卡氏肺孢子菌肺炎的诊断治疗分析

目的分析探讨卡氏肺孢子菌肺炎的早期诊断和治疗。方法分析福建省立医院2010年5月-2011年4月收治的曾误诊为细菌性肺炎的8例卡氏肺孢子菌肺炎病例的诊治。结果 8例中3例为风湿免疫性疾病患者,1例为风湿性心脏病二尖瓣换瓣术后10年,其余4例无基础疾病。8例中,外院就诊均误诊为细菌性肺炎,误诊率100%,误诊时间1～6个月。表现为反复发热,刺激样干咳、气促,病情进展快,出现不同程度呼吸衰竭。5例非风湿性疾病患者CD4细胞明显下降,HIV阳性,疑似为成人获得性免疫缺陷综合症（AIDS）。4例经纤支镜下肺泡灌洗,检及卡氏肺孢子菌,1例痰液检出肺孢子菌滋养体而确诊PCP。另外3例符合HIV合并PCP诊断标准。8例患者经SMZ-TMP联合克林霉素治疗14d,6例好转,1例效果欠佳转院,1例死亡。结论临床上不明原因发热、呼吸衰竭,胸部影像学进展迅速,常规抗感染效果差患者,应警惕卡氏肺孢子菌肺炎可能,需注意有无服用免疫抑制剂,注意筛查HIV抗体了解有无细胞免疫缺陷。早期、足量、足疗程治疗有助于改善患者预后。

Clinical analysis of Pneumocystis carinii pneumonia

Clinical data and therapeutics in 8 cases of Pneumocystis carinii pneumonia,which was misdiagnosised as bacterial pneumonia from May 2010 to April 2011 in Fujian Provincial Hospital,were reviewed in order to explore the clinical features and methods of early diagnosis of Pneumocystis carinii pneumonia.In these 8 cases,1 had a mitral valve replacement with rheumatic heart disease 10 year ago,3 cases had autoimmune diseases and took immunosuppressor for a long time,and others didn＇t have underlying diseases.All the 8 cases appeared fever of unknown origin,dry cough,shortness of breath and different degree of respiratory failure.The five non-rheumatic disease cases proved lower CD4 cell percentage of T ymphocyte and positive serum anti-HIV antibody.Then Pneumocystis carinii was found in two cases among them,one from bronchoalveolar lavage fluid（BALF）,another from sputum.Other 3 cases was diagnosed according to clinical diagnosis criterion.Another 3 non-HIV cases were diagnosis by detecting Pneumocystis carinii in BALF through bronchoscopy for 14 days.The 8 cases were all treated by sulfamethoxazole and trimethoprim（SMZ-TMP） and clindamycin,then 6 got better,1 was transferred to the lazaret,and 1 was dead.In conclusion,for the patients appearing fever with unknown origin,unintelligible respiratory failure,rapidly progressing in chest imaging and failure in conventional anti-infection treatment,pneumocystis carinii pneumonia should be taken into account,and their immune condition should be concerned.Whether the patients had immunosuppressed diseases or were taking immunosuppressor should be carefully confirmed and they had better plan to detect anti-HIV antibody too.Early treatment,sufficient dose,and full course therapy may contribute to improve the prognosis of patients.