Retrospective Analysis Of 62 Cases Of Pulmonary Cryptococcosis

Objective: To investigate the clinical features of pulmonary cryptococcosis and its guidance in diagnosing.Method: Data of clinical symptoms,cryptococcal capsular polysaccharide antigen test and thoracic CT findings in patients with pulmonary cryptococcosis from January 2016 to January 2019 were analyzed retrospectively to evaluate its diagnostic value in clinical practice.Result: A total of 62 cases of pulmonary cryptococcosis including 38 males and 24 females with an average age of 48±11.2 years were collected.The common symptoms were cough,expectoration,chest pain.The positive rate of capsular polysaccharide antigen was 50%(12/24)in alveolar lavage fluid,and 71.1%(27/38)in serum.There was no statistically significant difference of cryptococcal capsular polysaccharide antigen test result between serum and bronchoalveolar lavage fluid in 21 cases(P=0.08).Pulmonary nodules/masses which mostly distributed in the lower lobe and below the pleura,either solitary or multiple,were the most common thoracic CT findings,present in 51 cases(82.3%),and halo sign can be seen in 32 cases(51.6%),air bronchogram in 24 cases(38.7%).Solitary mass or multiple nodules with halo sign were found those cases with positive cryptococcal capsular polysaccharide antigen in both bronchoalveolar lavage fluid and serum samples.Among them,48.4% cases accepted surgical treatment,the rates of positive cryptococcal capsular polysaccharide antigen and examination in the surgical group were lower than those in the non-surgical group,besides,the malignant signs in thoracic CT were rare and there is no statistical signification between two groups.The pathological features of lung tissue sample included granulomatous inflammation,positive Periodic Acid-Schiff and Methenamie silver staining and negative acid-fast staining.Conclusion: The cryptococcal capsular polysaccharide antigen test in bronchoalveolar lavage fluid and serum samples should be recommended for pulmonary cryptococcosis diagnosing.Nodules or masses,solitary or multiple,were the common thoracic CT findings,and mostly distributed in the lower lobe and below the pleura.The associated Halo sign is usually found among those cases.For solitary nodule or mass lesions below the pleura with less malignant sign,attention should be paid to cryptococcal infection,and relevant examinations should be performed to improve the diagnosis and reduce unnecessary surgical resection.