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

ABSTRACT

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.