Clinical Analysis Of HIV-negative Patients With Pulmonary Cryptococcosis

Objective:27patients diagnosed as pulmonary cryptococcosis from general hospital of tianjin medical university during the period of 2010.01 to 2017.10 in respiratory ward.The paper analyses the clinical data aiming at enhancing the knowledge of pulmonary cryptococcosis.Methods: The medical records were reviewed retrospectively,collected during 2010.01 to 2017.10 in respiratory ward of tianjin medical university general hospital of the 27 cases diagnosed as pulmonary cryptococcosis,including pulmonary cryptococcosis epidemiology,clinical characteristics,imaging features,laboratory findings,treatment,prognosis of antifungal drugs,and other clinical data.Results: A total of 27 patients with HIV negative PC into the clinical analysis,male patients were the most,with men accounted for 59.3%,female patients accounted for 40.7%.The range age of all the patients was between 28 to 84,and the mean age was 43.5±15.19 years old.There is a wide variation in clinical symptoms,from asymptomatic only by abnormal chest computed tomography through physical examination,to obvious clinical symptoms such as fever,cough,sputum,chest pain,hemoptysis,fatigue.The latex agglutination method of the patients with symptoms had a high positive rate.The method was diagnostic.The main CT performances contain infiltrating type lesion type(29.6%),nodular lesions(44.4%),mixed lesions(25.9%).Patients with basic disease were more likely to occur nodular lesions(P=0.007)and mixed lesion(P=0.008).Infiltrating images were more common if the patients who had positive results of LA(P=0.012),the results has statistical difference.Nodule lesions involving the subpleural was common on chest CT pictures,wich can be accompanied by a variety of signs as follows: air-filled bronchogram(37%),hollow or cavity(22%).All patients were performed a lavage bronchoscopy,and all of them only 1 case found cryptococcus.27 patients were administrated of intravenous fluids and sequential oral treatment of fluconazole,and in the process of follow-up treatment only 1 patients lesions appeared increases,whose treatment was replaced by itraconazole,and so the outcome of the patients were clinical improvement.Conclusions: 1.Pulmonary cryptococcosis is more often to see in youngs and middle-aged men than others.The commom clinical features of the patients are fever,cough,sputum,chest pain,hemoptysis and so on.The clinical symptoms are nonspecific and there are some patients who were found abnormal lung shadow in the hospital,but they have non-obvious clinical symptoms.2.Pulmonary cryptococcosis is one of bacteriologic studies,the rate of sputum smear and bronchial lavage fluid examination positive are very low.Cryptococcal capsular polysaccharide antigen detection can offer reference for clinical diagnosis.3.There is a certain characteristic of imaging examination as follows: pulmonary lobe lesions;pleura is often involving,and nodular type image is common appearance in asymptomatic patients,at the same time,air-filled bronchogram within the cavity is a common sign.4.Positive line histologic examination is helpful for diagnosis in time,at the same time line for histopathologic PAS,gomoriˊs methenamine silver nitrate stain and other special dyeing is helpful to diagnosis.5.Fluconazole for treatment of cryptococcosis is the most commonly used drugs,with efficacy,security and fewer adverse reactions.