Objective To investigate clinical characteristics of community acquired pulmonary crypyococcosis（PC）.Methods A total of 30 cases of PC diagnosed at Zhongshan Hospital of Fudan University from Jan 2003 to Dec 2007 were retrospectively analysed.All cases were identified by pathological study.Results The patients consisted of 19 males and 11 females，with median age of 44 years（16 to 70 years），66.7% of whom without underlying deseases and with normal immune function.9 patients（30%） were asymptomatic，and 21 patients（70%） had respiratory and/or constitutional symptoms.The most common symptoms were dry cough（16.7%），expectoration（46.7%），fever（23.3%），chest pain（13.3%） and dyspnea on exertion（13.3%）.All symptoms were mild and often showed a self-limiting trend.The common imaging features were nodule and mass，either solitary or multiple（53.3%），infiltrates and consolidation（40%） or diffused and mixed lesions.Non-caseous granulomas was the main character of patholgical study（96.7%），in which 93.1% with multinucleated giant cells containing abundant vacuolus yeast forms with the periodic acid schiff（PAS） reaction and/or Grocott Gomori’s methenamine silver（GMS） staining postive.Only one case found Cryptococcus neoformans spores in biopsy tissue smear and another in sputum smear.16.7% of the patients had positive biopsy tissue cultures for Cryptococcus neoformans，and 3.3% were positive of sputum cultures.15 patients underwent latex agglutination test for pulmonary cryptococcosis，and 93.3% were positive.Conclusions Some immunocompetent healthy people may compromised with community acquired PC with mild symptoms or even not at all and heterogeneous imaging appearance.Pathology，etiology，and serology were valuable diagnostic tools.
Citation：
LIU Li ,HU Lijuan,ZHOU Yingying,ZHU Lei,HE Lixian. Clinical analysis of community acquired pulmonary cryptococcosis. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(5): 363-366. doi:
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| 1. |
Aberg JA，Mundy LM，Powderly WG.Pulmonary cryptococcosis in patients without HIV infection.Chest，1999，115：734-740.
|
| 2. |
Murayama S，Sakai S，Soeda H，et al.Pulmonary cryptococcosis in immunocompetent patients：HRCT characteristics.Clin Imaging，2004，28：191-195.
|
| 3. |
Fox DL，Müller NL.Pulmonary cryptococcosis in immunocompetent patients：CT findings in 12 patients.AJP Am J Roentgenol，2005，185：622-626.
|
| 4. |
Kerkering TM，Duma RJ，Shadomy S.The evolution of pulmonary cryptococcosis：clinical implications from a study of 41 patients with and without compromising host factors.Ann Intern Med，1981，94：611-616.
|
| 5. |
Núñez M，Peacock JE Jr，Chin R Jr.Pulmonary cryptococcosis in the immunocompetent host.Therapy with oral fluconazole：a report of four cases and review of the literature.Chest，2000，118：527-534.
|
| 6. |
Lam CL，Lam WK，Wong Y，et al.Pulmonary cryptococcosis：a case report and review of the Asian-Pacific experience.Respirology，2001，6：351-355.
|
| 7. |
Khoury MB，Godwin JD，Ravin CE，et al.Thoracic cryptococcosis：immunologic competence and radiologic appearance.AJR Am J Roentgenol，1984，142：893-896.
|
| 8. |
McAdams HP，Rosado-de-Christenson ML，Templeton PA，et al.Thoracic mycosis from opportunistic fungi：radiologic-pathologic correlation.Radiographics，1995，15：271-286.
|
| 9. |
赖国祥，张玉华，林庆安，等.国内22年肺隐球菌病回顾性分析.中国实用内科杂志，2005，25：176-178.
|
| 10. |
易祥华，罗本芳，张荣轩，等.10例肺隐球菌病病理和影像学对照分析.中华结核和呼吸杂志，2000，23：574-575.
|
| 11. |
Aberg JA.Pulmonary cryptococcosis in normal hosts：treat or observe? Chest，2003，124：2049-2051.
|
| 12. |
Saag MS，Graybill RJ，Larsen RA，et al.Practice guidelines for the management of cryptococcal disease.Infectious Diseases Society of America.Clin Infect Dis，2000，30：710-718.
|
| 13. |
中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则（草案）.中华内科杂志，2006，45：697-701.
|
- 1. Aberg JA，Mundy LM，Powderly WG.Pulmonary cryptococcosis in patients without HIV infection.Chest，1999，115：734-740.
- 2. Murayama S，Sakai S，Soeda H，et al.Pulmonary cryptococcosis in immunocompetent patients：HRCT characteristics.Clin Imaging，2004，28：191-195.
- 3. Fox DL，Müller NL.Pulmonary cryptococcosis in immunocompetent patients：CT findings in 12 patients.AJP Am J Roentgenol，2005，185：622-626.
- 4. Kerkering TM，Duma RJ，Shadomy S.The evolution of pulmonary cryptococcosis：clinical implications from a study of 41 patients with and without compromising host factors.Ann Intern Med，1981，94：611-616.
- 5. Núñez M，Peacock JE Jr，Chin R Jr.Pulmonary cryptococcosis in the immunocompetent host.Therapy with oral fluconazole：a report of four cases and review of the literature.Chest，2000，118：527-534.
- 6. Lam CL，Lam WK，Wong Y，et al.Pulmonary cryptococcosis：a case report and review of the Asian-Pacific experience.Respirology，2001，6：351-355.
- 7. Khoury MB，Godwin JD，Ravin CE，et al.Thoracic cryptococcosis：immunologic competence and radiologic appearance.AJR Am J Roentgenol，1984，142：893-896.
- 8. McAdams HP，Rosado-de-Christenson ML，Templeton PA，et al.Thoracic mycosis from opportunistic fungi：radiologic-pathologic correlation.Radiographics，1995，15：271-286.
- 9. 赖国祥，张玉华，林庆安，等.国内22年肺隐球菌病回顾性分析.中国实用内科杂志，2005，25：176-178.
- 10. 易祥华，罗本芳，张荣轩，等.10例肺隐球菌病病理和影像学对照分析.中华结核和呼吸杂志，2000，23：574-575.
- 11. Aberg JA.Pulmonary cryptococcosis in normal hosts：treat or observe? Chest，2003，124：2049-2051.
- 12. Saag MS，Graybill RJ，Larsen RA，et al.Practice guidelines for the management of cryptococcal disease.Infectious Diseases Society of America.Clin Infect Dis，2000，30：710-718.
- 13. 中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则（草案）.中华内科杂志，2006，45：697-701.
