[Pulmonary cryptococcosis: a retrospective analysis of 65 cases].

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

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.