Journal Article

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

Tang, Shuo, Deng, Huo-Jin, Li, He, Qi, Di, Chen, Gui-Hua, Zhang, Wei, Li, Chang-Yi, Xu, Wei, Li, Shen-Jin, Tu, Yue-Sheng, Zhu, Tao, Wu, Yan-Qiao, Luo, Wan-Ting, Wang, Dao-Xin

2018

Overview

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.

• Publisher: Wolters Kluwer India Pvt. Ltd,Medknow Publications and Media Pvt. Ltd,Lippincott Williams & Wilkins Ovid Technologies,Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China%Southern Medical University, Guangzhou, Guangdong 510280, China%Department of Orthopedic Medicine, Shenzhen Nanshan Hospital, Shenzhen, Guangdong 518052, China%Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China%Department of Respiratory Medicine, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China,Medknow Publications & Media Pvt Ltd,Wolters Kluwer
• Subject: Acquired immune deficiency syndrome / Adolescent / Adult / AIDS / Antigens / Biopsy / Chest Radiological Findings; Cryptococcal Antigen; Extensive Pulmonary Lesion; Pulmonary Cryptococcosis / Cross-Sectional Studies / Cryptococcosis / Cryptococcosis - immunology / Cryptococcosis - pathology / Diagnosis / False negative reactions / Health aspects / HIV / Hospitals / Human immunodeficiency virus / Humans / Infections / Lung / Lung cancer / Lung Diseases - immunology / Lung Diseases - pathology / Male / Medical tests / Neutrophils / Original / Retrospective Studies / Studies