新型隱球菌是特發(fā)性阻塞性細(xì)支氣管炎伴機(jī)化性肺炎的病因匯編

1、 immunocompetent individuals： Blood-RT:WBC8,700/mm3,85% segmented neutrophils electrolytes:normal LEF:normal CRP:147 mg/L Blood culturs：negative bronchoalveolar lavage (the Gram stain,acid fastbacilli ,fungal stains,viral,bacterial,mycobacterial,fung al cultures ) ： negative HIV serologic test:negat

2、ive PPD:negative Legionella urinary antigen test: negative an open lung biopsy: fibroblastic plugs involving bronchioles and surrounded by chronic inflammatory cells,indicate BOOP, Additionally, there were multinucleated giant cells and occasional small, non-caseating granulomas PAS: GSM: serum cryp

3、tococcal antigen test : negative image image oral steroids fluconazole ,400mg/d, 3-month course remained asymptomatic had no pulmonary infiltrates on chest radiograph. 9 months of follow-up Discussion 1976 2001 42 cases immunocompetent adults 37 (88%) Pulmonary involvement; 36 of the 37 Isolated pul

4、monary middle agedrespiratory/cons titutional symptomsgood outcomes 101 cases immunocompromised adults 1、observation alone without specific therapy 2、 treatment of symptomatic patients, particularly those with extensive disease on chest radiographs 3、high titers of serum cryptococcal antigen are bel

5、ieved to be a marker of systemic cryptococcal disease 4、antifungal therapy can probably be postponed with close observation for 23 months 5、oral fluconazole is an alternative 6、BOOP：an inflammatory/fibrosing process involving the small airways that often results in progressive, irreversible obstruct

6、ive pulmonary disease 7、pathogenesis：damage of the bronchiolar epithelial cells and recruitment of T lymphocytes and neutrophils to the site of injury; many cytokines and chemokines are secreted, perpetuating the inflammatory response and leading to fibroblast formation with obliteration of the airw

7、ays 5 case reports of an association between Cryptococcus and BOOP we report on a case of an immunocompetent young adult without history of previous lung disease who presented with a prolonged course of significant lung involvement and BOOP. CN should be kept in mind as a possible etiology in patients who present with severe pneumonitis or bronchiolitis, even if they do not have AIDS or other immunosuppression, as