Pulmonary cryptococcosis in patients without HIV infection
Pulmonary cryptococcosis in patients without HIV infection
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DOI：
10.1378/chest.115.3.734
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发表时间：
1999-03-01
期刊：
影响因子：
9.6
通讯作者：
Powderly, WG
中科院分区：
文献类型：
--
作者：
Aberg, JA;Mundy, LM;Powderly, WG
目的：进一步阐明非HIV感染的肺部隐球菌病患者的诊断和治疗方法。对象：1986年1月至1996年2月在中西部两家医院接受治疗的所有无HIV感染的患者，均为新型隐球菌呼吸道分离株。方法：回顾研究患者的病历，包括人口统计学数据、宿主免疫状况、呼吸道症状、诊断研究、治疗和随访。结果：42例患者的临床表现构成整个研究组。36例(85.7%)患者没有播散的证据，6例(14.3%)有播散性疾病。36例患者中有7例确诊为肺隐球菌病，15例为推定疾病，II例为新生杆菌定植。无论是基线人口学参数还是免疫状态，似乎都不能区分疾病患者和移居患者。18例患者中有7例血清隐球菌抗原(SCRAG)阳性，其中3例经培养证实为播散性感染。在11名患者中观察到阴性的残留物，其中一人已被证实已扩散。作为评估的一部分，15名患者接受了腰椎穿刺术，其中3名患者被诊断为隐球菌性脑膜炎，所有患者的血培养均为新生链球菌阳性，大多数患者没有接受抗真菌治疗。结论：在大多数患者中，肺部似乎是唯一受累的器官，全身感染的体检几乎没有帮助。阳性残留物不是传播的特异性，抗真菌治疗应保留给有症状的患者、残留物阳性的患者和潜在的免疫抑制患者。
Purpose: To further elucidate the diagnostic and therapeutic approaches to patients with pulmonary cryptococcosis who are not HIV-infected.Subjects: All of the patients without HIV infection who received care at two Midwest hospitals between January 1986 and February 1996 and had a respiratory isolate of Cryptococcus neoformans,Methods: The medical records of the study patients were reviewed for demographic data, host immune status, respiratory symptoms, diagnostic studies, treatment, and follow-up,Results: Forty-two patient presentations comprised the overall study group. Thirty-six patients (85.7%) had no evidence of dissemination, and six patients (14.3%) had disseminated disease. Seven of the 36 patient presentations were definitive pulmonary cryptococcosis, 15 were presumptive disease, and ii cr ere colonization with C neoformans. Neither the baseline demographic parameters nor the immune status appeared to discriminate the patients with disease from the patients with colonization. A serum cryptococcal antigen (sCRAG) was positive for 7 of 18 patients, 3 of whom were proven by culture to have a disseminated infection. A negative sCRAG was observed in 11 patients, one of whom had proven dissemination. Fifteen patients underwent a lumbar puncture as part of their evaluation, and cryptococcal meningitis was diagnosed in three of these patients, all of whom had positive blood cultures for C neoformans, The majority of the patients did not receive antifungal therapy.Conclusion: In the majority of the patients, the lung appeared to be the sole organ involved, and a workup for systemic infection was rarely helpful. A positive sCRAG was not specific for dissemination, Antifungal therapy should be reserved for symptomatic patients, for patients with a positive sCRAG, and for patients with underlying immunosuppression.