Chest
Volume 92, Issue 4, October 1987, Pages 692-695
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Clinical Investigations
Pulmonary Cryptococcosis in AIDS

https://doi.org/10.1378/chest.92.4.692Get rights and content

Cryptococcus neoformans is emerging as an important etiologic agent of disseminated infection in patients with the acquired immunodeficiency syndrome (AIDS). Little attention has been placed on the pulmonary expression of this systemic infection. We report five patients with AIDS and cryptococcosis with primary pulmonary involvement. Patients usually presented with fever, cough, dyspnea, and pleuritic chest pain. Chest x-ray findings varied from localized and diffuse infiltration to lymphadenopathy and pleural effusions. All patients developed disseminated disease despite antifungal therapy. Pulmonary cryptococcosis is a frequent presentation of this infection in patients with AIDS.

Section snippets

MATERIALS AND METHODS

The medical records of 11 patients with AIDS and cryptococcosis diagnosed between January 1981 and July 1985 at the Beth Israel Medical Center (BIMC) were examined retrospectively. All patients met CDC criteria for the diagnosis of AIDS. The diagnosis of cryptococcosis was established by the presence of the organism on fungal stain and on culture of respiratory secretions and/or pleural fluid, blood culture, spinal fluid, or by the presence of the organism in histopathologic specimens from

RESULTS

The results of this study are listed in Table 1. All five patients with documented pulmonary cryptococcosis and AIDS were men, and the mean age was 36.5 years. Two patients were intravenous drug abusers, one patient was homosexual, one patient was Haitian and homosexual, and another patient was Haitian alone. The most common presenting symptoms included fever (five of five patients), cough (three of five patients), pleuritic chest pain (three of five), and weight loss (three of five). Dyspnea

DISCUSSION

Cryptococcus neoformans, a ubiquitous fungus, is now emerging as an important etiologic agent of disseminated infections in AIDS.6, 7 Although other studies of immunocompromised hosts (both AIDS and non-AIDS) have emphasized the organism’s more obvious presentation as a central nervous system pathogen,1, 4, 5, 6, 7 this report describes its significant pulmonary effects. As recently as a decade ago, Salyer et al8 first described the primary pulmonary lymph node complex of Cryptococcus and

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Manuscript received February 6; revision accepted March 12.

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