title: Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients.
abstract: BACKGROUND
  Current understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC.
  
  
  METHODS
  HIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis.
  
  
  RESULTS
  60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0-205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were "laboratory-confirmed" cases, 48.2% were "clinically confirmed" cases and 16.1% were "clinically probable" cases. 85.7% of the pleural effusions could be "clinically confirmed" cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia.
  
  
  CONCLUSIONS
  This study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection.
authors.affiliation: Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China.
authors.forename: Zhiliang
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Pathology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China.
authors.forename: Qingfang
authors.initials: Q
authors.lastname: Xiong
authors.affiliation: Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China.
authors.forename: Yandan
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China.
authors.forename: Yongfeng
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of radiology, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China.
authors.forename: Chuanjun
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China.
authors.forename: Hongxia
authors.initials: H
authors.lastname: Wei
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging*; D000328:Adult; D018791:CD4 Lymphocyte Count; D003453:Cryptococcosis / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies