卡泊芬净联合复方磺胺甲嗯唑治疗重症肺孢子菌肺炎

目的 探讨卡泊芬净联合复方磺胺甲嗯唑治疗重症肺孢子菌肺炎的疗效.方法 分析总结6例肺孢子菌肺炎患者的临床特点和诊治经过.结果 6例患者均接受卡泊芬净联合复方磺胺甲噁唑治疗,除1例放弃治疗外,其余5例均收到满意疗效.其中3例患者初始单用复方磺胺甲噁唑治疗,病情无好转,后改为联合卡泊芬净,病情得到控制.结论 卡泊芬净联合复方磺胺甲噁唑治疗肺孢子菌肺炎取得了满意疗效,值得推荐作为单用复方磺胺甲噁唑不能控制的肺孢子菌肺炎的治疗选择.     

复方磺胺甲基异噁唑治疗过敏的爱滋病患者的卡氏肺孢子虫肺炎获得成功

例1为男性,34岁,同性恋者。因发热、体重减轻和双肺底间质浸润而住院。经活检确诊为卡氏肺孢子虫病,乃静脉注射复方磺胺甲基异噁唑(SMZ)和阿昔洛维(acyclovir)。治疗第10天,患者发热并出现红斑和斑点疹,于是在注射复方SMZ同时给予苯     

肾病综合征合并卡氏肺孢子菌肺炎3例报告并文献复习

目的分析肾病综合征合并卡氏肺孢子菌肺炎（PCP）的临床和影像学表现。方法对3例肾病综合征合并PCP患者的临床资料进行分析,并进行相关文献复习。结果3例皆以发热、咳嗽、进行性呼吸困难为首发症状,影像学表现为双肺弥漫性磨玻璃影;2例合并呼吸衰竭;3例均痰中找到卡氏肺孢子菌;治疗药物包括复方磺胺甲嗯唑,克林霉素及卡泊芬净;2例治愈,1例死亡。结论肾病综合征合并PCP时,有典型的临床和影像学表现;肾病综合征患者免疫抑制治疗后出现进行性低氧血症应考虑PCP的可能性,需早期诊断、早期治疗。     

甲氧苄啶-磺胺甲噁唑和乙胺嘧啶-磺胺莫托辛预防卡氏肺孢子肺炎的实验研究

根据报导卡氏肺孢子虫肺炎发病期间合并使用甲氧苄啶-磺胺甲(口恶)唑(Trimethoprim-Sulfamethoxazole)治疗剂量的1/5可以达到预防发病的作用。由于服药时间过长,考虑到会引起副作用,为此作者采用和乙胺嘧啶-磺胺莫托辛(Pyrimethamine-Sulfa-     

复方磺胺甲基异噁唑治疗尼泊尔的旅行者和外侨圆孢子虫感染的安慰剂对照试验

本文作者就复方磺胺甲基异噁唑7天疗程治疗圆孢子虫感染性腹泻的疗效进行了与安慰剂对照的双盲试验。 患者系来尼泊尔的旅游者和非尼泊尔籍侨民,有消化道症状,粪便镜检发现圆孢子虫。已排除禁用复方磺胺甲基异噁唑者、研究前已经采用该药治疗者或合并可能引起慢性腹泻的其它寄生虫感染者。患者随机接受复方磺胺甲基异噁唑(甲氧苄胺嘧啶160mg,     

99例AIDS患者痰液卡氏肺孢子虫PCR检测结果分析

目的 采用巢式PCR检测对AIDS患者痰液标本进行卡氏肺孢子虫检测,为AIDS患者合并卡氏肺孢子虫肺炎的临床诊断提供参考价值.方法 将我院感染科2008年1月至10月收治的具有呼吸道症状的99例AIDS患者痰液标本进行收集,将痰标本进行镜检,巢式PCR扩增卡氏肺孢子虫基因,并且对99例患者进行临床诊断和实验室诊断.结果 99例AIDS患者中,临床诊断卡氏肺孢子虫仅2例;油镜下观察到卡氏肺孢子虫4例;PCR痰阳性共43例,取其中4例成功扩增出耶氏肺孢子菌基因.结论 采用巢式PCR对AIDS患者痰液标本进行检测,可以早期诊断卡氏肺孢子虫,减少卡氏肺孢子虫肺炎患者的漏诊率.     

新药Atovaquone治疗卡氏肺孢子虫肺炎的临床经验

人体研究与动物实验表明,常规治疗卡氏肺孢子虫肺炎(PCP)的药物甲氧苄氨嘧啶-磺胺甲基异噁唑(TMP-SMX)和戊烷脒不能消灭肺内的虫体,给药后的副作用较多,因此有必要寻求其替换药物。 Atovaquone曾称566C80,属羟基萘醌类,动物实验表明它对原虫有致死性杀伤作     

人免疫球蛋白联合复方磺胺甲噁唑治疗艾滋病合并中重度肺孢子菌肺炎临床疗效分析

目的探讨人免疫球蛋白联合复方磺胺甲噁唑治疗艾滋病合并中重度肺孢子菌肺炎的临床疗效。方法选择2013年2月至2015年8月我院感染科收治的艾滋病合并肺孢子菌肺炎(PCP)患者64例作为研究对象,采用随机数字表法将其随机分为观察组及对照组,每组32例。对照组患者给予复方磺胺甲噁唑常规治疗;观察组患者在此基础上加用人免疫球蛋白联合治疗,比较两组患者血清乳酸脱氢酶(LDH)、淋巴细胞计数(LYM)、动脉血氧分压(PaO_2)、氧饱和度(SaO_2)的变化及临床疗效。结果治疗后两组患者LDH水平均较治疗前明显降低(P0.05),对照组患者PaO_2及观察组患者PaO_2、SaO_2较治疗前明显升高(P0.05);治疗3周后,观察组患者LDH、PaO_2水平优于对照组(P0.05),观察组患者总有效率(96.7%)明显高于对照组(72.4%),差异有统计学意义(P0.05),观察组患者临床疗效优于对照组(P0.05)。结论人免疫球蛋白联合复方磺胺甲噁唑治疗中重度肺孢子菌肺炎患者效果显著,安全性好,值得在临床推广应用。     

卡氏肺孢子虫肺炎治疗的研究进展

肺孢子虫肺炎是由卡氏肺孢子虫引起的急性肺炎,为一种发生于免疫力缺陷和免疫机能受到严重损害患者的肺部机会性感染。艾滋病病人早期约30％有卡氏肺孢子虫性肺炎,如不预防治疗,超过80％的艾滋病病人在其病程的某一时期出现这一感染。研究资料表明,我国的AIDS感染和流行情况日趋严重,因此,筛选有效抗肺孢子虫感染及传播的药物具有重要的理论和实际意义。     

系统性红斑狼疮并发卡氏肺孢子虫肺炎二例并文献复习

目的：研究系统性红斑狼疮（SLE）合并卡氏肺孢子虫肺炎（PCP）的临床表现，方法：回顾分析2例SLE合并PCP患者的临床资料，并复习相关文献，结果：2例患者均为31岁，SLE并狼疮肾炎病程分别为4年及7年，并曾使用大剂量泼尼松及环磷酰胺治疗，在诊断PCR时已分别停用激素或免疫抑制剂6个月及12个月。2例患者均表现为干咳，静息时气促，急性发热及进行性低氧血症，胸部X线表现为弥漫性网状阴影。支气管肺泡灌洗液（BAE）均发现卡氏肺孢子虫。使用复方磺胺甲基异恶唑片（SMZ）治疗后，1例患者临床症状及X线表现好转，另1例死亡。结论：必须警惕SLE患者出现快速进行低氧血症及Ⅰ型呼吸衰竭时PCR发生的可能性；SLE并发PCP病死率很高，早期诊断和治疗是改善预后的关键。PCP易复发，必须给以足够疗程的治疗。     

Humoral and cellular responses to Pneumocystis carinii, CMV, and herpes simplex in patients with AIDS and in controls

The titers of IgG and IgA to Pneumocystis carinii in 36 AIDS patients did not differ significantly from those in 31 controls. Only 2/15 patients (13%) with P. carinii pneumonia (PCP) had titers of IgM antibodies greater than or equal to 5, which is significantly less frequent than in 32 controls (62%) and in 21 AIDS patients without PCP (43%). The risk of PCP was 5 times higher in patients without IgM antibodies to P. carinii than in patients who had these antibodies. A significantly higher percentage of those without PCP (57%) showed increasing titers of IgM antibodies to P. carinii in the second of paired samples taken about 6 months apart, compared with whose with PCP (9%; p = 0.05). All patients had high titers of antibodies to CMV and HSV and normal total concentrations of immunoglobulins. None of the patients responded in lymphocyte transformation to P. carinii, CMV, or HSV antigens. There is no obvious explanation to the selective lack of IgM antibodies to P. carinii in patients with PCP. Lack of IgM antibodies may be a marker for an immunodeficiency to P. carinii.     

聚合酶链反应方法检测诱导排痰标本对卡氏肺孢子虫肺炎的诊断价值

目的 评价聚合酶链反应方法检测诱导排痰标本中卡氏肺孢子虫DNA对卡氏肺孢子虫肺炎（PCP）的诊断意义。方法 分别用姬姆萨和六胺银（GMS）两种染色方法和mt-rRNA-PCR方法检测痰液中的卡氏肺孢子虫。结果 化学染色法检测16例临床拟诊PCP的患者痰标本。结果 8例阳性,20例非PCP患者痰标本均为阴性,化学染色方法的敏感性和特异性分别为50％和100％。PCR方法检测16例临床拟诊PCP患者痰液中卡氏肺孢子虫,14例阳性,20例非PCP患者痰标本均为阴性,mt-rRNA-PCR方法的敏感性和特异性分别为88％和100％。结论 姬姆萨和GMS两种细胞化学染色方法联合检测痰标本卡氏肺孢子虫,特异性高,但敏感性偏低。mt-rRNA-PCR检测痰标本中卡氏肺孢子虫DNA方法敏感性高于化学染色法且特异性高,更适于临床应用。     

Occurrence of Pneumocystis carinii in HIV-positive patients with suspected pulmonary tuberculosis in Ethiopia

OBJECTIVE: To investigate the prevalence of Pneumocystis carinii in consecutive HIV-positive patients with suspected pulmonary tuberculosis (PTB) attending a university hospital in Ethiopia. METHODS: A PCR for P. carinii and an indirect immunoflorescence (IF) assay were performed on expectorated sputum samples from: 119 HIV-1-positive patients with negative smears and sputum cultures for Mycobacterium tuberculosis; 96 HIV-1-positive patients with culture-verified PTB; and 97 HIV-negative patients with negative mycobacterial cultures and 72 HIV-negative patients with culture-verified PTB, serving as controls. Outcome of PCR and IF were compared with the chest radiographic (CXR) and initial clinical diagnosis. RESULTS: In the HIV+PTB- group, P. carinii was found in 10.9% by IF, 8.4% by single PCR (sPCR) and 30.3% by nested PCR (nPCR). In the HIV+PTB+ group, 3.1% were P. carinii positive by IF and sPCR and 13.5% by nPCR. All IF- and sPCR-positive samples were nPCR positive. In the HIV-PTB+ and HIV-PTB- groups, 4.2% and 3.1% were nPCR positive, respectively. Six out of eight HIV+PTB- patients with CXR suggesting P. carinii pneumonia (PCP) were IF and/or nPCR positive for P. carinii. In the IF-positive and nested PCR-positive HIV+PTB- patients more than one-third were interpreted as PTB by CXR whereas only one patient was diagnosed with clinical PCP. CONCLUSIONS: P. carinii is prevalent in HIV-positive PTB suspects, suggesting that PCP may be an important, but not well recognized, differential diagnosis. Our findings have implications for treatment and primary prophylaxis for PCP in Ethiopia.     

Low levels of IgG antibodies against pneumocystis carinii among HIV-infected patients

IgG antibodies against Pneumocystis carinii (P. carinii) were detected by an ELISA method using urea-extracted material from human and rat P. carinii as the antigen. Carbohydrate formed a major part of the antigen responsible for reactivity in the ELISA assay, since periodate treatment reduced the reactivity of most sera tested. Cross-reactivity between human and rat P. carinii was detected. However, human serum recognized antigens specific for human P. carinii. With the ELISA method IgG antibody levels were compared between blood donors (n = 40), asymptomatic HIV-antibody positive patients (n = 30) and AIDS patients with (n=22) and without previous P. carinii pneumonia (PCP) (n=21). HIV-infected patients had significantly lower antibody reactivity against the microorganism compared with blood donors. Among HIV-antibody positive patients the highest antibody reactivity was seen in PCP patients. The antibody response to PCP was impaired, since an equal number of patients had an increase and a decrease in antibody reactivity. In conclusion, carbohydrate formed an important part of the P. carinii immunogenic antigen. Cross-reactivity between rat and human P. carinii was demonstrated, but reactivity was somewhat lower using antigen from rats. The antibody level was lower in HIV-infected patients and the ability to mount an antibody response to the infection was impaired, suggesting that the poor antibody response may contribute to the liability of HIV-infected patients to have PCP.     

Pneumocystis carinii Pneumonia in Patients with Ulcerative Colitis Treated with Corticosteroids

Today, Pneumocystis carinii pneumonia (PCP) is typically associated with AIDS. However, in the pre-AIDS era, PCP was known to be associated with various immunodeficiency states, malignancies, and immunosuppressive therapy, particularly the use of corticosteroids. PCP has been reported to occur during immunosuppressive therapy of some chronic inflammatory states, but it has never been reported in patients with inflammatory bowel disease. We report two patients with ulcerative colitis who developed PCP during high-dose corticosteroid therapy, and review the literature regarding non-AIDS PCP. PCP should thus be added to the list of bronchopulmonary complications in inflammatory bowel disease. This report should give gastroenterologists further impetus to limit immunosuppressive therapy to its minimal effective dose.     

Persistence of Pneumocystis carinii in lung tissue of acquired immunodeficiency syndrome patients treated for pneumocystis pneumonia

Eleven patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) were studied by repeat bronchoscopy during PCP treatment to assess histologic evidence of resolution of the pneumonia. Nine of 10 patients studied after 8 to 21 days of therapy demonstrated evidence of persistent PCP. Four of 6 patients studied after 22 to 35 days of therapy continued to demonstrate Pneumocystis carinii cysts on repeat examination, while only 1 of 4 patients studied after 35 days of therapy showed evidence of PCP pneumonia. The rate of resolution of PCP in patients with AIDS may be different from the rate of resolution of PCP in patients without AIDS. There was no apparent correlation between rate of clinical response and likelihood of histologic resolution on follow-up biopsy. The PCP in patients with AIDS may require more prolonged therapy for complete resolution of this pneumonic process.     

Antibody responses to a major Pneumocystis carinii antigen in human immunodeficiency virus-infected patients with and without P. carinii pneumonia.

Antibody responses to a major purified human Pneumocystis carinii surface antigen (gp95) were determined by ELISA in human immunodeficiency virus (HIV)-infected patients. Serum IgG directed against gp95 was measured in 129 consecutive HIV-infected patients who underwent bronchoscopy for evaluation of pulmonary symptoms. Significantly more patients with P. carinii pneumonia (PCP) had detectable antibodies compared with HIV-infected patients without PCP and with HIV-negative controls (50 [66%] of 76 vs. 18 [34%] of 53 and 7 [35%] of 20, respectively; P less than .001), and the level of antibody response was higher (mean optical density ratio: 0.6 vs. 0.23 and 0.2, respectively; P less than .01). Changes in antibody response were investigated in 78 patients for whom serial serum samples taken around the time of bronchoscopy were available. Of the 47 patients with verified PCP, 20 (43%) mounted an antibody response, compared with only 1 (3%) of 31 patients without PCP (P less than .001). This patient had PCP on the basis of clinical criteria, including response to therapy. Thus, despite severe immunosuppression, a proportion of HIV-infected patients with PCP can mount a specific IgG-mediated antibody response to P. carinii.     

Pneumocystis carinii cytochrome b mutations are associated with atovaquone exposure in patients with AIDS

This retrospective cohort study was conducted to determine whether Pneumocystis carinii cytochrome b gene mutations in patients with AIDS and P. carinii pneumonia (PCP) are associated with atovaquone exposure. Portions of the P. carinii cytochrome b genes that were obtained from 60 patients with AIDS and PCP from 6 medical centers between 1995 and 1999 were amplified and sequenced by using polymerase chain reaction. Fifteen patients with previous atovaquone prophylaxis or treatment exposure were matched with 45 patients with no atovaquone exposure. Cytochrome b coenzyme Q binding site mutations were observed in 33% of isolates from patients exposed to atovaquone, compared with 6% from those who were not (P=.018). There was no difference in survival 1 month after treatment between patients with or without cytochrome b mutations (P=.14). Thus, cytochrome b mutations are significantly more common in patients with AIDS and PCP with atovaquone exposure, but the clinical significance of these mutations remains unknown.     

Detection of Pneumocystis carinii by DNA amplification in patients with connective tissue diseases: re-evaluation of clinical features of P. carinii pneumonia in rheumatic diseases

OBJECTIVES: We evaluated the polymerase chain reaction (PCR) detection of Pneumocystis carinii DNA in induced sputum of patients with connective tissue diseases and assessed the clinical features of patients positive for P. carinii. METHODS: Sputum was induced by nebulization in 29 in-patients with various connective tissue diseases who presented with symptoms suggestive of P. carinii pneumonia (PCP), and was examined by PCR. RESULTS: Detection of P. carinii DNA by PCR was significantly more sensitive than cytology; 54.5% patients were positive by PCR and only 4.5% by cytology. The prevalence of PCP was higher than previously considered and was especially high in patients receiving > 30 mg/day prednisolone with or without other immunosuppressants. P. carinii-positive patients had significant lymphocytopenia and a low serum IgG level compared with P. carinii-negative patients. P. carinii disappeared within 7-10 days after therapy with trimethoprim/sulfamethoxazole. CONCLUSION: We propose that the use of PCR for detection of P. carinii using induced sputum is a useful and non-invasive method that has high sensitivity and specificity for the early diagnosis of PCP.