Pulmonary cryptococcosis in nonimmunocompromised patients
Pulmonary cryptococcosis in nonimmunocompromised patients
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DOI：
10.1378/chest.124.6.2143
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发表时间：
2003-12-01
期刊：
影响因子：
9.6
通讯作者：
Ryu, JH
中科院分区：
文献类型：
--
作者：
Nadrous, HF;Antonios, VS;Ryu, JH
背景：新型隐球菌可引起严重的全身感染，需要免疫功能低下的宿主进行全身抗真菌治疗。然而，据报道，非免疫功能低下宿主的孤立性肺隐球菌病无需治疗即可自行消退。研究目的：确定抗真菌治疗在非免疫功能低下宿主分离性肺隐球菌病治疗中的作用。设计：回顾性研究。设置：三级护理、转诊医疗中心患者。 1976 年至 2001 年间，有 36 名患有孤立性肺隐球菌病的非免疫功能低下受试者在梅奥诊所（明尼苏达州罗彻斯特）接受诊断。干预措施：无。测量和结果：在 42 名患有隐球菌感染的非免疫功能低下受试者中，36 名 (86%) 患有孤立性肺隐球菌病。这 36 名患者的平均 (+/- SD) 年龄为 61 +/- 15 岁（范围为 14 至 88 岁），其中包括 17 名男性 (47%) 和 19 名女性 (53%)。 24 名患者（67%）有症状，12 名患者（33%）无症状。最常见的症状是咳嗽、呼吸困难和发烧。痰培养和支气管冲洗液培养最常得出诊断结果。 11 名患者（31%）进行了脑脊液检查，结果均为阴性。 25 名患者 (69%) 获得了随访信息，中位随访时间为 19 个月（范围为 1 至 330 个月）。其中 23 名患者 (92%) 的疾病得到缓解（8 名患者未接受治疗；6 名患者仅接受手术切除；9 名患者接受抗真菌治疗）。其余两名患者的病情已有所好转。这 25 名患者中没有任何治疗失败、复发、传播或死亡的记录。结论：我们的研究结果表明，对于没有全身症状或传播证据的非免疫功能低下的肺隐球菌病受试者，以及局灶性隐球菌肺炎手术切除后，初始观察期不给予抗真菌治疗是一个合理的选择。
Background: Cryptococcus neoformans can cause serious systemic infections requiring systemic antifungal therapy in immunocompromised hosts. However, isolated pulmonary cryptococcosis in nonimmunocompromised hosts has been reported to resolve spontaneously without treatment.Study objectives: To determine the role of antifungal therapy in the management of isolated pulmonary cryptococcosis in nonimmunocompromised hosts.Design: Retrospective study.Setting: Tertiary care, referral medical centerPatients. Thirty-six nonimmunocompromised subjects with isolated pulmonary cryptococcosis who received diagnoses at the Mayo Clinic (Rochester, MN) from 1976 to 2001.Interventions: None.Measurements and results: Of 42 nonimmunocompromised subjects with cryptococcal infections, 36 (86%) had isolated pulmonary cryptococcosis. The mean (+/- SD) age of these 36 patients was 61 +/- 15 years (range, 14 to 88 years), and the groups included 17 men (47%) and 19 women (53%). Twenty-four patients (67%) were symptomatic, and 12 patients (33%) were asymptomatic. The most common presenting symptoms were cough, dyspnea, and fever. Cultures of sputum and bronchial washings most commonly yielded the diagnosis. Cerebrospinal fluid examination was performed in 11 patients (31%) and was negative in all of them. Follow-up information was available on 25 patients (69%) with a median duration of 19 months (range, I to 330 months). Twenty-three of these patients (92%) had resolution of their disease (no treatment, 8 patients; surgical resection only, 6 patients; and antifungal therapy, 9 patients). The condition of the two remaining patients had improved. There was no documented treatment failure, relapse, dissemination, or death in any of these 25 patients.Conclusions: Our findings suggest that an initial period of observation without the administration of antifungal therapy is a reasonable option for nonimmunocompromised subjects with pulmonary cryptococcosis in the absence of systemic symptoms or evidence of dissemination, as well as after surgical resection for focal cryptococcal pneumonia.