Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis

Yuan Zhang, Nan Li, Yuxuan Zhang, Huiping Li, Xueyuan Chen, Shanmei Wang, Xia Zhang, Rongxuan Zhang, Jinfu Xu, Jingyun Shi, Rex C. Yung

Research output: Contribution to journalArticle

Abstract

The aimof the present study was to investigate the clinical characteristics of pulmonary cryptococcosis patients in China, with analysis of immunocompetent and immunocompromised subjects. We performed a retrospective review of 76 patients diagnosed with tissue-confirmed pulmonary cryptococcosis at the Shanghai Pulmonary Hospital (Shanghai, China) during a 10-yr period (2001-2010). Of 76 patients (54 males and 22 females), 41 (53.95%) were immunocompetent and 35 out of the 41 were asymptomatic. Approximately 80% of the patients had histories suspicious of environmental fungal exposure. Radiological (computed tomography) findings showed predominantly peripheral findings (85.53%, 65 out of 76 patients) including nodular masses (55.26%, 42 out of 76), pneumonic infiltrates (23.68%, 18 out of 76) and mixed type (21.05%, 16 out of 76). 43.42% (33 out of 76) were initially misdiagnosed, often as cancer by false-positive 18F-fluorodeoxyglucose positron emission tomography ( 18FDG-PET) (28 out of 46 cases). 51 patients received antifungal therapy, 25 patients were clinically observed without treatment. As of December 31, 2010, 71 cases showed total recovery and four cases showed improvement (efficacy rate of 98.68%, 75 out of 76). One HIVpositive case died of cryptococcal meningitis. Incidence of pulmonary cryptococcosis in China may be related to environmental fungal exposures. Most presented as asymptomatic peripheral lung lesions. False-positive 18FDG-PET examinations often lead to initial clinical misdiagnosis of cancer. Unlike immunocompromised or clinically symptomatic patients, all immunocompetent patients had a good response, either to fluconazole monotherapy or observation, with a tendency for spontaneous remissions in the asymptomatic immunocompetent subjects.

Original languageEnglish (US)
Pages (from-to)1191-1200
Number of pages10
JournalEuropean Respiratory Journal
Volume40
Issue number5
DOIs
StatePublished - Nov 1 2012

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Keywords

  • Environmental exposure
  • Immunocompetent host
  • Pathological diagnosis
  • Pulmonary cryptococcosis
  • Serum cryptococcal antigen test

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Zhang, Y., Li, N., Zhang, Y., Li, H., Chen, X., Wang, S., Zhang, X., Zhang, R., Xu, J., Shi, J., & Yung, R. C. (2012). Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis. European Respiratory Journal, 40(5), 1191-1200. https://doi.org/10.1183/09031936.00168011