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Year : 2018  |  Volume : 131  |  Issue : 18  |  Page : 2210-2215

Extent of Lung Involvement and Serum Cryptococcal Antigen Test in Non-Human Immunodeficiency Virus Adult Patients with Pulmonary Cryptococcosis

1 Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
2 Southern Medical University, Guangzhou, Guangdong 510280, China
3 Department of Orthopedic Medicine, Shenzhen Nanshan Hospital, Shenzhen, Guangdong 518052, China
4 Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China
5 Department of Respiratory Medicine, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China

Correspondence Address:
Prof. Dao-Xin Wang
Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0366-6999.240815

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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.


 Abstract in Chinese




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。


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