Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients.
OBJECTIVE
We compared the clinical characteristics and imaging findings between immunocompetent and immunocompromised patients in whom pulmonary cryptococcosis had been diagnosed to define the role of serum cryptococcal antigen (sCRAG) and radiographs during a follow-up period of up to 1 year.


METHODS
Retrospective cohort study.


METHODS
University hospital.


METHODS
The clinical records, chest radiographs, and CT scan findings of 13 immunocompetent and 16 immunocompromised patients with a diagnosis based on cerebrospinal fluid (CSF) culture, sCRAG titers, and cytologic or histologic confirmation of the presence of pulmonary cryptococcosis were reviewed during the course of the study. Two thoracic radiologists reviewed chest radiographs and CT scans for morphologic characteristics and the distribution of parenchymal abnormalities, and a final reading was reached by consensus. The correlation between serial radiographs and sCRAG titers was examined in 9 immunocompetent and 10 immunocompromised patients.


METHODS
Serum or CSF cryptococcal antigen.


RESULTS
The most common clinical symptom was cough, which was present in 24 patients (82.8%). Pulmonary nodules were the most frequent radiologic abnormality. Cavitation within nodules and parenchymal consolidation were significantly less common in immunocompetent patients compared to immunocompromised patients (p = 0.02 and p = 0.05, respectively). Immunocompromised patients tended to have a larger extent of pulmonary involvement than immunocompetent patients, the changes seen on their serial radiographs were more variable, and their corresponding sCRAG titers were higher (> 1:256). In the immunocompetent patients, the radiographic characteristics of lesions usually improved with a corresponding decrease in sCRAG titers over time.


CONCLUSIONS
Our study suggests that pulmonary cryptococcosis usually follows a benign clinical course in immunocompetent patients. Immunocompromised patients often undergo an evolution to cavitary lesions that represent a more aggressive disease nature. Serial radiographic changes and changes in sCRAG titers reliably reflect disease progression and the response to therapy.
Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Wei-Chou
WC
Chang
Department of Surgery, National Defense Medical Center, Taipei, Taiwan, Republic of China. Electronic address: tzao@yahoo.com.
Ching
C
Tzao
Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Hsian-He
HH
Hsu
Department of Surgery, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Shih-Chun
SC
Lee
Division of Thoracic Surgery, Department of Internal Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Kun-Lun
KL
Huang
Division of Pulmonary and Critical Care Medicine, Tir-Service General Hospital, and the Department of Humanity and Social Studies, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Ho-Jui
HJ
Tung
Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Cheng-Yu
CY
Chen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000946:Antigens, Fungal / Q000097:blood*; D003453:Cryptococcosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology; D003455:Cryptococcus neoformans / Q000276:immunology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000000981:diagnostic imaging; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D000946:Antigens, Fungal