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Objective:To analyze the clinical features, imaging characteristics, diagnosis and treatment of elderly patients with pulmonary cryptococcosis, and to propose considerations for the early diagnosis and treatment of pulmonary cryptococcosis.Methods:Clinical data of 42 elderly patients with pulmonary cryptococcosis diagnosed at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2015 to September 2020 were retrospectively analyzed.Differences in clinical data were compared between immunocompromised patients and immunocompetent patients by using the SPSS software.Results:The mean age of patients of with pulmonary cryptococcosis was(66.0±5.3)years.Of the cases, 27 were immunocompromised, with common underlying diseases such as autoimmune rheumatic disorders, tumors and chronic kidney disease.Main clinical manifestations were cough, sputum expectoration, fever and chest tightness.Twenty-two cases showed nodules on chest CT scans, most of which contained multiple nodules.Twenty-four cases showed unilateral lesions, mainly in the lower lobe.There was no significant difference in clinical manifestations, lesion types or location distribution between the immunocompromised and immunocompetent groups( P>0.05), while the incidence of air bronchograms was higher in the immunocompetent group than in the immunocompromised group( P<0.05). Seventeen cases were diagnosed by histopathology, and the clinical diagnosis of 25 cases was confirmed by the positive detection of capsular polysaccharide antigens.Nine cases were treated surgically, 1 case underwent clinical observation postoperatively, and 8 cases were treated with fluconazole after surgery.Thirty-three cases were treated with antifungal therapy, 6 of whom were treated with a combination of drugs.Eight cases were lost to follow-up, 29 were cured or improved, 2 progressed, and 3 died. Conclusions:Pulmonary cryptococcosis in the elderly is more common in immunocompromised patients, with atypical clinical symptoms and a high rate of misdiagnosis.Cryptococcal capsular polysaccharide antigen testing is helpful for early diagnosis, and treatment plans need to be chosen and adjusted according to the patient's immune status and specific conditions.
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Objective To discuss the significance and therapy monitoring of detection cryptococcal capsular polysaccharide anti-gen in HIV-positive patients with secondary cryptococcal meningitis.Methods Cerebrospinal fluid and serum samples of 23 HIV-positive patients with secondary cryptococcal meningitis were collected,retrospective analysis was conducted in the capsular antigen titer changes data which from 23 patients with the cerebrospinal fluid(CSF)and serum samples before and after treatment.And the capsular antigen in 1 3 patients before and after treatment of CSF and serum specimens were compared in matching t test.Results The CSF and serum samples before and after treatment of cryptococcal capsular antigen titer decreased both with statistical signifi-cance(P<0.01),but by effective treatment and fungal culture and smears were negative in the 13 patients,the cryptococcal capsu-lar antigen was still positive.Conclusion Cryptococcal capsular antigen test could help improve HIV-infected patients with crypto-coccal meningitis secondary to early diagnosis,it could be used to determine the efficacy of antigen titer,but not as a cure indicator.