RT Journal Article
SR Electronic
T1 Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1191
OP 1200
DO 10.1183/09031936.00168011
VO 40
IS 5
A1 Yuan Zhang
A1 Nan Li
A1 Yuxuan Zhang
A1 Huiping Li
A1 Xueyuan Chen
A1 Shanmei Wang
A1 Xia Zhang
A1 Rongxuan Zhang
A1 Jinfu Xu
A1 Jingyun Shi
A1 Rex C. Yung
YR 2012
UL http://erj.ersjournals.com/content/40/5/1191.abstract
AB The aim of the present study was to investigate the clinical characteristics of pulmonary cryptococcosis patients in China, with analysis of immunocompetent and immunocompromised subjects. We performed a retrospective review of 76 patients diagnosed with tissue-confirmed pulmonary cryptococcosis at the Shanghai Pulmonary Hospital (Shanghai, China) during a 10-yr period (2001–2010). Of 76 patients (54 males and 22 females), 41 (53.95%) were immunocompetent and 35 out of the 41 were asymptomatic. Approximately 80% of the patients had histories suspicious of environmental fungal exposure. Radiological (computed tomography) findings showed predominantly peripheral findings (85.53%, 65 out of 76 patients) including nodular masses (55.26%, 42 out of 76), pneumonic infiltrates (23.68%, 18 out of 76) and mixed type (21.05%, 16 out of 76). 43.42% (33 out of 76) were initially misdiagnosed, often as cancer by false-positive 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) (28 out of 46 cases). 51 patients received antifungal therapy, 25 patients were clinically observed without treatment. As of December 31, 2010, 71 cases showed total recovery and four cases showed improvement (efficacy rate of 98.68%, 75 out of 76). One HIV-positive case died of cryptococcal meningitis. Incidence of pulmonary cryptococcosis in China may be related to environmental fungal exposures. Most presented as asymptomatic peripheral lung lesions. False-positive 18FDG-PET examinations often lead to initial clinical misdiagnosis of cancer. Unlike immunocompromised or clinically symptomatic patients, all immunocompetent patients had a good response, either to fluconazole monotherapy or observation, with a tendency for spontaneous remissions in the asymptomatic immunocompetent subjects.