肾移植后并发卡氏肺孢子虫肺炎36例资料回顾(英文)

背景:卡氏肺孢子虫肺炎是常见的肾移植后早期并发症,起病隐匿,进展快,若诊治不及时,死亡率高,认识和掌握肾移植后卡氏肺孢子虫肺炎的发生发展规律和干预措施具有重要的临床意义。目的:回顾性分析肾移植后并发卡氏肺孢子虫肺炎的病因、临床特点、诊疗措施及预后。方法:回顾分析36例南方医科大学珠江医院器官移植科收治的肾移植后并发卡氏肺孢子虫肺炎患者的临床资料,分析一般状况、临床表现、治疗方案及人、肾预后情况,总结和认识该病诊断干预措施。结果与结论:36例患者中男22例,女14例,33例痊愈且移植肾功能保持良好,3例患者并发严重急性呼吸窘迫综合征死亡。36例患者卡氏肺孢子虫肺炎发生在肾移植后6个月内31例,7～18个月5例。15例(41.7%)通过纤维支气管镜下支气管灌洗液或肺组织活检检出卡氏肺孢子虫,21例未检出。多数患者经过减少免疫抑制剂、给予复方磺胺甲恶唑及支持治疗后痊愈且移植肾功能良好。提示卡氏肺孢子虫肺炎多发生在肾移植后6个月内,临床症状典型,病原体难以发现,早期诊断主要依据临床病史、症状和影像学检查,尽早、足量给予复方磺胺甲恶唑,减少免疫抑制剂,充分的支持治疗能改善预后。     

肾移植后重症卡氏肺囊虫肺炎1例

背景：卡氏肺囊虫肺炎是肾移植后较为少见的严重并发症,起病隐匿,临床症状不典型,病情进展迅速,死亡率高。 目的：探讨肾移植后并发卡氏肺囊虫肺炎的临床特点、治疗及预防方法。 方法：回顾性分析2011年在西安交通大学医学院第一附属医院诊断治疗的1例肾移植后并发重症卡氏肺囊虫肺炎患者的临床资料。 结果与结论：1例62岁女性同种异体肾移植患者术后100 d出现发热及进行性低氧血症,经支气管镜检及肺泡活检检出卡氏肺囊虫,病情进展迅速,经口服复方磺胺甲噁唑片、呼吸机辅助通气及对症支持治疗后治愈。结果提示具有危险因素的患者在出现发热及进行性低氧血症时应提高警惕,预防应用复方磺胺甲噁唑片等药物尤为重要;另外免疫抑制剂的调整在卡氏肺囊虫肺炎的治疗过程中很关键,CD4+/CD8+可作为一项有益的指导指标。     

肾移植后合并卡氏肺孢子虫肺炎：10年同一机构378例中的12例

背景：在肾移植后早期,由于免疫抑制剂用量较大,患者的免疫功能明显受到抑制,卡氏肺孢子虫肺炎在此期间相对高发。 目的：分析肾移植后并发卡氏肺孢子虫肺炎的临床特点、诊治及预防。 方法：收集佛山市第一人民医院肾内科2000-11/2010-07肾移植378例中并发卡氏肺孢子虫肺炎12例患者的临床资料,分别对其发病时间、易感因素、诊断方法、临床表现及治疗方案、预防效果进行回顾性分析。 结果与结论：发病时间为移植后5.3(3~11)个月。12例患者均有发热,体温达38.0~40.2 ℃,气促及紫绀。9例轻微咳嗽,5例少量白痰,1例红色泡沫痰。5例合并细菌感染,2例合并真菌感染,2例合并巨细胞病毒感染,1例合并结核。服用他克莫司患者感染发生率为7.8%(7/89),服用环孢素A患者感染发生率为1.7%(5/289)。9例使用呼吸机,2例使用呼吸机无创性连续鼻或口鼻面罩治疗。8例痊愈,2例治疗中出现血小板减少致脑出血死亡,1例合并真菌感染死亡,1例合并血气胸死亡。治疗期间,无排斥反应发生。说明早期诊断,联合用药,减少免疫抑制剂用量是提高卡氏肺孢子虫肺感染治愈率的关键。     

小剂量复方磺胺甲噁唑预防肾移植后肺孢子菌肺炎

背景：2009年肾脏病预后组织指南推荐所有肾移植受者移植后均应预防性使用复方磺胺甲噁唑预防肺孢子菌肺炎,但疗效有待观察。 目的：观察肾移植移植后预防性应用小剂量复方磺胺甲噁唑预防早期肺孢子菌肺炎的疗效。 方法：回顾性分析珠江医院器官移植科2006/2009期间接受肾移植患者的临床资料,移植后1年内规律随访并有完整的数据资料者,患者均排除肝炎、二次移植、群体反应性抗体阳性以及移植后失访等因素后纳入统计。记录入选患者的年龄、性别、免疫抑制诱导治疗方案、免疫抑制维持方案、皮疹、肝肾损害、急性排斥反应和耶氏肺孢子菌肺炎发病情况。其中部分患者接受复方磺胺甲噁唑预防肺孢子菌肺炎,设为预防组,部分患者未进行预防,设为非预防组。肺孢子菌肺炎通过病程分析、临床表现、影像学检查和实验室检查等确诊。 结果与结论：围手术期中预防组与非预防组在年龄、性别、免疫诱导方案(生物制剂选用)、免疫维持方案和移植后1个月时血肌酐值均差异无显著性意义(P > 0.05)。随访期间患者急性排斥反应、巨细胞病毒感染、移植后1年肾功能等指标以及骨髓抑制、肝功能、药物性皮疹等方面差异无显著性意义(P > 0.05);而肺孢子菌肺炎的发病率预防组较非预防组明显降低(P < 0.05)。结果证实,肾移植后预防应用小剂量复方磺胺甲噁唑能明显降低早期肺孢子菌肺炎的发生率。     

肾移植后并发肺炎17例

背景：肺炎是肾移植后患者常见的并发症和主要的死亡原因。 目的：探讨肾移植后患者并发肺炎的临床特点及诊治方法。 方法：收集2008-05/2010-12期间住院治疗的17例肾移植后并发肺炎患者的临床资料进行回顾性分析。 结果与结论：肺炎发生于肾移植后6个月以内的有12例(70.6%),6个月~1年1例(5.9%),1年以上4例(23.5%)。其中14例(82.4%)获得病原体检测结果,包括革兰阴性杆菌8例(47.1%),巨细胞病毒7例(41.2%),革兰阳性球菌6例(35.3%),卡氏肺孢子虫3例(17.6%),结核杆菌3例(17.6%),念珠菌3例(17.6%),军团菌1例(5.9%)。5例为单一病原体感染,9例为混合感染。存活9例(52.9%),死亡8例(47.1%)。肾移植术后并发肺炎多数为混合感染,纤维支气管镜检查是寻找病原体的重要手段,除合理的抗感染治疗外,综合治疗及不断调整免疫抑制剂的方案同样重要。     

双氢青蒿素对卡氏肺孢子虫肺炎大鼠TNF-α水平的影响

目的研究双氢青蒿素治疗对卡氏肺孢子虫肺炎大鼠血清和肺泡巨噬细胞培养上清液 TNF- α水平的影响。方法以醋酸可的松皮下注射 Wistar大鼠建立卡氏肺孢子虫肺炎动物模型 ,用 60 m g/ kg双氢青蒿素治疗实验大鼠 ,杀鼠取肺 ,用胶原酶消化法分离肺泡巨噬细胞 ,用 L PS刺激培养 72 h,同时设有感染组和正常对照。用 TNF- α试剂盒分别检测血清和培养上清液 TNF- α的水平。结果感染组和治疗组 TNF- α水平均高于正常对照 ,治疗组 TNF- α水平则低于感染组。结论卡氏肺孢子虫感染引起大鼠肺泡巨噬细胞分泌高水平的 TNF- α,但双氢青蒿素治疗后 PCP大鼠肺泡巨噬细胞产生 TNF- α水平降低。     

卡氏肺孢子虫的分类、命名、体外培养及其动物模型的建立

以往所称的“卡氏肺孢子虫” (Pneumocystiscarinii,Pc)能感染包括人和实验动物在内的多种哺乳动物 ,免疫力低下的宿主感染后能引起致命的卡氏肺孢子虫肺炎 (Pneumocystiscariniipneumonia,PCP )或称肺孢子虫病(Pneumocystosis)。国际上已将原感染人体的卡氏肺孢子虫 (Pneumocystiscarinii)更名为Pneumocystisjeroveci,国内张瑞娟、朱淮民( 2 0 0 3)将其译为耶氏肺孢子虫 ,然尚未被广泛应用。其生物学分类也由原来动物界的原虫定为真菌界的真菌类。重新命名和跨界的分类归属具有重要意义 ,然而 ,国内有关“卡氏肺孢子虫”的报道 ,尚未启…     

双氢青蒿素对卜氏肺孢子虫肺炎大鼠TNF—α水平的影响

目的 研究双氢青蒿素对卡氏肺孢子虫肺炎大鼠血清和肺泡巨噬细胞培养上清液TNF－α水平的影响。方法 以醋酸可的松皮下注射Wistar大鼠建立卡氏肺孢子虫肺炎动物模型，用60mg/kg双氢青蒿素治疗实验大鼠，杀鼠取肺，用胶原酶消化法分离肺泡巨噬细胞，用LPS刺培养72h，同时设有感染组和正常对照，用TNF－α水平则低于感染组。结论 卡氏肺孢子虫感染引起大鼠肺泡巨噬细胞分泌高水平的TNF－α，但双氢青蒿素治疗后PCP大鼠肺泡巨噬细胞产生TNF－α水平降低。     

卡氏肺孢子虫感染大鼠血清中蛋白及血液中嗜酸粒细胞的变化分析

卡氏肺孢子虫肺炎（pneumocystis carinii pneumonia,PCP）是由卡氏肺孢子虫（pneumocystis carinii,PC）引起的一种呼吸系统机会性感染,多见于免疫功能低下患者。据报道,未经药物预防的爱滋病（AIDS）患者约80％感染PCP。     

寄生虫学

弓形虫不同地理株致密颗粒蛋白基因的比较研究；zs株弓形虫p22基因片段在巨噬细胞中的表达；急性弓形虫感染所致昆明鼠不孕的实验研究；弓形虫p24基因敲除转染质粒pGB／P5-P3的构建；大鼠天然抗体相关的弓形虫抗原基因的免疫筛选与克隆；弓形虫膜抗原SAG3基因打靶载体的构建及筛选；大鼠卡氏肺孢子虫肺炎的实验病理学研究；卡氏肺孢子虫病鼠氧化损害与中药防治的实验研究；肾移植后并发卡氏肺孢子虫肺炎12例临床研究；人蛔虫Ⅱ期幼虫提取物诱导人肺上皮细胞凋亡；旋毛虫新生幼虫cDNA文库的免疫筛选；广州管圆线虫成虫cDNA文库抗原基因的筛选；用组织化学方法鉴别日本血吸虫细胞来源的研究；日本血吸虫EST序列的电子延伸及结果分析。     

Pneumocystis carinii pneumonia after renal transplantation

Being immuno-suppressed, renal allograft recipients are at increased risk of contracting various infectious complications. Pneumocystis carinii pneumonia (PCP) is one of the important opportunistic infection causing high morbidity and mortality in these patients. Majority of studies has reported the occurrence of PCP during 6 months to one year after renal transplantation. This communication describes occurrence of PCP in five renal allograft recipients 10 weeks to 72 months after transplantation. In view of elusive presentation, strong clinical and radiological suspicion followed by direct demonstration of the organisms is essential for early diagnosis and prompt treatment. These observations also indicate that PCP is an emerging opportunistic infection in immuno-compromised patients in tropical countries.     

Trimethoprim-sulfamethoxazole desensitization in AIDS

Summary Trimethoprim-sulfamethoxazole (TMS) desensitization was carried out in three patients with AIDS and Pneumocystis carinii pneumonia (PCP) in whom treatment with TMS had to be discontinued after 8 to 12 days due to an allergic reaction. Although the pneumonia was under control we decided for a desensitization to TMS because of the frequent reinfection and the high mortality rate particularly if treatment is incomplete. On the first day the patients took 0.4 mg/2 mg trimethoprim/sulfamethoxazole orally. The dose was increased during 9 successive days to 80 mg/400 mg trimethoprim/sulfamethoxazole. From the 10th to the 16th day 160 mg/800 mg trimethoprim/sulfamethoxazole was given daily and subsequently twice daily which is the recommended dose for prophylaxis of PCP. The desensitization was successful in two patients and a PCP prophylaxis was possible.Abbreviations AIDS acquired immunodeficiency syndrome - TMS trimethoprim-sulfamethoxazole - PCP Pneumocystis carinii pneumonia     

Pneumocystis jirovecii pneumonia 13 years post renal transplant following a recurrent cytomegalovirus infection

Pneumocystis jirovecii (formerly Pneumocystis carinii) pneumonia (PCP) is a rare but serious infection that usually occurs within a year after solid organ transplantation. PCP may occur after 1?year post transplantation, but the rate is reported to be very low. Studies have shown an association between cytomegalovirus (CMV) infection in solid organ transplant patients and an increased risk of opportunistic infection. This increased risk is thought to be a result of the immunomodulatory effects of the CMV infection. We present a case of PCP infection occurring 13?years after a renal transplantation. This occurred following a recurrent CMV infection while the patient was on low-dose immunosuppressants.     

A rat model for combined Trypanosoma cruzi and Pneumocystis carinii infection

Dexamethasone treated rats inoculated with Trypanosoma cruzi developed acute parasitemia. In addition, these animals concomitantly developed severe Pneumocystis carinii pneumonia (PCP) and died after 4 weeks of immunosuppression (100%). However, immunocompetent (untreated) rats inoculated with T. cruzi did not acquire P. carinii and recovered from T. cruzi infection. Rats immunosuppressed, but not inoculated with T. cruzi, developed only PCP and died 5-6 weeks later (93%). In contrast, immunocompetent or immunocompromised IRC mice infected with T. cruzi all died of acute parasitemia in only 8-12 days with no detectable PCP infection. In conclusion, rats immunosuppressed and T. cruzi inoculated can serve as a MOPPS model for a single drug evaluation. In addition, T. cruzi infection independently does not provoke P. carinii pneumonia in this model. Finally, patients with Chagas' disease treated with corticosteroids may be at risk for PCP and should be considered for chemoprophylaxis.     

Quantitative and qualitative comparison of DNA amplification by PCR with immunofluorescence staining for diagnosis of Pneumocystis carinii pneumonia.

AIM: To compare the results of DNA amplification by the polymerase chain reaction (PCR) with immunofluorescence staining for detecting Pneumocystis carinii in bronchoalveolar lavage specimens taken from symptomatic HIV seropositive patients with suspected P carinii pneumonia (PCP). METHODS: Bronchoalveolar lavage specimens were obtained from 28 symptomatic HIV seropositive patients. Specimens were examined for P carinii using immunofluorescence, and by DNA amplification with PCR to obtain results on gel electrophoresis (gel) and a more sensitive Southern hybridisation (blot) technique. Specimens positive by immunofluorescence and gel electrophoresis were serially diluted to a 10(-6) concentration and each dilution strength tested for P carinii using PCR to compare quantitatively immunofluorescence with PCR. RESULTS: Of the 28 specimens analysed, 18 were negative for P carinii by both immunofluorescence and PCR, two were positive only by the blot technique of PCR, four were equivocally positive and four unequivocally positive by immunofluorescence. Three of the four equivocally positive patients tested by immunofluorescence were negative for P carinii by PCR, although one was positive by PCR (blot) technique. This patient had clinically confirmed PCP. Of the four unequivocally positive patients tested by immunofluorescence, three were gel and blot positive by PCR and had PCP clinically, but one was negative by both gel and blot techniques, although the patient certainly had PCP on clinical grounds. This patient had received nine days of treatment with high dose co-trimoxazole before bronchoalveolar lavage specimens were obtained. The three specimens positive by gel and blot techniques remained gel positive down to dilutions of between 10(-4) and 10(-6). CONCLUSIONS: PCR results may become negative soon after starting treatment for PCP. Specimens should therefore be taken before, or soon after, starting treatment. PCR seems to be between 10(4) and 10(6) times more sensitive than immunofluorescence.     

Can data from an electronic medical record identify which patients with pneumonia have Pneumocystis carinii Infection?

BACKGROUND: Pneumocystis carinii is the leading opportunistic pulmonary infection in HIV-infected patients. Invasive diagnostic procedures might be avoided if available electronic data can accurately identify patients with Pneumocystis pneumonia (PCP). METHODS: We extracted data from electronic hospital records, emergency department records, and a pathology database for 299 HIV-infected patients with pneumonia who underwent bronchoscopy. We identified independent indicators of confirmed PCP using logistic regression analysis on a random half of the patients and validated the predictive power of the resulting model on the other half. RESULTS: Bronchoscopy confirmed pneumocystis carinii in 111 patients (37%). Five of the seven significant independent predictors of PCP came from patients' electronic medical records: infiltrate on chest radiograph, male gender, lower red cell distribution width, lower serum creatinine, and a prior positive HIV test. The other two (duration of illness and presence of dyspnea) came from the emergency department record. A simple index found 43% of patients at low risk (18% with pneumocystis), 37% at moderate risk (36% with pneumocystis), and 20% at high risk (74% with pneumocystis). CONCLUSIONS: Data from electronic medical records can help quantify the risk of PCP among HIV-infected patients. However, the model failed to identify 18% of patients with PCP in the low risk group, and empiric therapy would erroneously treat 26% of patients classified as high risk. Bronchoscopy is needed to accurately diagnose PCP among HIV-infected patients with pneumonia. However, if bronchoscopy is not available, the model can help with initial decisions about antibiotic therapy.     

Pneumocystis carinii pneumonia in a Yorkshire terrier dog.

A 14-month-old male Yorkshire terrier was presented to the Autonomous University of Barcelona Veterinary Teaching Hospital because of a history of chronic non-productive cough and acute dyspnea. A follow-up radiograph revealed a diffuse, bilaterally interstitial-alveolar lung disease with presence of air bronchograms. The dog died 5 h after admission with severe dyspnea. Histological sections of the necropsy specimens revealed the presence of characteristic Pneumocystis carinii cysts within alveolar spaces. A diagnosis of P. carinii pneumonia (PCP) was made on the basis of these results. To our knowledge, PCP has not been described in a Yorkshire terrier dog.