Saturday, February 14, 2009

Pulmonary cryptococcosis misdiagnosed as lung cancer

Pulmonary cryptococcosis is a rare disease, with solitary pulmonary shadow as the main imaging features, and easily misdiagnosed as lung cancer, diagnosed to be based on pathological examination(
Susceptible: Pulmonary cryptococcosis mainly by respiratory tract infection caused by Cryptococcus, which is disseminated disease, no significant regional and ethnic differences. High-risk groups include: 1. Long-term use of glucocorticoid; 2. AIDS; 3. Organ Transplant; 4. Malignancies; 5. Chronic lung disease; 6. Diabetes. The disease often occurs in adults, more men than women, children rarely incidence. Many have pigeon feces, soil history of exposure to mycophenolate, sputum culture or India ink staining can be found in cryptococcosis. In recent years, without basic medical history and pigeon dung, a history of exposure to mycophenolate territories were gradually increased morbidity, hidden morbidity also increased, and the lesion is located in many peripheral subpleural lung, it fiberoptic bronchoscopy positive rate low.
Misdiagnosis: 1. The lack of characteristic clinical manifestations. 2. The relevant checks before the surgery is not comprehensive(
Clinical manifestations: Of this disease without the characteristic signs and symptoms are often difficult to diagnose certain. Symptoms is often mild, can have low-grade fever, cough, expectoration, chest pain, such as respiratory symptoms, or with fatigue, night sweats, weight loss and other systemic symptoms, severe acute respiratory time failure. On 1 / 3 ring cover asymptomatic, many in the medical examination found. AIDS have impaired immune function, such as basic diseases most obvious symptoms may be complicated by adult respiratory distress syndrome, and easily could be combined extra-pulmonary Cryptococcus infection to the central nervous system, skin and urinary system involvement common(
Diagnostic tool: imaging diagnosis, laboratory examination, pathological examination.
Prevention of complications after surgery: guard against post-operative complications, including wound infection, empyema, bronchial pleural crate, etc.. The most important complications and higher mortality are cryptococcal meningitis, there were reports of surgical resection of pulmonary cryptococcosis in patients after surgery do not use anti-fungal treatment, one year after easily cryptococcal meningitis. Therefore, when the diagnosis of pulmonary cryptococcosis, even when no symptoms of central nervous system infection, but also the need for routine examination of cerebrospinal fluid after surgery should be supplemented by antifungal therapy, in order to reduce the chance of systemic dissemination. Pulmonary recurrence after surgery can be medical treatment, surgical indications have to be positive again surgery(

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