Cryptococcosis in patients with diabetes mellitus II in mainland China: 1993‐2015

Diabetes mellitus II (DM II) is a newly defined independent factor contributing to the morbidity and mortality of cryptococcosis. This retrospective case analysis aims to explore the epidemiology, clinical profile and strain characteristics of cryptococcosis in Chinese DM II patients. This study included 30 cases of cryptococcosis with DM II occurring from 1993 to 2015 in mainland China. The hospital‐based prevalence of cryptococcosis in DM II was 0.21%. The mean age of the patients was 56.1 years (95% confidence interval: 51.5, 60.6), and 93% of the patients were older than 40 years. Sixty‐two per cent of the patients experienced untreated or poorly controlled blood glucose before infection. Multilocus sequence typing analysis categorised all cultured strains as Cryptococcus neoformans and sequence type 5. Sixty‐nine per cent of pulmonary cryptococcosis patients experienced misdiagnoses and treatment delays. Sixty per cent of cryptococcal meningitis patients received substandard antifungal therapy. The overall death rate was 33%. Considering the large population size of DM II patients in China, improved attention should be paid to the high prevalence of cryptococcosis as revealed by us. We also emphasised the importance of blood glucose control for infection prevention, especially among the elderly.     

肺隐球菌病CT征象分析

目的 分析经病理证实的肺隐球菌病(PC)的CT影像表现,加深对本病影像征象的认识及提高诊断水平.方法 回顾性分析经穿刺或手术病理证实的19例PC患者的CT影像及临床资料.结果 ①结节或肿块型10例,结节型多见,直径1~2.5 cm,多发结节易融合.斑片、实变浸润型6例,所见斑片或实变的密度较炎性斑片高,边界多清楚.双肺病灶多为一侧为主,另一侧受累.混合型3例,表现为结节、实变及磨玻璃影等混合存在,均为双肺分布.②病灶分布特点为下肺分布(47%)及胸膜下分布(68%),多为轻~中度强化.③19例患者中,出现影像征象依次为胸膜增厚8例(42%),支气管气相7例(36%),晕轮征5例(26%),空洞4例(21%).结论 PC的CT表现具有多样性.①病灶以下肺及近胸膜分布多见.②病变多为轻~中度强化.③胸膜增厚、支气管气相、晕轮征、空洞等征象对诊断有一定提示意义.     

Detection of IgM and IgG antibodies to Cryptococcus neoformans proteins in blood donors and HIV patients with active cryptococcosis

The serological responses to Cryptococcus neoformans proteins of blood donors and HIV patients with active cryptococcosis from a tropical region were investigated in this study. Exposure to C. neoformans , an organism ubiquitous in the environment, contributes to the antibody responses observed in the blood donors. IgG responses to cryptococcal proteins were stronger than IgM responses in most sera tested in this study. A 53-kDa cryptococcal protein fragment was identified as the most immunoreactive protein on the IgM immunoblots of both blood donors and patients. Overall, there was no obvious difference in IgG responses of patients when compared with blood donors. Some immunogenic protein fragments (27.5, 76, 78 and 91.5 kDa) were detected at least two times more frequently on IgM immunoblots of patients compared with those of blood donors. It is yet to be investigated whether the proteins identified in this study may have any potential to be used as biomarker for cryptococcosis.     

伊曲康唑、氟康唑与特比萘芬联合治疗肺隐球菌病1例

采用伊曲康唑、氟康唑与特比萘芬联合治疗1例肺隐球菌病。患者男,48岁。发热、咳嗽、右肺部出现大片阴影27d。经皮肺穿刺活检,确诊为肺隐球菌病。给予氟康唑150mg／a、特比萘芬250mg／a口服治疗,1个月后复查胸部X线片及CT,肺部病变明显好转,但随后恢复较慢,改用伊曲康唑200mg／a联合特比萘芬250mg／d口服治疗3个月后,肺部阴影完全消失。     

Cryptococcosis in the Vocal Cords,Trachea, and Bronchi

Laryngeal and endobronchial cryptococcosis are rare conditions, and to our knowledge, there have been only 23 cases of laryngeal cryptococcosis, and 18 cases of endobronchial cryptococcosis previously reported in the English literature. We herein report an extremely rare case of cryptococcosis with simultaneous laryngeal and endobronchial involvement. This case highlights the importance of paying close attention to possible occurrence of cryptococcosis of the airway tract in patients with asthma treated with high-dose inhaled corticosteroids.     

Pleural effusion in an immunocompetent host with cryptococcal pneumonia:A case report

BACKGROUND Pulmonary cryptococcosis is an opportunistic infection that mainly occurs among immunocompromised patients although it can sometimes occur in immunocompetent individuals.However,the imaging findings of pulmonary cryptococcosis in immunocompetent hosts differ from those in immunosuppressed patients.In addition,the most common imaging findings of isolated pulmonary cryptococcosis are single or multiple nodules.Cavities and the halo sign are,however,prevalent in immunosuppressed patients.In immunocompetent patients,lung consolidation,pleural effusion or cavities are scarce.CASE SUMMARY A 29-year-old Asian male was admitted to our hospital with complaints of cough and fever that had persisted for a month.As a chest computed tomography scan showed consolidation in his left lower lobe,he was initially diagnosed with pneumonia and received antibiotic treatment.A second review of the chest computed tomography image revealed multiple cavities and pleural effusion.Flexible fiberoptic bronchoscopy was subsequently performed,bronchoalveolar lavage fluid and serum cryptococcal antigen tests were positive.Cryptococcus capsules were observed in bronchoalveolar lavage fluid ink stain.Histopathological examination of a percutaneous lung biopsy from the left lower lobe further revealed granulomatous inflammation,and periodic acid-Schiff staining showed red-colored yeast walls,signifying pulmonary cryptococcosis.The patient was then treated with a daily dose of fluconazole(0.4 g),but the cough and fever still persisted.We therefore changed treatment to voriconazole(0.2 g,twice a day),and the patient’s clinical outcome was satisfactory.CONCLUSION Although rare,clinicians should not disregard the possibility of cavities and pleural effusion occurring in immunocompetent hosts without underlying diseases.     

1例全身隐球菌病患儿的护理体会

全身性隐球菌病又称播散性隐球菌病,是新型隐球菌血行播散引起的全身多系统感染,其有病程长,起病隐匿,临床表现缺乏特异性,误诊率及死亡率均很高[1]。我科收治1例患儿,经静脉用药76d,治愈出院。现将护理体会报告如下。     

乙型肝炎并发肺隐球菌病例治疗

1例57岁中年男性患者,既往为乙肝表面抗原携带者30年余,右肺下叶切除术后13 d,发热2 d入院。入院诊断为肺隐球菌病,先后给予两性霉素B脂质体和氟康唑抗真菌治疗。治疗期间因氟康唑给药频率不适宜,药师建议修改给药频率后,患者病情控制稳定。     

宿主免疫正常的成人肺隐球菌病的 CT表现

肺隐球菌病（pulmonary cryptococcosis,PC）是条件致病性深部真菌病,其致病菌为新型隐球菌。该菌在土壤中广泛存在,主要侵犯肺脏及中枢神经系统,也可侵犯腹部实质脏器及皮肤黏膜。多发生在细胞免疫缺陷患者中。但近年来发现,在无任何基础疾病的免疫正常人群中,也出现越来越多的隐球菌感染,尤以肺部感染更多见,在临床上常被误诊。笔者回顾性分析经临床确诊的免疫正常成人的肺隐球菌的CT表现,寻找其影像学特征,以提高对此类疾病的认识,在诊断上提供一定的参考。