Clinical analysis of 42 elderly patients with pulmonary cryptococcosis / 中华老年医学杂志

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.

The significance and therapy monitoring of detection cryptococcal capsular polysaccharide antigen in HIV-positive patients with secondary cryptococcal meningitis / 国际检验医学杂志

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.

The diagnostic value of urine C polysaccharide antigens for Streptococcus pneumoniae infection / 国际检验医学杂志

Objective To explore the value of urine C polysaccharide antigens for the diagnosis of Streptococcus pneumonia in‐fection .Methods 372 cases of patients with community‐acquired pneumonia were selected ,and their urine C polysaccharide antigens were tested by using BinaxNOW kit .Results The sensitivity and specificity of urine C polysaccharide antigens were 63 .0% and 85 .3% ,respectively .The positive rate of urine C polysaccharide antigens in patients diagnosed with Streptococcus pneumonia infec‐tion was 84 .0% ,and that in patients suspected with Streptococcus pneumonia infection was 57 .4% .Conclusion The test of urine C polysaccharide antigens can be a diagnostic adjunct for Streptococcus pneumonia infection .

Deficiência específica de anticorpo antipolissacarídeo de pneumococo e resposta humoral a vacinas pneumocócicas: atualização em diagnóstico / Specific anti-pneumococcal polysaccharide antibody deficiency and humoral response to pneumococcal vaccines: uptdate on diagnosis

A deficiência específica de anticorpo antipolissacarídeo de pneumococo é o comprometimento da resposta IgG específica aos antígenos polissacarídeos do pneumococo e manifesta-se de maneira semelhante às outras deficiências de imunoglobulinas, com infecções recorrentes do trato respiratório. A prevalência é variável, entre 7 a 19%, representando no Brasil 8,7% dos casos de imunodeficiências. O diagnóstico funcional baseia-se na capacidade do organismo montar uma resposta imune constituída pela produção de anticorpos quando estimulado por antígenos polissacarídeos presentes na vacina pneumocócica polissacarídea pura. No estudo da resposta à vacina pneumocócica polissacarídea pura é necessário testar os sorotipos não comuns à vacina polissacarídea conjugada para determinar a resposta de anticorpos antipolissacarídeos sem a interferência de anticorpos antiproteínas advindos da vacina polissacarídea conjugada. São reconhecidos quatro diferentes fenótipos da doença, denominados memória, leve, moderada e grave. O objetivo do presente trabalho foi realizar revisão da literatura para verificar a epidemiologia, diagnóstico e fenótipos da deficiência específica de anticorpo antipolissacarídeo de pneumococo. Trata-se de revisão narrativa de artigos nos últimos 10 anos sobre a deficiência de anticorpo específica para o pneumococo. Concluímos que a deficiência específica de anticorpo antipolissacarídeo de pneumococo é frequente, com espectro laboratorial variável.

Specific anti-pneumococcal polysaccharide antibody deficiency is characterized by impairment of specific IgG response to pneumococcal polysaccharide antigens. Its clinical manifestation is similar to other immunoglobulin deficiencies, with recurrent infections of the respiratory tract. Prevalence is variable, ranging from 7 to 19%; in Brazil, it accounts for 8.7% of cases of immunodeficiencies. Diagnosis is based on the body’s functional ability to mount an immuneresponse including the production of antibodies after stimulation by polysaccharide antigens present in the pure pneumococcal polysaccharide vaccine. When studying responses to this vaccine, it is necessary to test serotypes other than those present in the pneumococcal conjugate vaccine, in order to determine the response of anti-polysaccharide antibodies not influenced by antiprotein antibodies originating from the conjugate vaccine. Four different phenotypes of the disease are known: memory, mild, moderate, and severe. The objective of the present study was to review the literature on the epidemiology, diagnosis, and phenotypes of specific antipolysaccharide antibody deficiency. This narrative review includes papers published in the past 10 years on specific anti-pneumococcal polysaccharide antibody deficiency. We conclude that the condition is common, with a variable spectrum of laboratory findings.

Imunodiagnóstico da leptospirose humana. 1. Antígeno polissacarídico para a prova de hemaglutinação passiva / Immunodiagnosis of human leptospirosis. 1. Polysaccharide antigen for passive hemagglutination test

Antígenos polissacarídicos F. foram extraídos de leptospiras dos sorotipos icterohaemorrhagiae e pato c, cuja relação proteína/carboidrato foi de 1,24 e 0,54, respectivamente. Sua especificidade sorológica foi avaliada na reação de hemaglutinação passiva para o diagnóstico da leptospirose humana. Para tanto, hemácias de carneiro previamente fixadas com glutaraldeído foram sensibilizadas com ambas as preparações. Esta prova foi experimentada em 91 soros obtidos de 35 pacientes com leptospirose, causada presumivelmente pelos sorotipos icterohae-morrhagiae, copenhageni, grippothyphosa e pomona. Verificou-se que ambas as frações F. comportaram-se de maneira semelhante. A reação de hemaglutinação passiva foi gênero específica, bastante sensível, positivando-se precocemente na fase aguda da doença. Foram salientadas as vantagens do emprego do antígeno F. patoc, por se tratar de sorotipo não patogênico (AU).