24例肺隐球菌病临床特征及诊断策略分析

Clinical characteristics and diagnostic strategies of pulmonary cryptococcosis:an analysis of 24 cases

目的分析肺隐球菌病的临床特征,探讨其诊断策略。方法收集2012年2月至2019年7月我院24例肺隐球菌病例,对其临床特征及诊断进行回顾性分析。结果24例肺隐球菌病中仅4例患者有免疫抑制相关疾病;常见临床症状有咳嗽、咳痰、胸痛等,有9例患者无症状;常见胸部影像学表现有结节影13例,团片影4例,混合病变7例,特征性胸部CT表现主要为混合型病变、晕征、胸膜下病灶、近端支气管通气征;21例行隐球菌抗原检测者有20例阳性(95.2%,20/21);15例行病理组织学检查者12例阳性(80%,12/15),其中1例组织培养病原学阳性;10例仅隐球菌抗原或病理组织学阳性者给予氟康唑诊断性治疗9例有效。结论无免疫功能抑制的肺隐球菌病常见且临床症状多无特异性;患者临床症状、影像学特征性表现结合隐球菌抗原及病理组织学阳性可临床诊断;隐球菌抗原和病理组织学仅有一项阳性时氟康唑诊断性治疗有助于诊断。

Objective To analyze the clinical features of pulmonary cryptococcosis and discuss its diagnostic strategies.Methods A total of 24 cases of pulmonary cryptococcosis admitted in our hospital from February 2012 to July 2019 were recruited,and their clinical data were collected.The clinical features and diagnosis were analyzed retrospectively.Results Only 4 of the 24 patients had immunosuppressive related diseases.Their common clinical symptoms included cough,expectoration,chest pain,etc.,and 9 of them had no symptoms.Common chest imaging manifestations were nodular shadow in 13 cases,mass shadow in 4 cases and mixed lesion in 7 cases.The characteristic chest CT manifestations were mainly mixed lesion,halo sign,subpleural lesion and proximal bronchial ventilation sign.Of the 21 cases tested for cryptococcus antigen,20 were positive(95.2%,20/21);Of the 15 patients who underwent histopathological examination,12 were positive(80%,12/15),and 1 of them was positive in tissue culture etiology.For the 10 patients who were only positive to cryptococcus antigen or histopathologically,fluconazole treatment was effective to 9 of them.Conclusion Pulmonary cryptococcosis without immunosuppression is common and has nonspecific clinical symptoms mostly.Clinical diagnosis can be made based on clinical symptoms,imaging features,cryptococcal antigen and histopathological positivity of the patients.Fluconazole diagnostic therapy is helpful for diagnosis when there is only one positivity to cryptococcal antigen or histopathology.