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  • Title: Extent of Lung Involvement and Serum Cryptococcal Antigen Test in Non-Human Immunodeficiency Virus Adult Patients with Pulmonary Cryptococcosis.
    Author: Zhu T, Luo WT, Chen GH, Tu YS, Tang S, Deng HJ, Xu W, Zhang W, Qi D, Wang DX, Li CY, Li H, Wu YQ, Li SJ.
    Journal: Chin Med J (Engl); 2018 Sep 20; 131(18):2210-2215. PubMed ID: 30203796.
    Abstract:
    BACKGROUND: Serum cryptococcal antigen (CrAg) test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this study was to investigate the factors associated with false-negative CrAg test among non-human immunodeficiency virus (HIV) adult patients with pulmonary cryptococcosis and its clinical features. METHODS: One hundred and fourteen non-HIV adult patients with pulmonary cryptococcosis, proven by biopsy, were retrospectively reviewed. Finally, 85 patients were enrolled; 56 were CrAg positive (CrAg+ group) and 29 were negative (CrAg- group). It was a cross-sectional study. Then, baseline characteristics, underlying diseases, clinical symptoms, laboratory findings, and chest radiological findings were reviewed and analyzed. Chi-square test was used to analyze categorical variable. Odds ratio (OR) was used to measure correlation. Student's t- test was obtained to analyze continuous variable. RESULTS: No difference in baseline characteristics, underlying diseases, clinical symptoms, and laboratory findings were found between two groups (P > 0.05 in all). Nevertheless, diffuse extent lesion was 82.1% in CrAg+ group and 10.3% in CrAg- group (χ2 = 40.34, P < 0.001; OR = 39.87). CONCLUSIONS: Among patients with limited pulmonary involvement, a negative serum CrAg does not preclude the diagnosis of pulmonary cryptococcosis. However, among patients with extensive pulmonary involvement, serum CrAg is a useful diagnostic tool for pulmonary cryptococcosis. Furthermore, we also noticed that the untypical and mild presentations with extensive pulmonary lesion might be the features of pulmonary cryptococcosis, which needs further investigation. 成年非HIV感染的肺隐球菌病患者血隐球菌抗原水平与肺部病变范围的相关性研究摘要背景：血隐球菌抗原(CrAg)检测是临床上最常用的隐球菌病非有创性检查手段。但该方法在临床应用中假阴性结果并不少见。因此，本研究的目的是探讨在成年非HIV感染的肺隐球菌病患者出现血隐球菌抗原检测假阴性结果的原因，及成年非HIV感染的肺隐球菌病的临床特征。 方法：在该回顾性横断面研究中我们共收集了114例成年非HIV感染的肺隐球菌病病例。根据入选标准和排除标准，最后纳入患者85例，其中血隐球菌抗原阳性组(CrAg+组) 56例，血隐球菌抗原阴性组(CrAg-组) 29例。并对患者基线特征、基础疾病、临床症状评分、实验室检查和胸部影像学结果进行记录和分析。卡方检验用于分类变量分析。优势比(OR)用于关联强度分析。t检验用于连续变量分析。 结果：两组患者的基线特征、基础疾病、临床症状评分和实验室检查结果均无明显统计学差异(P均>0.05)。但弥漫性病灶发生率在CrAg+组为82.1%，CrAg-组为10.3% (χ2 = 40.34, P < 0.001)。OR为39.87。 结论：若患者胸部影像学为局限性病灶，患者血CrAg检测阴性时仍不能排除肺隐球菌病的可能。对于弥漫性病灶的患者，血CrAg检测意义较大。同时我们的研究还发现肺部存在广泛病灶但临床症状不明显可能是肺隐球菌病的临床特征，但仍需进一步临床研究证实。.
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