[Pulmonary cryptococcosis: a retrospective analysis of 65 cases]

To improve understanding of the clinical manifestations and imaging features of pulmonary cryptococcosis.

The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 65 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Nanjing General Hospital , Suqian Municipal People's Hospital and People's Liberation Army 81 Hospital from January 2001 to March 2013.

There were 65 proven cases diagnosed with pulmonary cryptococcosis, including 44 males and 21 females, aged from 12 to 73 years [average (44 ± 13) years]. The most common clinical symptoms included cough (n = 32), expectoration(n = 20) , fever (n = 16), and chest pain (n = 14), while some patients(n = 18) had no symptoms. Common chest imaging findings included single or multiple masses or nodules (n = 36), patchy infiltrates (n = 19, and mixed lesions (n = 10). Among the 21 cases with cryptococcal capsular polysaccharide antigen detection, 14 were positive. The antigen titre ( ≥ 1: 8 for positivity) was positively correlated with disease severity and lesion extent. The diagnosis of 45 cases was proven by percutaneous lung biopsy and 3 were diagnosed by bronchoscopic biopsy, while 17 were confirmed by surgery. Among 65 patients, 53 underwent Acute Physiology and Chronic Health EvaluationII (APACHEII) scoring, and 45 had a score of less than 10. Among them, 38 cases acquired complete or partial recovery, 4 were progressive and 3 died. Eight cases had a score of 10 or more, of whom 3 acquired complete or partial recovery, 1 was progressive and 4 died.

The most common clinical manifestations of pulmonary cryptococcosis were cough and expectoration and the most common chest imaging features were masses or nodular shadows. Percutaneous lung biopsy was a commonly used method to diagnose this disease. Cryptococcal capsular polysaccharide antigen detection was helpful for the diagnosis and management with a relatively high sensitivity. Antifungal drug therapy was the major treatment and a few patients may need surgery. The prognosis was better in patients with mild disease.