Chest Infections: Chest Infections |

Diagnostic Analysis of Pulmonary Cryptococcosis in 134 Serum CRAG-Negative Cases FREE TO VIEW

Kebin Cheng; Xiaobin Ji; Beilan Gao; Shuo Liang; Jiuwu Bai; Haiwen Lu; Shuyi Gu; Jinfu Xu; Huiping Li
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Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A86. doi:10.1016/j.chest.2016.02.091
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SESSION TITLE: Chest Infections

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Saturday, April 16, 2016 at 02:15 PM - 03:45 PM

PURPOSE: The clinical presentations of pulmonary cryptococcosis (PC) are generally non-specific, and it may easily be misdiagnosed or underdiagnosed, which may worsen the prognosis. The aim of this study was to improve the clinical diagnosis, through the analysis of the clinical characteristics of serum CRAG-negative PC patients.

METHODS: We retrospectively reviewed the clinical data of 134 patients with tissue-confirmed pulmonary cryptococcosis at Shanghai Pulmonary Hospital (Shanghai, China) during a 12-yr period (2003-2014). CRAG was detected by latex agglutination (LA) test using CryptoTrol (Immuno - Mycologics co. LTD, USA).

RESULTS: Of 134 patients, 110 cases were immunocompetent hosts and 24 cases were immunocompromised hosts. Mean patient age was 50.46 years and 89 patients (66.42%) were male. 82 (61.19%) patients had no symptoms, while 52 cases with one or more symptoms. The main symptoms were cough (42 cases), expectoration (35 cases), chest pain (16 cases), dyspnea (10 cases), emaciation (9 cases), fever (6 cases) and hemoptysis (4 cases). Radiological findings showed predominantly peripheral findings (73.88%) including solitary nodule or mass (65.67%), multiple nodules and masses (13.43%), patchy consolidation opacity (10.45%), and combined patchy and nodular shadows (10.45%). Lesions were found more frequently in the right lung or the lower lung than in the left lung or the upper lung. The positive rate of 18FDG-PET was 58.33% (42/72). Cryptococcal granulomas were found in 126 cases (94.03%), and colloid lesions containing cryptococci were revealed in 8 case who were immunocompromised hosts.

CONCLUSIONS: PC is frequently found in middle-aged NICH male, whose clinical features and radiographic features are non-specific; Nodular lung masses are relatively common in people with negative LA test, so TBLB or PNLB will be chosen to confirm.

CLINICAL IMPLICATIONS:The purpose of the study could help physicians to improve the clinical diagnosis of PC.

DISCLOSURE: The following authors have nothing to disclose: Kebin Cheng, Xiaobin Ji, Beilan Gao, Shuo Liang, Jiuwu Bai, Haiwen Lu, Shuyi Gu, Jinfu Xu, Huiping Li

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