原发性肺隐球菌病12例临床分析

目的分析12例原发性肺隐球菌病患者的临床特点，提高对肺隐球菌病的临床诊疗水平，减少延诊、误诊。方法回顾性分析2007年1月-2010年9月深圳市人民医院确诊的12例原发性肺隐球菌病患者的资料，包括临床症状、影像学特点、实验室检查以及治疗。结果12例肺隐球菌患者中，4例患有基础病，8例有咳嗽、咳痰、胸痛、气促、发热等临床症状。影像学表现为肺单发或多发结节，或片状渗出影。7例行肺叶切除，仅2例术后接受抗真菌治疗。4例患者给予氟康唑治疗，1例未抗真菌治疗。结论原发性肺隐球菌病可发生于免疫功能正常者，临床表现和影像学表现无特异性，易误诊，确诊依靠病理活检。治疗手段包括抗真菌药物治疗，部分病例需行手术。氟康唑有良好疗效且不良反应小，可作为该病首选药物。

Retrospective analysis of 12 cases of primary pulmonary cryptococcosis

Objective To improve the awareness of pulmonary cryptococcosis via analysis of the clinical data of 12 patients with primary pulmonary cryptococcosis. Methods Twelve patients were diagnosed as pulmonary cryptococcosis in our hospital from January 2007 to September 2010. The clinical characteristics, imaging features, laboratory tests and treatment strategies of these cases were retrospectively reviewed. Results Four of these patients had underlying diseases. Eight patients had obvious clinical symptoms such as cough and expectoration, chest pain, dyspnea and fever. Four patients were identified only in health checkup. The patients showed various imaging manifestations, from single or multiple nodules to patchy exudation. Seven patients had received lung lobe resection and 2 of them had received prior antifungal therapy after operation. Other 4 cases were treated with antifungal agent, such as fluconazole. Only one patient did not receive any treatment. Conclusions Immunocompetent people can also develop pulmonary cryptococcosis. The clinical presentation and imaging features are not specific. It may be misdiagnosed at early stage. The diagnosis is mainly dependent on pathology. The treatment of pulmonary cryptococcosis includes surgical resection and antifungal treatment. Fluconazole is effective in the treatment of pulmonary cryptococcosis with few side effects. It should be used as the first line choice.