Video-assisted thoracoscopic surgery for primary pulmonary cryptococcosis

Chao-Wen Lu; Wang-Da Liu; Hsao-Hsun Hsu; Un-In Wu; Yung-Ming Jeng; Yee-Chun Chen; Jin-Shing Chen

doi:10.1016/j.jfma.2022.04.014

Video-assisted thoracoscopic surgery for primary pulmonary cryptococcosis

J Formos Med Assoc. 2022 Nov;121(11):2237-2247. doi: 10.1016/j.jfma.2022.04.014. Epub 2022 Apr 30.

Authors

Chao-Wen Lu¹, Wang-Da Liu², Hsao-Hsun Hsu³, Un-In Wu², Yung-Ming Jeng⁴, Yee-Chun Chen⁵, Jin-Shing Chen⁶

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taiwan.
² Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taiwan.
³ Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taiwan. Electronic address: ntuhsu@gmail.com.
⁴ Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan.
⁵ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taiwan.
⁶ Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taiwan; Department of Surgery, National Taiwan University Cancer Center, Taiwan.

PMID: 35501211
DOI: 10.1016/j.jfma.2022.04.014

Abstract

Background: The surgical outcome for primary pulmonary cryptococcosis remains unclear. In this study, we investigated the clinical characteristics, treatment, and outcomes of video-assisted thoracoscopic surgery (VATS) for primary pulmonary cryptococcosis.

Methods: We retrospectively reviewed the medical records of 49 patients with confirmed pulmonary cryptococcosis who underwent VATS for pulmonary nodules at the National Taiwan University Hospital between May 2013 and March 2019. Serum cryptococcal antigen (CryAg)-positive and CryAg-negative patients were compared.

Results: The diagnosis of pulmonary cryptococcosis was confirmed using histopathology or tissue swab culture. The mean age of the patients was 56.0 ± 12.2 years, and 27 patients (55.1%) were male. Most patients were asymptomatic (67.3%) and admitted following the detection of pulmonary lesions on a computed tomography scan of the chest. A greater proportion of patients in the CryAg-positive group (62.5%) underwent lobectomy compared with those in the CryAg-negative group (7.3%, P < 0.001). Three patients (6.1%) had neurological symptoms (headache or dizziness) and all were serum CryAg-positive. One patient with Cryptococcus gattii developed fluctuating serum CryAg titers after a 12-month antifungal treatment. No relapse occurred in the remaining 48 patients, irrespective of postoperative antifungal treatment.

Conclusion: In patients with primary pulmonary cryptococcosis, serum CryAg detection rate is low, and VATS was an effective and safe diagnostic and therapeutic tool.

Keywords: Cryptococcosis; Surgery; Video-assisted thoracoscopic surgery.

MeSH terms

Adult
Aged
Antifungal Agents / therapeutic use
Antigens, Fungal
Cryptococcosis* / diagnosis
Cryptococcosis* / drug therapy
Cryptococcosis* / surgery
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Retrospective Studies
Thoracic Surgery, Video-Assisted* / methods

Substances

Antifungal Agents
Antigens, Fungal