Objective To analyze the clinical characteristics and diagnostic methods of primary pulmonary cryptococcosis. Methods The medical records of adult HIV-negative patients diagnosed with primary pulmonary cryptococcosis between 2006 and March 2011 were reviewed retrospectively. Results 90 patients were enrolled in the study. The mean( ±SD) age was ( 46. 3 ±12. 42) years( range 19 to 71 years) . The clinical manifestations of pulmonary cryptococcosis were mild without obvious physical signs. The imaging features can be classified into 3 types. Nodule or mass type was common. The right lung and lower lobe were most commonly involved. There was no significant difference of the lesion type between the groups with or without underlying diseases ( P gt;0. 05) . Sputum or BALF culture for Cryptococcus neoformans yield no positive result. The main diagnostic methods were video-assisted thoracic surgery( VATS, 42 cases) , transbronchial lung biopsy( TBLB, 28 cases) and transthoracic needle aspiration biopsy( TNAB, 14 cases) . The latex agglutination( LA) test yield positive results in 31 patients out of 48 patients( 64. 58% ) . The LA test positive group often used TBLB as diagnostic method( 64. 52% ) .Meanwhile the LA test negative group and the group without LA test often used thoracoscope as diagnostic method( 47. 06% and 76. 19% ) . There was significant difference in diagnostic method between the three groups( P lt;0. 05) . Conclusions It is not impossible to acquire pulmonary cryptococcosis in immunocompetent patients. The clinical manifestations and imaging features of pulmonary cryptococcosis were lack of characteristics. The diagnosis level can be improved by invasive examination such as TBLB and TNAB. The LA test for Cryptococcus neoformans can be used as an early noninvasive diagnostic method.
目的:归纳分析42例隐球菌脑膜炎的发病情况、临床特点并总结抗真菌药物的治疗经验,以提高对隐球菌脑膜炎的诊治水平。方法:回顾分析四川大学华西医院2001～2007年所收治42例隐球菌脑膜炎病例的临床表现、实验室检查结果、抗真菌药物的疗效及预后,并对两性霉素B联合5氟胞嘧啶抗真菌治疗的药物剂量、疗效、不良反应以及疗程与预后的关系加以剖析。结果:临床以发热、头痛、颅内压升高、脑膜刺激征为主要表现,采用两性霉素B联合5氟胞嘧啶治疗,总有效率78.5%,42例患者治愈9例,好转24例,死亡5例,自动出院后失访4例。结论:隐球菌脑膜炎由于临床表现、脑脊液常规和生化检查以及影像学检查无明显特异性,易于误诊;脑脊液墨汁染色有助于早期诊断本病,对疑似病例反复进行脑脊液墨汁染色有利于确诊;两性霉素B联合5氟胞嘧啶治疗治疗隐球菌脑膜炎效果良好。但需注重合理应用并密切监测不良反应。
ObjectiveTo evaluate the diagnostic value of cryptococcal antigen lateral flow immunochromatographic assay (CrAg-LFA) in bronchoalveolar lavage fluid (BALF) among pulmonary cryptococcosis (PC) patients.MethodsPatients from the Zhongshan Hospital, Xiamen University, Zhangzhou Municipal Hospital of Fujian Medical University, Second Affiliated Hospital of Fujian Medical University, and Quanzhou First Hospital of Fujian Medical University were enrolled prospectively from March 2015 to October 2018. They were confirmed without human immunodeficiency virus infection and were divided into non-PC group (236 cases) and PC group (72 cases). The PC was definitely diagnosed by histopathological evidence from lung biopsy. The CrAg-LFA and culture were performed in both the serum and BALF among the enrolled patients.ResultsAmong 72 PC patients, 54 had a positive serum CrAg-LFA, 1 had positive serum culture; 67 patients had a positive BALF CrAg-LFA, 9 had positive BALF culture. Among the non-PC group, only 1 patient had a weak positive serum CrAg-LFA, none had positive serum culture of PC; 236 cases non-PC patients underwent BALF CrAg-LFA detection, none had a positive BALF CrAg-LFA; none of the 121 cases who had BALF culture yielded a positive result in PC. The sensitivity, specificity, positive predicted value, and negative predicted value in serum were 75.0%, 99.6%, 98.2%, and 92.9%, respectively. Those above mentioned values in the BALF yielded 93.6%, 100.0%, 100.0%, and 97.9%, respectively. Among the PC group, the sensitivity was higher in BALF than that in serum (χ2=8.745, P<0.05).ConclusionsThe CrAg-LFA is a simple and rapid diagnostic method for PC. The diagnostic value of CrAg-LFA in the BALF is superior to that in serum and fungal culture among the PC patients. The positive BALF CrAg-LFA result is consistent with mycological positive results.
Cryptococcosis, mainly caused by Cryptococcus neoformans/gattii species complexes, is a lethal infection in both immunosuppressive and immunocompetent populations. With the upgrade of detection methods and the increase of clinical knowledge, the incidence rate of cryptococcosis is increasing, and it has become one of the most important fungi threatening human health. In recent years, great progress has been made in this field, including the taxonomy and nomenclature of Cryptococcus spp., laboratory diagnostic methods and antifungal susceptibility tests, as well as the characteristics and treatments of cryptococcosis. This article reviews the above contents, in order to improve the clinical and laboratory understanding of the Cryptococcus spp., and realize the timely diagnosis and early treatment of cryptococcosis.
ObjectiveTo investigate the diagnostic value of lateral chromatography for cryptococcal capsular polysaccharide antigen in cryptococcal infection.MethodsThe data of patients who detected cryptococcal capsular polysaccharide antigen in West China Hospital of Sichuan University in 2018 were collected. The sensitivity, specificity, positive predictive value and negative predictive value of cryptococcal capsular polysaccharide antigen detected by lateral chromatography were analyzed. The samples with positive lateral chromatography and definite clinical diagnosis were compared with the results of ink staining and fungal culture.ResultsA total of 721 cases were detected. The sensitivity, specificity, positive predictive value and negative predictive value of lateral chromatography detection were 100.00%, 99.39%, 93.93%, 100.00%, respectively. The positive rates of ink staining, fungal culture and cryptococcal capsular polysaccharide antigen for cryptococcal infection were 63.46%, 48.00% and 100.00%, respectively. Sixty-two patients were clinically diagnosed, including 45 cases of cryptococcal meningitis (72.58%), 16 cases of cryptococcal pneumonia (25.81%), and 1 case of bone cryptococcal infection (1.61%).ConclusionsLateral chromatography detection for cryptococcal capsular polysaccharide antigen shows well performing sensitivity and specificity in the diagnosis of cryptococcal infection. Considering its rapid and simple pre-operation, cryptococcal capsular polysaccharide antigen detection with lateral chromatography has good application value for early diagosis of cryptococcal infection.
肺隐球菌病（PC）是一种由隐球菌感染引起的急性或亚急性肺部真菌病。好发于免疫功能低下者。在HIV感染者中，PC的发生率为5%~10%。非HIV感染者，PC发病的危险因素包括：结节病、关节炎、Crohn’s病、结缔组织病、肾小球肾炎、糖尿病、肿瘤、实体器官移植受者、接受抗肿瘤坏死因子α治疗、接受激素治疗或免疫抑制剂治疗等。约15%的PC患者没有基础疾病，属于免疫功能健全者。有研究发现免疫功能健全的PC发病与患者吸烟史、既往激素治疗史和曾有肿瘤史相关[1]，这可能与这类患者存在自然免疫缺陷有关[2]。患者没有任何肺原发病症和肺结构异常而形成PC感染称为原发性隐球菌型肺炎，约50%是发生在免疫功能健全的患者中，大多数患者肺为单一受累器官。
Objective To retrospectively analyze the clinical information of a series of patients with cryptococcal neoformans meningitis in order to improve the diagnosis and treatment level. Methods Fifteen patients with etiological diagnosis as cryptococcal neoformans meningitis from January 2004 to December 2009 in the Affiliated Shengjing Hospital of China Medical University were included in the study. The clinical manifestations, treatment and prognosis of those patients were retrospectively analyzed. Results Seven of the total 15 patients were misdiagnosed with misdiagnosis rate of 46.7%. Twelve patients were treated by combination of amphotericin B/Lipo-AMB and fluconazole intravenously infusion, and then followed by the maintenance therapy of fluconazole orally administration, of which 7 were cured, 3 were improved, and 2 died. Five patients undergoing lumbar cisterna drainage were all cured. The follow-up study showed that 4 cases were accompanied by auditory or/and visual dysfunction within 1 to 5 years after hospital discharge. Three cases died that were not treated with anti-fungal drugs. Conclusion The misdiagnosis rate of cryptococcal neoformans meningitis is high. The keys to reduce mortality are raising vigilance, early diagnosis, rational use of antifungal drugs, and effectively lowering the intracranial pressure. The integrated therapy of amphotericin B/Lipo-AMB and fluconazole is effective and safe. Lumbar cisterna drainage can effectively lower the intracranial hypertension, quickly relieve symptoms and improve prognosis.
Objective To systematically review the CT characteristic differences between pulmonary cryptococcosis (PC) and lung cancer presenting as solitary nodules. Methods PubMed, Embase, Web of Science, Cochrane Library, Wanfang, China National Knowledge Infrastructure and SinoMed were searched to collect case-control studies of the patients with PC and lung cancer presenting as solitary nodules on CT. The search period was from databases establishment to December 2023. We conducted a meta-analysis on the included studies. Results A total of 7 studies were included, 342 PC patients, and 370 lung cancer patients. The meta-analysis results showed that compared with lung cancer, PC patients were more likely to have the following characteristics in CT (P<0.05): nodules located in the lower lobe of the lung [odds ratio (OR)=1.91, 95% confidence interval (CI) (1.39, 2.62)], presence of bronchial inflation sign [OR=5.79, 95%CI (1.45, 23.21)], and halo sign [OR=6.64, 95%CI (2.87, 15.38)]. Compared with PC, lung cancer patients were more likely to have the following characteristics in CT (P<0.05): nodules located in the upper lobe of the lung [OR=0.52, 95%CI (0.35, 0.78)], presence of lobulation sign [OR=0.15, 95%CI (0.08, 0.27)], spiculation sign [OR=0.48, 95%CI (0.35, 0.65)], pleural indentation sign [OR=0.15, 95%CI (0.04, 0.50)], and vascular bundle sign [OR=0.20, 95%CI (0.05, 0.77)]. There was no statistically significant difference in CT between PC patients and lung cancer patients in terms of lesion size, relationship with pleura, vacuolar sign, cavity, and whether the broad base was connected to pleura (P>0.05). Conclusions For CT showing solitary nodules, PC nodules are more likely to be distributed in the lower lobe of the lungs, with bronchial inflation sign and halo sign. Lung cancer nodules are more likely to be distributed in the upper lobe of the lungs, with lobulation sign, spiculation sign, pleural indentation sign and vascular bundle sign.
In 2024, the European Confederation of Medical Mycology, the International Society for Human and Animal Mycology, and the American Society for Microbiology jointly published the first global clinical guideline for cryptococcosis in The Lancet Infectious Diseases, which systematically established differentiated diagnostic and treatment strategies tailored to distinct host types and infection sites. This article provides an in-depth interpretation of the guideline, focusing on critical clinical aspects including diagnosis and screening of cryptococcal infection, management of central nervous system (CNS) infections, pulmonary infections, non-CNS/non-pulmonary infections, intervention strategies for complications such as immune reconstitution syndrome, and individualized treatment recommendations for special populations (pregnant women and children). The article aims to deliver standardized and actionable clinical guidance for healthcare providers, facilitating optimized comprehensive management of cryptococcosis across multi-tier healthcare institutions.