Introduction
Method
Retrospective study
Systematic review
Search strategy
Pulmonary cryptococcosis complicated with pulmonary aspergillosis definition
Inclusion and exclusion criteria
Result
Demographic and clinical characteristics of patients with pulmonary cryptococcosis complicated with pulmonary aspergillosis
NO. | Country | Age | Gender | cardinal symptom | Underlying diseases/Drug use | Therapeutic process | Ultimate treatment | Prognosis | Means of diagnosis |
---|---|---|---|---|---|---|---|---|---|
P1 | China | 50 | Female | Cough, Bloodshot sputum | Diabetes | Pulmonary cryptococcosis → Fluconazole 6 month (poor response) → right lower lobe resection. Pathology: Cryptococcus + Aspergillus | Voriconazole | Cure | Thoracoscopic lobectomy |
P2 | China | 38 | Male | Physical examination revealed lung shadow | / | Pulmonary cryptococcosis → Voriconazole 5 m (no absorption) to Fluconazole 3 m (no absorption) → Pathology slide consultation: Cryptococcus + Aspergillus | Voriconazole | Cure | TBLB |
P3 | China | 35 | Male | Cough, Phlegm, Fever | Horseshoe kidney | Pulmonary cryptococcosis → Fluconazole 10 m (first reduced and then increased) →pathology: Aspergillus | Voriconazole | Cure | TBLB + CT-guided percutaneous lung biopsy |
P4 | China | 53 | Male | Physical examination revealed a cavity in the right lung | Diabetes | Pulmonary cryptococcosis → Fluconazole 2 m (first reduced lesion, then no change) → Pathology: pulmonary Aspergillus with cryptococcus | Voriconazole | Cure | TBLB |
P5 | China | 32 | Male | Physical examination revealed a shadow of the lower left lung | / | Pulmonary cryptococcosis → Fluconazole (lesion enlargement)→ Pathology: pulmonary Aspergillus with cryptococcus | Voriconazole | Improvement | TBLB |
P6 | America16 | 31 | Male | Chest pain, Dry cough, Night sweats | / | Pulmonary cryptococcosis + Aspergillus disease → amphotericin B (cavity enlargement) → lobectomy → amphotericin B | Amphotericin B + lobectomy | Improvement | Lobectomy |
P7 | China15 | 33 | Female | Chest pain, Fever | Systemic lupus erythematosus (glucocorticoid hormone + azathioprine) | Pulmonary aspergillosis + pulmonary cryptococcosis → amphotericin B + Fluconazole | Amphotericin B + Fluconazole | Improvement | VATS lung biopsy |
P8 | Japan14 | 74 | Male | Dry cough | Tuberculosis | Suspected malignancy of the left inferior void → lobectomy → pathology: pulmonary aspergillosis + pulmonary cryptococcosis | Not mentioned | Not mentioned | Thoracoscopic lobectomy |
P9 | Japan13 | 64 | Male | Two cavities in the lungs with aspergillus pellets | Rheumatoid arthritis (glucocorticoid + cyclophosphamide) | TBLB was used to diagnose Cryptococcus pneumoniae with fungal spherules → Fluconazole →VATS, and PCR confirmed cryptococcus with aspergillus infection | Fluconazole | Not mentioned | VATS lung biopsy |
P10 | China12 | 33 | Male | Haemoptysis | / | Empiric anti-infective + anti-tuberculosis therapy 1 week (no improvement in symptoms) →VATS left lower lobectomy → Pathology: pulmonary Aspergillus + Cryptococcus pulmonary | Amphotericin B + Fluconazole | Cure | Thoracoscopic lobectomy |
P11 | America11 | 69 | Female | Dyspnoea, Fever, Dry cough, Loss of appetite, Fatigue | Post-bone marrow transplantation | Pulmonary cryptococcosis → Flucytosine + amphotericin B liposomes (aggravation of symptoms and CT findings) | Voriconazole | Improvement | Cryptococcal antigen titre 1:640; BALF-GM test was 3.258 |
Laboratory and radiographic characteristics of patients with pulmonary cryptococcosis complicated with pulmonary aspergillosis
No. | WBC | NEU | LYM | Cryptococcus antigen test (serum) | Cryptococcus antibody | Aspergillus antigen | aspergillus antibody | G test | Cryptococcus antigen test (BALF) | GM test (BALF) | Pathogen culture | mNGS | Histopathological examination | Initial diagnosis and basis | Final diagnosis and basis | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
P1 | 7 | 3.8 | 2.5 | negative | / | negative | / | negative | undetected | undetected | Sputum + BALF culture: Cryptococcus neoformans | / | Lung tissue changed to cryptococcus + Aspergillus infection | Pulmonary cryptococcosis Sputum + BALF culture: Cryptococcus neoformans | Pulmonary cryptococcosis complicated with pulmonary aspergillosis Lung tissue changed to cryptococcus + Aspergillus infection | ||
P2 | 7 | 3.0 | 3.2 | negative | / | negative | / | negative | < 3.2(negative) | 0.267(negative) | negative | / | Lung tissue showed pulmonary cryptococcosis with aspergillus infection | Pulmonary cryptococcosis Lung tissue showed pulmonary cryptococcosis | Pulmonary cryptococcosis complicated with pulmonary aspergillosis Lung tissue showed pulmonary cryptococcosis with aspergillus infection | ||
P3 | 6.98 | 3.6 | 2.6 | > 100.0 ug/L | / | negative | / | negative | 8.701 µg/L | negative | BALF culture: Cryptococcus neoformans | Lung Tissue: Aspergillus fumigatus | Lung tissue showed chronic bronchitis with aspergillus infection | Pulmonary cryptococcosis BALF culture: Cryptococcus neoformans and Cryptococcus antigen test (BALF): 8.701 µg/L | Pulmonary aspergillosis Lung Tissue: Aspergillus fumigatus and Lung tissue mNGS showed aspergillus infection | ||
P4 | 9.9 | 5.8 | 2.8 | negative | / | negative | / | negative | 9.329 µg/L | 0.309 µg/L(negative) | negative | / | Lung tissue showed lesions consistent with pulmonary aspergillus with cryptococcus infection | Pulmonary cryptococcosis Cryptococcus antigen test (BALF): 9.329 µg/L | Pulmonary cryptococcosis complicated with pulmonary aspergillosis Lung tissue showed lesions consistent with pulmonary aspergillus with cryptococcus infection | ||
P5 | 5.7 | 3.4 | 1.6 | positive | / | 2.44 µg/L | / | negative | negative | 2.0479 | negative | BALF: Cryptococcus neoformans | Lung tissue showed pulmonary Aspergillus with cryptococcus infection | Pulmonary cryptococcosis Cryptococcus antigen test(serum): positive, BALF culture: Cryptococcus neoformans | Pulmonary cryptococcosis complicated with pulmonary aspergillosis Lung tissue showed pulmonary cryptococcosis with aspergillus infection | ||
P6 | unreported | unreported | unreported | 1:2 | positive | unreported | / | unreported | unreported | unreported | Sputum smear: Cryptococcus; Sputum culture: Aspergillus fumigatus + Candida albicans | / | Lung tissue changed to cryptococcus + Aspergillus infection | Pulmonary cryptococcosis complicated with pulmonary Lung tissue changed to cryptococcus + Aspergillus infection | Co-infection diagnosis was made at once | ||
P7 | unreported | unreported | unreported | unreported | / | unreported | / | unreported | unreported | unreported | Lung tissue culture: Aspergillus flavus | / | Wrapped Cryptococcus yeast cells and entwined aspergillus filaments were seen in lung tissue | Pulmonary cryptococcosis complicated with pulmonary Wrapped Cryptococcus yeast cells and entwined aspergillus filaments were seen in lung tissue | Co-infection diagnosis was made at once | ||
P8 | unreported | unreported | unreported | undetected | / | undetected | / | undetected | undetected | undetected | Lung tissue culture: Aspergillus and Cryptococcus neoformans | / | The lung tissue showed positive anti-aspergillus antibody for cryptococcus and isolated hypha | Suspected malignancy of the left inferior void | Pulmonary cryptococcosis complicated with pulmonary aspergillosis The lung tissue showed positive anti-aspergillus antibody for cryptococcus and isolated hypha | ||
P9 | 13.4 | unreported | unreported | positive | / | negative | negative | negative | undetected | undetected | Lung tissue culture: Cryptococcus neoformans | / | A ball of fungus + cryptococcus | Pneumoniae cryptococcosis with fungal spherules A ball of fungus + cryptococcus | Pulmonary cryptococcosis complicated with pulmonary aspergillosis A ball of fungus + cryptococcus And PCR confirmed Aspergillus infection | ||
P10 | unreported | unreported | unreported | unreported | / | negative | / | negative | unreported | unreported | negative | / | Two fungal lesions in lung tissue, one was cryptococcal lesion, the other was aspergillus lesion | Undefined | Pulmonary cryptococcosis complicated with pulmonary aspergillosis Two fungal lesions in lung tissue, one was cryptococcal lesion, the other was aspergillus lesion | ||
P11 | unreported | unreported | unreported | 1: 640 | / | negative | / | unreported | unreported | 3.258 | negative | / | / | Pulmonary cryptococcosis Cryptococcal antigen test 1:640 | Pulmonary cryptococcosis complicated with pulmonary aspergillosis Cryptococcal antigen test 1:640 BALF-GM test was 3.258 And Flucytosine + amphotericin B liposomes treat aggravation of symptoms and CT findings |