Background: This study investigates the clinical presentations, diagnostic approaches, and treatment outcomes of pulmonary cryptococcosis (PC) in non-HIV patients in Fujian Province, and explores the correlation between immunological status and clinical features.

Methods: A prospective, multicenter cohort study was conducted from April 2017 to March 2022, involving 234 PC patients from 47 hospitals in nine prefecture-level cities in southeastern China's Fujian Province.

Results: The study included 145 male and 89 female PC patients, average age 50.66 ± 14.11 years. Immunological status varied: 115 immunocompetent, 17 with potential immunodeficiency due to certain comorbidities, 69 with mild-to-moderate immunodeficiency, and 33 with severe immunodeficiency. Diabetes mellitus was the most common comorbidity. The prevalence of PC is higher in Eastern Fujian (51.7%). 18.4% of patients were exposed to birds/pigeons droppings prior to admission. 37.6% of patients were asymptomatic. Cough and expectoration were common symptoms. Radiologically, multiple lesions with subpleural and lower lobe involvement were typical. The Cryptococcus capsular antigen (CrAg) test showed a sensitivity of 94.9%. Fluconazole was the primary treatment (87.0%), followed by voriconazole. At final follow-up, 85.4% of patients had recovered or improved.

Conclusions: PC incidence in non-HIV-infected adults in Fujian is higher in males. Most patients were immunocompetent and from eastern Fujian, with few significant environmental exposures. Clinical and radiological findings were non-specific, highlighting diagnostic challenges. The CrAg test is a valuable diagnostic tool. Treatment with fluconazole and voriconazole resulted in favorable outcomes.

Keywords: Clinical characteristics; Immune status; Perspective study; Pulmonary cryptococcosis.

© 2025. The Author(s).

背景： 本研究调查了福建省非HIV患者肺隐球菌病（PC）的临床表现、诊断方法和治疗结果，并探讨免疫状态与临床特征之间的关联。

方法： 从2017年4月至2022年3月，本研究在福建省九个地级市的四十七家医院开展了一项前瞻性多中心队列研究，共纳入了234例PC患者。

结果： 该研究包括145名男性和89名女性PC患者，平均年龄为50.66 ± 14.11岁。患者的免疫状态不同：115人免疫功能正常，17人因某些合并症可能有潜在的免疫缺陷，69人轻至中度免疫缺陷，33人重度免疫缺陷。糖尿病是最常见的合并症。东部福建地区的PC发病率较高（51.7%）。入院前，18.4%的患者接触过鸟类或鸽子排泄物。37.6%的患者无症状。咳嗽和咳痰是常见症状。影像学上，多发性病变伴肺间质及下叶受累较为典型。隐球菌荚膜抗原（CrAg）检测敏感性为94.9%。氟康唑是最主要的治疗药物（87.0%），其次是伏立康唑。最后随访时，85.4%的患者恢复或改善。

结论： 在福建省非HIV感染成人中，肺隐球菌病发病率男性较高。大多数患者免疫功能正常且来自东部福建地区，并无显著环境暴露因素。临床和影像学发现缺乏特异性，提示诊断挑战性较大。CrAg检测是重要的诊断工具。使用氟康唑和伏立康唑治疗取得了良好效果。

关键词： 临床特征；免疫状态；前瞻性研究；肺隐球菌病。