老年肺隐球菌感染临床分析并文献复习

Clinical Analysis of Pulmonary Cryptococcus Infection in the Elderly and Literature Review

目的分析老年肺隐球菌感染临床表现、诊治方法及误诊原因。方法回顾分析老年肺部隐球菌感染3例的临床资料。结果本组1例反复咳嗽咳痰多年,加重伴左侧胸痛半年,有类风湿关节炎病史多年,免疫功能异常,同时有鸽子密切接触史,CT发现左肺上叶炎症,考虑为慢性支气管炎,抗感染治疗后症状无好转,后经支气管灌洗液病原学检查诊断为肺隐球菌感染。1例有慢性支气管炎病史20年,间断咳嗽咳痰20余年加重并发现肺结节1个月就诊,考虑慢性支气管炎急性发作,予抗感染治疗后症状无好转,肺结节经胸腔镜下肺穿刺活检术证实为肺隐球菌感染。1例有2型糖尿病史多年,消瘦、乏力、痰中带血半年,胸部CT示右肺占位性病变,存在阻塞性炎症,高度怀疑肺肿瘤,后经超声支气管镜引导下经支气管针吸活检术明确诊断为肺隐球菌感染。3例确诊后予足疗程抗真菌治疗,预后良好。结论老年人基础疾病较多,免疫力低下,肺部感染新型隐球菌后临床症状多种多样,胸部CT表现不典型,临床易误诊误治。临床医生应加深对肺隐球菌感染的认识,在常规治疗效果不理想时,要开拓诊断思维,注意排除特殊病原体如肺新型隐球菌感染的可能性,减少肺隐球菌感染的漏误诊,改善患者预后。

Objective To analyze the clinical manifestations,diagnosis and treatment methods and causes of misdiagnosis of pulmonary cryptococcus infection in the elderly.Methods The clinical data of 3 elderly patients with pulmonary cryptococcus infection were retrospectively analyzed.Results In this group,one patient had repeated cough and sputum for many years,which was aggravated accompanied by left chest pain for half a year,rheumatoid arthritis history for many years,abnormal immune function,and close contact with pigeons.The inflammation of the upper lobe of the left lung was found by CT,which was considered to be chronic bronchitis,and the symptoms did not improve after anti-infection treatment.After the bronchial lavage fluid etiological examination,he was diagnosed as pulmonary cryptococcus infection.One patient presented with a history of chronic bronchitis for 20 years and intermittent cough and sputum for more than 20 years,which were aggravated accompanied by pulmonary nodules for 1 month.Acute onset of chronic bronchitis was considered,but the symptoms did not improve after anti-infection treatment.Pulmonary cryptococcus infection was confirmed by thoracoscopic aspiration biopsy.One patient had a history of type 2 diabetes for many years,as well as a six-month history of emaciation,fatigue,and blood in sputum.Chest CT showed space-occupying lesions in the right lung and obstructive inflammation,and lung tumor was highly suspected.After endobronchial ultrasound guided transbronchial needle aspiration,the patient was diagnosed with pulmonary cryptococcus infection.All three cases were treated with antifungal therapy after diagnosis,and the prognosis was good.Conclusion The elderly have many basic diseases,low immunity,diverse clinical symptoms after pulmonary infection with Cryptococcus neoforme,and chest CT manifestations are not typical,which may lead to misdiagnosis and mistreatment in clinical practice.Clinicians should improve the understanding of pulmonary cryptococcus infection,expand the thinking of diagnosis and treatment when the conventional therapeutic effect is not satisfactory,and pay attention to exclude the possibility of special pathogens such as pulmonary cryptococcus neoformans infection,to reduce the misdiagnosis and missed diagnosis of pulmonary cryptococcosis,reduce the fatality rate and improve the prognosis of patients.