肺隐球菌病17例临床分析

目的 提高对肺隐球菌病的临床诊疗水平.方法 回顾分析上海瑞金医院2009年1月至2011年10月收治的17例肺隐球菌病病例的临床资料,对其临床特点、影像学表现、实验室检查、治疗方法进行综合分析.结果 本组肺隐球菌病患者中,有临床症状者14例,主要表现为咳嗽、咳痰、发热、胸痛、气急.其余3例体检发现.影像学主要表现为肿块结节型或片状渗出影.所有患者血清乳胶凝集试验均为阳性.17例患者均经病理确诊为肺隐球菌病,其中14例经CT引导下经皮肺穿刺活检证实.所有患者均接受抗真菌治疗,疗程2至6月,15例患者治愈或显效.结论 肺隐球菌病临床表现缺乏特异性,血清乳胶凝集试验对本病的诊断价值较高.本病确诊依靠病理,同时应优先考虑CT引导下经皮肺穿刺活检获得病理组织.药物治疗需要足够疗程.

Clinical Analysis of 17 Cases of Pulmonary Cryptococcosis

Objective To improve the cognition of diagnosis and treatment of pulmonary cryptococcosis by analyzing clinical data of 17 patients suffering from this disease.Methods Seventeen patients was diagnosed as pulmonary cyrptococcosis in Ruijin Hospital from Jan.2009 to Oct.2011,and their data of clinical characteristic,imaging manifestation,laboratory test,treatment was retrospectively reviewed.Results Among these patients with pulmonary cryptococcosis,14 patients had clinical symptoms such as cough and expectoration,fever,chest pain and dyspnea,and 3 cases were found only by health screen;Imaging manifestation was nodule or pathcy exudative shadow;All of whom were positive for serum latex agglutination test.The diagnosis was confirmed in all cases by pathological finding,14 by CT guided transthoracie needle aspiration lung biopsy.All the patients received anti-fungal agents.A course of treatment should need two months until six months,15 patients were cured or markedly improved.Conclusion Its clinical manifestation and imaging findings are lack of specificity,serum latex agglutination test is valuable.Its diagnosis mainly depend on pathology,and should give priority to acquire Pathological tissue by CT guided transthoracic needle aspiration lung biopsy.A long-term drug therapy is needed.