Associations of serum cryptococcal antigen with different of clinical characteristics: a comprehensive analysis of 378 pulmonary cryptococcosis patients

Abstract

Background: Pulmonary cryptococcosis (PC) is an infection typically diagnosed in immunocompromised or immunocompetent patients, which can lead to severe disease if not treated appropriately. We aimed to determine the association between clinical manifestations, computed tomography (CT) findings, and host immune status with the serum cryptococcal antigen (CRAG) test results of PC patients. Methods:The clinical data of 378 PC patients over a 12-year period were retrospectively reviewed at Shanghai Pulmonary Hospital (Shanghai, China). Serum CRAG was detected by a latex agglutination (LA) test using CryptoTrol (Immuno-Mycologics Inc., Norman, OK, USA). Patients were categorized according to their serum LA results, and their clinical characteristics were analyzed: 244 of 378 patients showed positive serum LA results and 134 had negative results.Results: Immunocompromised hosts (ICH) were more likely to present positive LA results. The ICH group had higher titers of LA test than the non-immunocompromised host (NICH) group. Patients with negative LA results often had no symptoms and their CT findings presented a solitary nodule or mass, while LA-positive patients had variable symptoms such as cough, expectoration, fever, etc. A large diversity of CT manifestations were observed in the LA-positive patients, such as multiple nodules, patchy shadows, interstitial infiltrates, and diffuse granular shadows. Patients with a solitary nodule or mass had lower titers than did the patients with other manifestations. The clinical characteristics of LA-positive patients were different from those of LA-negative patients.Conclusions: Serum CRAG test results were found to be associated with the clinical manifestations, CT findings, and host immune status of PC patients.

Lesion size as a prognostic factor in the antifungal treatment of pulmonary cryptococcosis: a retrospective study with chest CT pictorial review of 2-year follow up

“…The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised [20]. In clinical practice, CrAg has significant value as a specific biomarker in the diagnosis of cryptococcosis and evaluation of therapeutic efficacy [21]. One study showed that the sensitivity, specificity, positive predictive value, and negative predictive value of CrAg in lung tissue and serum samples were 100%, 97%, 89%, 100%, and 37.5%, 100%, 100%, and 76%, respectively [22].…”

Case Report: A Great Mimicker of Neoplasm: Pulmonary Cryptococcosis in an Immunocompetent Host After High-Altitude Descent

“…This case demonstrates the importance of maintaining a high index of suspicion for Cryptococcus as part of the differential in immunocompetent patients with exposure to globally endemic locations because these findings can mimic malignancy. 16 The recommendation to treat as a central nervous system disease include cryptococcocemia, evidence of dissemination, or evidence of high fungal burden based on cryptococcal antigen titer . 512.…”

Pulmonary cryptococcosis coexisting with lung adenocarcinoma: A case report and review of the literature

“…However, the incidence of PC has recently increased rapidly in hosts with normal immune function (5,6). Different immune statuses may affect the pulmonary CT manifestations of cryptococcosis (7,8). The diagnosis of PC is challenging due to its diverse and nonspecific CT findings, which may mimic those of lung cancer, bacterial pneumonia or tuberculosis (5).…”