[Retrospective analysis of 117 cases of pulmonary cryptococcosis]

Objective: To investigate the clinical features of pulmonary cryptococcosis(PC). Methods: A total of 117 cases of PC, confirmed by pathological examinations at Fuzhou Pulmonary Hospital of Fujian from January 2009 to December 2013, were studied. Results: The patients consisted of 75 males and 42 females, with a mean age of (44.1±13.7) years (range, 16 to 76 years). Thirty-eight cases were immunocompromised hosts (ICH) and 79 cases were non-immunocompromised hosts (NICH). The clinical symptoms of most patients were mild and the main clinical manifestations were cough and sputum production. The chest CT manifestations were as follows: nodular or mass-like shadows in 66, patchy infiltrates or consolidation in 34, and mixed lesions in 17 cases. There were a variety of CT signs accompanied, with halo sign (78 cases) and proximal air bronchogram (63 cases) being the most common. These two signs were more common in NICH than ICH (77.2%, 44.7%, P=0.001; 60.8%, 39.5%, P=0.047). They were also more likely to be seen in the patchy infiltrates or consolidation and mixed patterns than in nodular or mass-like type of PC(82.4%, 82.4% and 54.5%, P=0.007; 76.5%, 82.4% and 33.3%, P=0.000), while lobulation sign, spicule sign and pleural indentation were more likely to be seen in the latter(0%, 5.9% and 30.3%, P=0.000; 0%, 5.9% and 27.3%, P=0.000; 0%, 5.9% and 19.7%, P=0.005). The lesions of PC were mainly found in the right lung and lower lobes. The lesions in NICH were more commonly seen in multiple lobes than ICH. Enhanced CT scanning was performed in 38 patients, and 24 cases showed uniform enhancement and 27 moderate enhancement. The diagnosis was confirmed in all cases by pathological findings. A hundred and one cases were treated and carefully followed in our hospital except 16 cases who were lost for follow-up. Seventy-one were cured and 30 were improved. Conclusions: The clinical symptoms of PC were diverse and nonspecific. Halo sign and proximal air bronchogram are helpful for the diagnosis of PC. The outcome of most patients was satisfactory after appropriate treatment.