Retrospective Analysis of 76 Immunocompetent Patients with Primary Pulmonary Cryptococcosis

Ye, Feng; Xie, Jiaxing; Zeng, Qing; Chen, Guoqin; Zhong, Shu-qing; Zhong, Nanshan

doi:10.1007/s00408-011-9362-8

Cited by 55 publications

(48 citation statements)

References 31 publications

(47 reference statements)

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“…In the present study, the most common manifestation of pulmonary cryptococcosis in plain chest CT scans was pulmonary nodules, including single and multiple nodules, which were observed in 40.74% (11 out of 27) of patients, in comparison with 46.06% of patients in the study by Ye et al (27) and 55.2% in the study by Zhang et al (23). Multiple nodules (63.64%) were more common compared with single nodules (36.36%) and bilateral lung lesions were identified in certain patients (45.45%), consistent with previous findings (19).…”

Section: Discussioncontrasting

confidence: 48%

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Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

et al. 2017

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Abstract. Pulmonary cryptococcosis is most commonly reported in immunocompromised patients, whereas immunocompetent hosts are rarely affected and may be asymptomatic, resulting in reduced diagnostic performance of computed tomography (CT) imaging. Thus, the aim of the present study was to review the plain and contrast-enhanced chest CT scan findings of primary pulmonary cryptococcosis in immunocompetent patients, with the aim of improving the diagnosis of this type of pulmonary disease. In the present study, a total of 27 immunocompetent patients of clinically confirmed pulmonary cryptococcosis were analyzed retrospectively. Of the 27 patients, 14 patients underwent plain and contrast-enhanced chest CT scans, while 13 patients only underwent plain chest CT scanning. The clinical and imaging characteristics, including the location, shape, size, number, edge and attenuation or intensity of each lesion, in unenhanced and contrast-enhanced CT scans were reviewed. The results indicated that the most common CT finding was pulmonary nodules (40.74%), with multiple nodules (25.93%) being more common compared with solitary nodules (14.81%). The majority of the nodules were poorly defined and inhomogeneous with observed air-bubble sign. Other findings included consolidation (25.93%), ground-glass opacities (GGO; 22.22%) and a mass (11.11%). The halo, air bronchogram and cavity signs were observed more frequently (22.22, 18.52 and 14.81%, respectively). The pulmonary lesions presented a predominant distribution in the lower lung lobes and peripheral area in 55.55 and 74.07% of the cases, respectively. On the contrast-enhanced CT images, the majority of nodules presented ring enhancement with the mean maximal enhancement value of 20.92±5.67 Hu, and masses demonstrated inhomogeneous enhancement with a mean maximal enhancement value of 35.61±8.32 Hu. In conclusion, familiarity with the CT findings and occupational environment exposure history will assist in earlier and easier diagnosis of pulmonary cryptococcosis in immunocompetent patients.

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Section: Discussioncontrasting

confidence: 48%

“…Enlargement of mediastinal lymph nodes and pleural effusion may also occur, although this appears to be more likely in immunocompromised patients rather than in immunocompetent ones (26,27).…”

Section: Discussionmentioning

confidence: 99%

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

et al. 2017

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“…(Chang et al, 2006;The Chinese Medical Journal Editor Committee, 2006;Ye et al, 2012;Zhang et al, 2012). The patients enrolled in the study all used to be in good health, and had no basic diseases or a history of using immunosuppressants.…”

Section: Discussionmentioning

confidence: 99%

“…The PC patients recruited all had negative determination of HIV antibodies, a history of good health, no basic diseases, and met the following exclusion criteria (Chang et al, 2006;The Chinese Medical Journal Editor Committee, 2006;Ye et al, 2012;Zhang et al, 2012): 1) peripheral absolute neutrophil count below 2.0 x 10 9 /L or absolute lymphocyte count below 0.9 x 10 9 /L, 2) humoral immune parameters below the lower limits of the normal range (IgG 6-16, IgA 0.7-5.0, and IgM 0.6-2.0 g/L), 3) undergoing or having undergone immunosuppressant therapy, 4) having undergone organ transplantation or presence of graft versus host disease, 5) continuous administration of steroid hormones for more than 3 weeks, and 6) chronic diseases (including diabetes mellitus, cancer, and rheumatoid immune diseases, etc. ), long stay in the intensive care unit after surgery or trauma, long-term mechanical ventilation, an indwelling catheter in the body, all parenteral nutrition, and long-term therapy by broad-spectrum antibiotics.…”

Section: Patients and Diagnostic Criteriamentioning

confidence: 99%

Changes of Th1/Th2 cytokines in immunocompetent patients with pulmonary cryptococcosis

Wang¹,

Li²,

Luo³

et al. 2013

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the changes of Th1/Th2 cytokines in immunocompetent patients with pulmonary cryptococcosis (PC). Twenty immunocompetent patients with PC were identified by histopathological examination and were enrolled in the study along with the age-and gender-matched healthy controls. The serum concentrations of interferon-g (IFN-g), interleukin-4 (IL-4), and interleukin-12 (IL-12) were measured by enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells (PBMCs) in both groups were isolated and incubated with or without recombinant human IL-12 (rhIL-12) for 48 h, and the concentrations of IFN-g and IL-4 in the supernatant were measured by ELISA. Serum IFN-g levels were greatly decreased in the patients compared with control groups (P < 0.01), whereas no significant difference was observed in serum IL-4 and IL-12 levels. The concentrations of IFN-g and IL-4 in the supernatant of PBMCs without the stimulation of rhIL-

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“…Cryptococcosis may, in fact, arise even in patients with no underlying disease [11, 12]. In other words, these patients may have various degrees of immune deficiency and risk for dissemination.…”

Section: Introductionmentioning

confidence: 99%

The CD4+ T-lymphocyte count is an important predictor for the prognosis of cryptococcosis

Yuan

et al. 2016

Eur J Clin Microbiol Infect Dis

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There is great heterogeneity of immunity among patients with cryptococcosis, and severe immunodeficiency can lead to negative clinical outcomes. Underlying disease is a poor surrogate for immune status and inferior in predicting an individual’s prognosis. This study was intended to determine whether T-lymphocyte subgroups would be more suitable indicators regarding the severity of infection and clinical outcomes of such patients. We retrieved clinical data on 101 patients with cryptococcosis and compared the validity of multiple parameters (underlying disease and T-lymphocyte subgroups) in predicting the severity of infection and clinical outcome in these patients. For patients with CD4+ T-lymphocyte counts lower than 400/μL, the odds ratio of disseminated cryptococcosis was 23.3 (P = 0.005). There was a moderate negative correlation between CD4+ T-cell count and Apache II score (−0.609, P < 0.001). Mortality among patients with low levels of CD4+ T lymphocytes was significantly higher than among those with normal levels (23.8% vs 5.3%, P = 0.016). However, the difference was not significant if the patients were grouped by underlying disease (P = 0.067). The CD4+ T-lymphocyte count in peripheral blood is a simple and more accurate biomarker for predicting severity of infection and clinical outcome in patients with cryptococcosis.Electronic supplementary materialThe online version of this article (doi:10.1007/s10096-016-2880-9) contains supplementary material, which is available to authorized users.

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Retrospective Analysis of 76 Immunocompetent Patients with Primary Pulmonary Cryptococcosis

Abstract: Primary pulmonary cryptococcosis was found mainly in immunocompetent patients aged <50 years without preexisting lung disease. Shadow on the chest X-ray is the predominant feature. Treatment with a complete course of fluconazole and/or other antifungal agents can achieve favorable outcome.

Cited by 55 publications

References 31 publications

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

Changes of Th1/Th2 cytokines in immunocompetent patients with pulmonary cryptococcosis

The CD4+ T-lymphocyte count is an important predictor for the prognosis of cryptococcosis

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