Clinical-imaging and therapeutic evaluation of nodule-mass pulmonary cryptococcosis and pneumonia-type pulmonary cryptococcosis.

BACKGROUND

The different morphological changes of pulmonary cryptococcosis (PC) cause difficulties in diagnosis and treatment. To evaluate the clinical-imaging and therapeutic differences between nodule-mass PC and pneumonia-type PC.

MATERIALS AND

METHODS

The clinical-imaging data of 68 patients with PC were collected, including nodule-mass PC (36 cases) and pneumonia-type PC (32 cases). Their clinical-imaging findings were retrospectively analyzed to determine the independent discriminators. Their diagnostic and therapeutic effects were compared.

RESULTS

Compared with nodule-mass PC, pneumonia-type PC was more common with respiratory symptoms (19.4% vs. 81.3%, P < 0.001), inflammatory response (16.7% vs. 71.9%, P < 0.001), bilateral distribution (16.7% vs. 68.8%, P < 0.001), mediastinal lymphadenopathy (0 vs. 21.9%, P = 0.010) and pleural effusion (0 vs. 25%, P = 0.005). While CT malignant signs were more common in nodule-mass PC (66.7% vs. 12.5%, P < 0.001). Multivariate logistic regression analysis showed respiratory symptoms, inflammatory response, bilateral distribution, and malignant CT signs were independent discriminators, with moderate areas under the curve (AUC, 0.760-0.809). Their combined efficacy was significantly improved, with the highest AUC (0.937). Unlike pneumonia-type PC, nodule-mass PC was often treated with low-dose, short-term monofluconazole treatment. However, both groups showed good therapeutic effects.

CONCLUSION

Respiratory symptoms, inflammatory response, bilateral distribution, and malignant CT signs were different between nodule-mass PC and pneumonia-type pulmonary PC. Combining these independent discriminators could reveal its clinical-imaging diversity. The graded antifungal therapy based on CT morphology was effective.