Pulmonary cryptococcosis complicated with pulmonary aspergillosis: a series of studies and a literature review

• Published in: BMC infectious diseases Vol. 24; no. 1; pp. 92 - 12
• Main Authors: Wang, Xidong, Li, Shaoqiang, Zhu, Mangui, Qiu, Ye, Hui, Yilei, Li, Yongming, Zhan, Yangqing, Wang, Yan, Ye, Feng, Li, Zhengtu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.01.2024; BioMed Central; BMC
• Subjects: Antifungal agents; Antigens; Aspergillosis; Aspergillus; Bacterial infections; Biopsy; Care and treatment; Case reports; Comorbidity; Complicated infection; Concurrent infection; Cryptococcal infections; Cryptococcosis; Development and progression; Diagnosis; Disease; Fungal diseases; Fungal infections; Fungi; Health aspects; Health services; HIV; Hospitals; Human immunodeficiency virus; Lavage; Lesions; Literature reviews; Lung diseases; Lungs; Management; Medical research; Medicine, Experimental; Metagenomics next generation sequencing; Patients; Pulmonary aspergillosis; Pulmonary cryptococcosis; Secondary data analysis; Thoracic surgery; Voriconazole; China; Complicated infection; Metagenomics next generation sequencing; Pulmonary aspergillosis; Pulmonary cryptococcosis; Voriconazole
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09014-8

With the development of society, pulmonary fungal diseases, represented by pulmonary aspergillosis and pulmonary cryptococcosis, have become increasingly common. However, there is a lack of clear understanding regarding coinfection by these two types of fungi in immunocompetent individuals. A retrospective study from 2014 to 2022 and a systematic literature review of original articles published in English were performed. Patients with pulmonary cryptococcosis complicated with pulmonary aspergillosis including 5 in the retrospective study and 6 in the systematic literature review. The diagnosis of concurrent pulmonary cryptococcosis and pulmonary aspergillosis in patients was confirmed through repeated biopsies or surgical resection. Pulmonary cryptococcosis is often diagnosed initially (6/11, 55%), while the diagnosis of pulmonary aspergillosis is established when the lesions become fixed or enlarged during treatment. Transbronchial lung biopsy (3/11, 27%), thoracoscopic lung biopsy (2/11, 18%), and percutaneous aspiration biopsy of the lung (1/11, 9%) were the main methods to confirm concurrent infection. Most patients were treated with voriconazole, resulting in a cure for the coinfection (6/11, 55%). Pulmonary cryptococcosis complicated with pulmonary Aspergillus is an easily neglected mixed fungal infection. During the treatment of lesion enlargement in clinical cryptococcus, we need to watch out for Aspergillus infection.