Clinical analysis of non-AIDS patients with pulmonary cryptococcosis and the change in their clinical features over 30 years in a tertiary hospital in Beijing, China

Abstract

Over the past few decades, understanding of the clinical features of pulmonary cryptococcosis (PC) has progressed, yet there is a lack of data on the manifestations of PC over time. To investigate the differences in clinical characteristics of PC across different time periods, we performed a retrospective review of 130 non-AIDS patients diagnosed with pathologically or microbiologically confirmed PC from 1990-2020. Among 130 PC patients, 24 (18.5%) exhibited immunosuppression, and 44 (33.8%) had underlying diseases. In radiology, 118 (90.8%) presented with subpleural lesions, and 68 (53.1%) presented with nodules with diameters ranging from 1-5 cm. Seventy-five patients (57.7%) underwent surgery alone. PC clinical features at different time periods showed that hospitalization days decreased (P=0.009), and patients with symptoms decreased over time. Patients exhibiting isolated lesions decreased (P=0.022), and patients exhibiting subpleural lesions increased (P=0.020). Patients with lesions presenting 3-10 mm nodules increased (P=0.028). In conclusion, more and more patients have been diagnosed of PC in the last 30 years. The timing of PC diagnosis has shifted to early in disease progression. Pulmonary lesions caused by cryptococcosis are easily misdiagnosed and may lead to unnecessary surgical treatment. Further research is needed to identify lung lesions caused by cryptococcosis.