,38.2% were asymptomatic,and 61.8% had respiratory and（or） constitutional symptoms.The common symptoms were cough/expectoration,fever,chest pain,and dyspnea on exertion.The common computed tomography（CT） scan patterns were nodule and mass,either solitary or multiple（53.0%）,infiltration and consolidation（31.4%）,or diffused and mixed lesions（15.7%）.Twenty-five patients underwent latex agglutination test for pulmonary cryptococcosis,and 100% were positive.Cryptococcus neoformans was found in four biopsy tissue smears,in one sputum culture,and in two bronchoscopic lavage fluid cultures.Non-caseous granuloma was the main characteristic in pathological study,with multinucleated giant cells containing abundant vacuolus yeast forms shown by periodic acid-Schiff（PAS） reaction and/or Grocott-Gomori＇s methenamine silver（GMS） staining.In conclusion,community-acquired pulmonary cryptococcosis is more prevalent in middle-aged male patients,the symptoms are mild,and the imaging patterns are multiple.Pathological,etiological,and serological examinations are valuable diagnostic tools.