新型隐球菌是特发性阻塞性细支气管炎伴机化性肺炎的病因

1、新型隐球菌是特发性阻塞性细支气管炎伴机化性肺炎的病因1immunocompetent individuals：1111111 Blood-RT:WBC8,700/mm3,85% segmented neutrophilselectrolytes:normalLEF:normalCRP:147 mg/LBlood culturs：negativebronchoalveolar lavage(the Gram stain,acid fastbacilli ,fungal stains,viral,bacterial,mycobacterial,fungal cultures ) ：negative

2、HIV serologic test:negativePPD:negative1Legionella urinary antigen test:negativean open lung biopsy: fibroblastic plugs involving bronchioles and surrounded by chronic inflammatory cells,indicate BOOP, Additionally, there were multinucleated giantcells and occasional small, non-caseating granulomasP

3、AS: GSM:serum cryptococcal antigen test :negativeimageimage111oral steroidsfluconazole ,400mg/d, 3-month course remained asymptomatic had no pulmonary infiltrates on chest radiograph. 9 months of follow-up 1Discussion1976200142 cases immunocompetent adults 37 (88%)Pulmonary involvement; 36 ofthe 37I

4、solated pulmonarymiddle agedrespiratory/constitutional symptomsgood outcomes101 casesimmunocompromised adults 11、observation alone without specific therapy2、 treatment of symptomatic patients, particularly those with extensive disease on chest radiographs3、high titers of serum cryptococcal antigen a

5、re believed to be amarker of systemic cryptococcal disease4、antifungal therapy can probably be postponed with close observation for 23 months5、oral fluconazole is an alternative16、BOOP：an inflammatory/fibrosing process involving the small airways that often results in progressive, irreversible obstr

6、uctive pulmonary disease7、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 ai

7、rways15 case reports of an association between Cryptococcus and BOOPwe 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 immunosuppre