Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients

Abstract

BackgroundCurrent 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.MethodsHIV 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.Results60 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.ConclusionsThis 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.

Underlying Cryptococcal Diseases and the Correlation With Serum Cryptococcal Antigen Titers in Hospitalized HIV-Infected Patients Screened Positive for Cryptococcal Antigenemia

“…An important reason for this discrepancy may be that chest CT scan, which was more sensitive to reveal pulmonary lesions compared with chest radiograph, was routinely performed for patients with cryptococcal antigenemia in our study. As we and others had previously described, the most characteristic radiological features of HIV-associated PC were pulmonary nodules/masses with or without cavitation that may not always be associated with significant respiratory symptoms; clinicians may be unawareness of PC when pulmonary symptoms were not severe (Hu et al, 2013(Hu et al, , 2017Xie et al, 2015). Together, our study suggested that the prevalence of PC in HIV-infected patients may be underestimated.…”

“…Here, the characteristic radiographic features were pulmonary nodules/masses with or without cavitation, as we and others found that those lesions were the most common radiological features of PC in immunocompromised HIV-infected patients (Hu et al, 2013(Hu et al, , 2017Xie et al, 2015). If other forms of PC lesions existed, they were generally accompanied by co-existing pulmonary nodules/masses in our practice (Hu et al, 2017). Therefore, calculating those characteristic lesions may underestimate the prevalence of PC, however, in a mild degree.…”

Comparison of Clinical Features and Prognostic Factors of Cryptococcal Meningitis Caused by Cryptococcus neoformans in Patients With and Without Pulmonary Nodules

“…When asymptomatic, it may be discovered incidentally on radiological imaging. The most common presentation of PC on chest computed tomography (CT) is pulmonary nodules, both in HIVinfected and in HIV-uninfected patients [7][8][9]. Although the common route of cryptococcal infection was considered to be Cryptococcus inhalation into the lung, it mainly affects the central nervous system, causing fever, headache, and other symptoms, while symptomatic pulmonary infection is uncommon.…”

Clinical Significance of Low Serum Cryptococcal Antigen Titers by Lateral Flow Assay in Immunocompromised Patients: a Retrospective Case-Control Study

“…A large proportion of the patients tested for serum CrAg in our study presented with respiratory symptoms and demonstrated chest radiographic findings, prompting testing. Pulmonary cryptococcosis is challenging to diagnose given the suboptimal sensitivity of respiratory cultures, nonspecificity of radiologic findings, and uncertainty of low-titer serum CrAg results (15,18,24,25). We found that regardless of culture confirmation or clinical signs of disease, the vast majority of patients in the low-titer group were given antifungal therapy for treatment of cryptococcosis.…”