| Research backgroundPulmonary cryptococcosis(PC)is an invasive fungal infectious disease mainly caused by the inhalation of Cryptococcus spores in the inhaled air environment.In recent years,the incidence of PC has been rising,and it has ranked third in the domestic pulmonary fungal disease.In the past,it was often considered that PC mainly occurred in people infected with human immunodeficiency virus(HIV),However,it has been reported that the proportion of non-HIV infected patients is relatively high in China.In addition to the susceptible group,such as malignant tumor,diabetes,organ transplantation,long-term use of hormones or immunosuppressants,it can also occur in immunocompetent people,and the proportion is relatively high.Due to the various clinical manifestations and limitations of diagnostic methods,it is still challenging to make a rapid and accurate diagnosis of PC,which deserves more clinical attention.Early diagnosis is crucial to clinical prognosis,missed diagnosis and misdiagnosis need to be avoided to delay the best time for treatment,resulting in disease progression.ObjectiveBy analyzing and summarizing the clinical data of patients with PC,this study discussed the pathogenesis and diagnosis status of PC,so as to improve the cognitive level of clinicians to the disease,avoid missed diagnosis and misdiagnosis of PC,and provide reference for the diagnosis and treatment of PC.Research object and methodsA retrospective analysis was carried out on the clinical data of 130 patients diagnosed with PC by histopathography in the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2021.The patients were divided into immunocompetent group and immunocompromised group,and the clinical data of the two groups were compared.The following contents were collected:general information,combined diseases,clinical symptoms,laboratory results,imaging results and misdiagnosis,diagnosis methods and pathological features,treatment and prognosis.SPSS 21.0 was used for statistical analysis of data,the measurement data of normal distribution was expressed as mean ± standard deviation(x±s),t-test was used for comparison between the two groups,the counting data was expressed in the number of cases and composition ratio(%)by χ2 test or Fisher exact probability method;Mann Whitney U test was used to compare the therapeutic effects between the two groups.The test level was a=0.05.Results1.General data:Among the 130 patients,70 cases(53.85%)were male and 60 cases(46.15%)were female,the ratio of male to female was 1.17:1.The average age was(50.31±12.82)years old.72 cases(55.38%)were between 41 and 60 years old.4 cases(3.08%)had an exposure history of contacting with birds,soil or other environmental substance.There were 70 cases(53.85%)in immunocompetent group and 60 cases(46.15%)in immunocompromised group.The average age of immunocompetent group was lower than that of immunocompromised group,The difference was statistically significant(P<0.05).2.Clinical symptoms:41 cases(31.54%)were asymptomatic and 89 cases(68.46%)were symptomatic.There were 71 cases(54.62%)of cough,50 cases(38.46%)of expectoration,31 cases(23.85%)of fever,24 cases(18.46%)of chest distress,19 cases(14.62%)of chest pain,11 cases(8.46%)of hemoptysis,6 cases(4.62%)of backache,3 cases of headache(2.31%),and 3 cases(2.31%)of night sweats.There was no significant difference in clinical symptoms between the two groups(P>0.05).3.Laboratory tests:Among 130 patients,12 cases(9.23%)had increased white blood cell count,14 cases(10.77%)had increased neutrophil count,and 15 cases(11.54%)had increased neutrophil percentage.C-reactive protein was tested in 102 cases,29 cases(28.43%)were elevated.Procalcitonin was tested in 97 cases,39 cases(40.21%)were elevated.The erythrocyte sedimentation rate was increased in 34 cases(36.56%)of 93 cases.96 cases of serum(1,3)-β-D-glucan test and serum galactomannan(GM)test were respectively positive in 8 cases(8.33%)and 21 cases(21.88%).Blood T-cell blot test(T-SPOT)was detected in 61 cases,14 cases(22.95%)were positive.42 patients were tested for cryptococcal capsular polysaccharide antigen(CrAg),and 20 cases(47.62%)were positive.130 cases of serum HIV antibody were negative.The results of 15 cases of cerebrospinal fluid ink staining were negative.Sputum fungal culture was negative in 8 cases.The blood culture was negative in 4 cases.The increase rate of procalcitonin in immunocompetent group was lower than that in immunocompromised group,and the difference was statistically significant(P<0.05).4.Imaging examination and misdiagnosis:Among 122 patients,the imaging manifestations were nodular or mass type in 69 cases(56.56%),consolidation infiltrating type in 14 cases(11.48%)and mixed type in 39 cases(31.97%).There were 75 cases(61.48%)with single lung,105 cases(86.07%)with right lung,87 cases(71.31%)with lower lung and 107 cases(87.70%)with subpleural lesions.The misdiagnosis rate was 34.43%by CT.The rate of nodular or mass type,single lung involvement and single lobe involvement in immunocompetent group were significantly higher than those in immunocompromised group(P<0.05).14 cases underwent positron emission tomography-Computed tomography(PET-CT),and 12 cases(85.71%)had increased Maximal standard uptake value(SUVmax).5.Diagnostic methods and pathological changes:113 cases(86.92%)were diagnosed by CT guided percutaneous lung biopsy,9 cases(6.92%)were confirmed by bronchoscopic lung biopsy and 8 cases(6.15%)were confirmed by surgical resection of lung tissue.The accuracy of CT guided percutaneous lung biopsy was 99.12%(113/114).Most of the pathological manifestations were granulomatous inflammation,and the positive rate of gomori’s methenamine silver nitrate stain(GMS)was 92.80%(116/125).The positive rate of Periodic Acid-Schiff(PAS)was 92.00%(115/125).The positive rate of mucicarmine stain(MCS)was 71.43%(10/14).6.Treatment and outcome:In the 100 patients for treatment and follow-up,there were 91 cases treated with antifungal drugs alone,2 cases treated with surgery alone,5 cases treated with surgery combined with postoperative antifungal treatment and 2 cases treated with surgery after antifungal treatment,the overall effective rate was 79.00%(79/100),and the efficacy of single antifungal therapy was better in immunocompetent group than immunocompromised group,the difference was statistically significant(P<0.05).ConclusionThere is no obvious specificity in clinical symptoms and laboratory tests of pulmonary cryptococcosis.The imaging manifestations are variable and the misdiagnosis rate is high,which can vary according to different immune states.CT guided percutaneous lung biopsy is the most commonly used way to obtain clinical specimens of lung tissue.Special staining techniques are helpful to improve the detection rate,The overall prognosis of PC is good.The immunocompetent patients have better antifungal effect than immunocompromised patients. |
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