Pulmonary Cryptococcosis without Human Immunodeficiency Virus Infection:a Clinical Analysis of 29 cases
Objective To summarize clinical features and diagnosis of pulmonary cryptococco-sis in non-human immunodeficiency virus(non-HIV)population so as to improve clinicians'un-derstanding and management of the disease.Methods The clinical data of 29 cases of pulmonary cryptococcosis in non-HIV population diagnosed in Jiangxi Provincial People's Hospital from 2016 to 2021 were retrospectively analyzed,including clinical symptoms,laboratory tests,lung im-aging characteristics,treatment and prognosis.Results There were 21 males and 8 females among the 29 patients,with the median age 56.5 years.The underlying diseases were as followed:5 cases(5/29)with renal transplantation,9 cases(9/29)with autoimmune system diseases,2(2/29)with diabetes mellitus,1 case(1/29)with splenectomy,and 12 cases(12/29)without any associated un-derlying disease.The first symptoms were common:cough in 10 cases(10/29),chest pain in 6 ca-ses(6/29),and fever in 5 cases(5/29);lung imaging showed nodular mass in 19 cases,with 10 ca-ses of infiltrative type and 3 cases of mixed type.24 patients(24/29)tested positive for cryptococ-cal capsular polysaccharide antigen(CrAg)in bronchoscopic lavage fluid(BALF),20(20/29)posi-tive for CrAg in peripheral blood,and 3(3/29)positive for CrAg in cerebrospinal fluid.Among the 29 patients,the diagnosis of 8 cases was confirmed by bronchoscopic lavage and biopsy,6 cases by surgical resection,5 cases by percutaneous lung biopsy;the other 10 cases were diagnosed by CrAg test and follow-up after treatment.All the 29 patients were treated according to the stand-ardized guideline,with a course of treatment ranging from 6 to 12 months:25 cases were cured and 4 cases failed(3 of them were immunodeficient hosts,and 1 case gave up the treatment due to economic reasons).Conclusion There can be no specific clinical symptoms and signs for pulmonary cryptococcosis in non-HIV patients.Serologic detection of CrAg may be considered by clinicians,and invasive tests such as electronic bronchoscopy and percutaneous lung puncture may be needed to make a definitive diagnosis,and the majority of patients can have a positive prognosis after standardized treatment.
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