Pulmonary cryptococcosis
Introduction
Introduction to pulmonary cryptococcosis Pulmonary cryptococcal disease (pulmonary cryptococcosis) is a subacute or chronic visceral fungal disease caused by a novel cryptococcal infection. This bacterium is a saprophytic yeast that does not form hyphae and spores and is widely found in nature. The low immune function of the body is the main cause of the disease. Most of the bacteria are inhaled into the human body by the respiratory tract, forming an infection in the lung. It mainly invades the lungs and central nervous system, but it can also invade bones, skin, mucous membranes and other organs. After infection, healthy people can self-heal or the lesions are confined to the lungs without clinical symptoms. basic knowledge The proportion of the disease: the probability of the population is 0.074% Susceptible people: no special people Mode of infection: respiratory transmission Complications: pleural effusion meningitis
Cause
Cause of pulmonary cryptococcosis
Immunity factor (35%):
Low immune function is an important cause of cryptococcal disease. Inhalation of cryptococcus in normal people causes intrapulmonary infection. The lesions are mostly confined to the lungs, rarely appearing symptoms, and often have self-healing tendency.
Disease factor (30%):
If patients with chronic diseases (such as advanced malignant tumors, leukemia, long-term exposure to large doses of hormones, broad-spectrum antibiotics, and anticancer drugs) due to overwork or immunodeficiency, inhalation of fungi, formation of lesions in the lungs, can be disseminated by blood To the whole body, and more invading the central nervous system.
Environmental factors (25%):
The bacteria usually enter the body through the respiratory tract, and the lungs are the first site of infection.
Prevention
Pulmonary cryptococcosis prevention
1. The application of long-term antibiotics can cause imbalance of the body flora; the abuse of adrenocortical hormone can inhibit the body's immune response, which creates conditions for the infection and spread of cryptococcus. Therefore, the use of the above drugs should be strictly To prevent abuse, for cases of long-term use of antibiotics or adrenocortical hormones, if the condition does not improve or worsen, you should consider the possibility of cryptococcal infection, timely pathogen examination.
2. Pay attention to health care, avoid eating decayed pears, peaches and other fruits to prevent the contamination of the environment by pigeon droppings and rat droppings.
3. Should enhance the body's immunity, avoid wounds infected with soil and bird droppings.
Complication
Pulmonary cryptococcosis complications Complications pleural effusion meningitis
There may be pleural effusion, cryptococcal meningitis and the like. Low fever, light cough, cough mucus, occasional pleural inflammation. May have mild cough, a small amount of mucus or blood stasis, chest pain, low fever, fatigue and weight loss. A small number of cases showed acute pneumonia, occasionally chest pain or signs of lung consolidation and pleural effusion. The respiratory movement of the affected side was weakened, the vocal tremor disappeared, and the percussion area showed a voiced sound or a real sound. The auscultation breath sounds weakened or disappeared, and the trachea and mediastinum moved to the healthy side.
Symptom
Symptoms of pulmonary cryptococcosis Common symptoms Fever with cough, sputum... sputum mucus purulent hypothermia dyspnea cryptococcal capsular polysaccharide accumulation
In the early stage of cryptococcal infection of the lungs, most patients may be asymptomatic. A small number of patients have low fever, mild cough, cough mucus, and occasional pleural inflammatory disease. In AIDS patients, cryptococcal infection is often widely spread, and the immune function is severely affected. Acute respiratory distress syndrome (ARDS) can occur in patients with impaired disease. X-ray findings are pleomorphic. Lightness is only manifested as increased texture or isolated nodular shadows in the lower lungs, occasional cavity formation, acute interstitial Inflammation can be characterized by diffuse infiltration or miliary lesions that need to be differentiated from tuberculosis, primary or metastatic lung cancer. The experience of John.R.Perfect is that when cryptococcal infection occurs, X-ray findings can be in any type of lung, any type of Infiltration, nodules or exudation can occur. In recent years, more common manifestations in patients with HIV infection are interstitial infiltration resembling Pneumocystis carinii infection, due to cryptococcal infection in the lungs. Other disease processes in the lungs are repeated, so the X-ray has no typical features.
Examine
Examination of pulmonary cryptococcosis
1. Laboratory examination: sputum, pleural fluid and cerebrospinal fluid for ink smear or culture, complement binding reaction.
2. White blood cell count and mild and moderate increase of neutrophils. In advanced cases, there may be anemia and erythrocyte sedimentation rate.
3. X-ray performance:
It can be in any one of the lungs, any type of infiltration, nodules or exudation can occur, with bilateral middle and lower lungs being more common, or unilateral or limited to one lobe, which can be isolated large spherical foci Or several nodular lesions, no obvious reaction around, similar to tumors, or diffuse miliary shadows, or flaky infiltration shadows, about 10% of patients have cavity formation, in recent years in patients with HIV infection Common manifestations are interstitial infiltration similar to Pneumocystis carinii infection. X-rays have no typical features because cryptococcal infections in the lungs can be repeated with other disease processes in the lungs.
Diagnosis
Diagnosis and identification of pulmonary cryptococcosis
diagnosis
Diagnosis requires histological and microbiological evidence. Cerebrospinal fluid staining smear microscopy of meningitis patients found that cryptococcal bacteria are helpful for diagnosis. Sputum, pleural fluid and cerebrospinal fluid are used for ink smear or culture, and the diagnosis can be confirmed when cryptococcus is detected. Positive complement fixation is also helpful in diagnosis.
Differential diagnosis
It is differentiated from fungal pneumonia caused by fungi such as dermatitis bud, capsular histoplasma, coccidioidomycetes, sclerosporium, cryptococcus, aspergillus or mucor. It also needs to be differentiated from tuberculosis, primary or metastatic lung cancer. With various symptoms and signs of bronchial pneumonia, but the onset is slow, mostly in the application of antibiotic treatment, pneumonia appears or aggravates, may have fever, severe cough, sputum is colorless jelly-like, occasional bloodshot. Pulmonary auscultation can have small and medium blisters.
