艾滋病合并肺孢子虫肺炎12例报道

目的：报告艾滋病并卡氏肺孢子虫肺炎患者112例,方法：选择经上海疾病控制中心免疫印迹检测证实的25例AIDS患者中并发肺孢子虫肺炎（PCP）者12例,均为男性。结果：PCP的发病率为485（12／25）,经SMZ－CO治疗后复发率为50％（6／12）,病死率为165（4／12）,结论：PCP为AIDS最常见的机会感染。     

卡氏肺孢子虫肺炎的诊断

卡氏肺孢子虫肺炎(PCP)是AIDS一项有价值的诊断指标,大约85%的PCP病人继发于AIDS。近年来随着人体免疫缺陷病毒(HIV)感染的增加,PCP患者也不断增     

AIDS合并肺部感染90例分析

目的提高对艾滋病(AIDS)合并肺部感染的认识.方法对1995～2001年在佑安医院就诊的90例AIDS合并肺部感染的患者进行分析.结果 (1)结核病(TB)38例(42.2%),卡氏肺孢子虫肺炎(PCP)35例(38.9%),肺隐球菌病2例(2.2%),军团菌肺炎2例(2.2%),非何杰金氏淋巴瘤1例(1.1%),其它不明原因肺部感染12例(13.3%).(2)90例肺部感染的患者中,CD+4 2～340/μl,平均CD+4 125±86/μl,CD+4/CD+8 0.01～0.51.其中CD+4>200/μl 7例(7.8%),CD+4 100～200/μl 19例(21.1%),CD+4<100/μl 64例(71.1%).结论中国成人AIDS合并肺部感染以TB和PCP为主.AIDS患者在CD+4<200/μl时容易并发肺部感染,其中以CD+4<100/μl时较为常见;CD+4越低,肺部感染越严重.     

卡氏肺孢子虫肺炎

直至第二次世界大战,全欧在居住拥挤、营养不良的儿童中发生肺炎的暴发流行时,人们才对人类肺孢子虫病引起重视。该病的肺组织学显示,间质内大量单核细胞浸润和泡沫样空泡肺泡渗出物,因此被命名为间质性浆细胞肺炎,1952年明确其与卡氏肺孢子虫感染有关。直至最近才了解到肺孢子虫肺炎(PCP)主要侵袭以下病人,如接收免疫抑制剂和皮质类固醇治疗的癌症病人、器官移植者等。1981年以来详细报道了PCP、其他机会感染和卡波氏肉瘤与获得性免疫缺陷综合征(AIDS)之间的关系。AIDS已引起医学界的密切注意,最近英国报告了169例AIDS,欧州762例,美国8,495例。因为PCP是AIDS极为常见的机会     

AIDS合并卡氏肺孢子虫肺炎8例报告

卡氏肺孢子虫肺炎(PCP)是艾滋病(AIDS)最常见的机会性感染之一，也是最主要的死因之一。现就我院收治的8例PCP患者的临床资料，报告如下。     

艾滋病合并重症卡氏肺孢子虫肺炎25例临床病例分析

目的探讨艾滋病(AIDS)合并重症肺孢子虫肺炎(PCP)的临床特点、诊断和治疗。方法分析重庆市公共卫生救治中心收治的25例AIDS合并重症PCP患者的临床资料。结果发热、咳嗽、进行性呼吸困难是最常见的临床症状,CD4+T淋巴细胞数为:2～68个/ul;典型影像表现是肺部磨玻璃影;25例重症PCP患者经过复方磺胺甲基异噁唑联合强的松治疗,如合并其他机会感染予以相应的治疗,14例好转,11例死亡,死亡患者大都同时合并其他病原菌感染。结论 AIDS合并重症PCP患者病情重,常合并多种病原菌及多系统感染,疗效欠佳,故采用合理有效的抗HIV治疗措施以减少其发病。     

口服皮质类固醇对轻度卡氏肺孢子虫肺炎和AIDS患者的效果

有许多研究表明,在中度与重度AIDS合并卡氏肺孢子虫肺炎(PCP)的患者,用皮质类固醇治疗,可以改善预后,延长生存时间。本文报告轻度AIDS合并PCP患者用皮质类固醇的治疗结果。     

用乙胺嘧啶-周效磺胺预防卡氏肺孢子虫感染

获得性免疫缺陷综合症(AIDS)患者感染卡氏肺孢子虫肺炎(PCP)的机会最多。尽管co-trimoxazole或戊烷脒疗效良好,但常复发。白血病患儿口服co-trimoxazole可预防肺孢子虫病。该药最适用于有PCP病史的AIDS患者,但常伴有过敏及其他严重副反应。作者等试用抗疟药法西达(乙胺嘧啶和周效磺胺按1:20配方)预防PCP,其优点是半衰期较长(130小时)。     

肺孢子虫肺炎的发病机制和药物治疗

耶氏肺孢子虫(pneumocystis jiroveci,简称肺孢子虫)是常见于免疫功能低下患者的机会性感染病原体,多在人免疫缺陷病毒(HIV)感染、恶性肿瘤、器官移植、自身免疫及血液系统疾病患者中发病.一旦发生肺孢子虫肺炎(pneumocystis pneumonia,PCP),病情进展迅速,病死率极高,若不经治疗,33至4周内几乎100%患者死亡;倘若治疗,不同人群的死亡率不同,HIV感染者死亡率为5%～10%,免疫缺陷的肿瘤患者死亡率高达20%～25%,需要机械通气者死亡率则更高,达60%～90%~([1,2]).PCP的病情严重性与免疫功能和炎症反应程度密切相关,而与病原体数量无关.本文拟就PCP发病机制、临床特征和药物治疗的最新进展作一简述.     

艾滋病和卡氏肺孢子虫肺炎患者血清乳酸脱氯酶活性

为了研究乳酸脱氢酶(LD)作为艾滋病(AIDS)和艾滋病相关复合体(ARC)思者合并卡氏肺孢子虫肺炎(PCP)的临床标志,作者测定3组患者的LD:组1系AIDS 和新证明有活动性PCP 的患者(30     

Complications during clinical courses of Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome

OBJECTIVE: To describe the incidence of complications before and during therapy of Pneumocystis carinii pneumonia (PCP) in patients with acquired immunodeficiency syndrome (AIDS). METHODS: A retrospective review of the patient's medical records. PATIENTS: A total of 29 patients with AIDS and PCP who were admitted to the AIDS Clinical Center, International Medical Center of Japan from July 1996 to November 1999. RESULTS: Adverse effects were found in 24 (88.9%) of 27 patients treated with trimethoprim/sulfamethoxazole (T/S), 6 (46.1%) of 13 treated with parenteral pentamidine, and 2 (20%) of 10 treated with inhaled pentamidine. Infectious and/or non-infectious complications were found in 25 (86.2%) of 29 study patients. Regarding infectious complications, 16 (55.2%) were found on admission and 10 cases (34.5%) with infectious complications were identified during admission; including oral candidiasis (37.9% and 17.2%, respectively) and genital herpes (3.4% and 6.9%, respectively). Cytomegalovirus antigenemia was detected in 4 cases (13.8%) on admission and 12 cases (41.4%) during admission. Non-infectious complications affected 11 cases (37.9%) on admission, and 6 cases (20.7%) during admission, the latter included heart failure (10.3%) and pneumothorax (6.9%). PCP was successfully treated in all but one patient who suffered from repeated pneumothorax. CONCLUSION: Treatment of PCP can be problematic and it is important to be aware of the high incidence of various complications that can occur during the treatment of PCP.     

Pneumocystis carinii pneumonia in pregnancy

OBJECTIVE: To report five new cases of Pneumocystis carinii pneumonia (PCP) and to review and analyze the existing reports on the subject. METHOD: Five new cases of PCP during pregnancy are described. The cases, case series, and related articles on the subject in the English language were identified through a comprehensive MEDLINE search and reviewed. RESULTS: More than 80% of women with AIDS are of reproductive age, and PCP is the most common cause of AIDS-related death in pregnant women in the United States. Among 22 reviewed cases, the mortality rate was 50% (11 of 22 patients), which is higher than that usually reported for HIV-infected individuals with PCP. Respiratory failure developed in 13 patients (59%), and mechanical ventilation was therefore required, and the survival rate in patients requiring mechanical ventilation was 31%. Maternal and fetal outcomes were better in cases of PCP during the third trimester of the pregnancy. A variety of treatment regimens were used, including sulfamethoxazole-trimethoprim (SXT) alone or in combination with pentamidine, steroids, and eflornithine. The survival rate in patients treated with SXT alone was 71% (5 of 7 patients) and for those treated with SXT and steroids was 60% (3 of 5 patients), with an overall survival rate in both groups of 66.6% (8 of 12 patients). CONCLUSION: PCP has a more aggressive course during pregnancy, with increased morbidity and mortality. Maternal and fetal outcomes remain dismal. Treatment with SXT, compared to other therapies, may result in an improved outcome. Withholding appropriate PCP prophylaxis may adversely affect maternal and fetal outcomes.     

中国大陆肺孢子虫肺炎回顾性研究

目的 分析中国大陆1959-2006年间肺孢子虫肺炎（PCP）的流行特点和趋势，为PCP的防治提供依据。方法 利用互联网资源，从中国生物医学文献系统web版（CBM）等数据库搜索PCP病例报告，排除重复报道及不可信病例，（1）从基础疾病等多个角度对比分析21世纪前、后我国PCP流行特点和趋势，（2）从HIV／AIDS患者的机会感染频率的角度分析文献报道的HIV感染者或AIDS患者中PCP的发病情况。结果 （1）1959-2006年文献报道的PCP共384例，1959-2000年报道的有100例，其中HIV／AIDS相关PCP13例（占13％）；非HIV相关PCP87例，主要涉及抗肿瘤化疗41例（41％），肾移植15例（15％）及其他原因导致免疫机能低下者24例（24％）等。2001-2006年间报道了284例，其中HIV／AIDS相关PCP160例（占56．3％）。（2）在检获的HIV／AIDS患者合并PCP11份文献中，报道了1985-2006年诊断的AIDS患者共1249例，其中合并PCP163例（13．1％）。结论 21世纪以前，我国大陆PCP的基础疾病主要是非HIV感染者（87％）；21世纪以后主要为HIV／AIDS患者（56．3％）。但中国大陆AIDS患者合并PCP的发牛率仅为13．1％（163／1249）。     

Survival following mechanical ventilation for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome: a different perspective

PURPOSE: Pulmonary infection is a frequent cause of morbidity and mortality in patients with acquired immunodeficiency syndrome (AIDS), and Pneumocystis carinii pneumonia (PCP) is the predominant infection in these patients. In those patients who experience progression to respiratory failure from PCP, the reported mortality rate has been between 87% to 100%. This, in addition to the ultimately fatal outcome of patients with AIDS, has led many physicians to question the advisability of instituting mechanical support for respiratory failure in the setting of PCP. It had been our impression that the outcome of patients on our service was not as poor as was generally reported. We therefore undertook a retrospective analysis of our clinical experience. PATIENTS AND METHODS: We reviewed the clinical course of patients admitted to our service between December 1984 and June 1988 who required intubation and mechanical ventilation for PCP or presumed PCP. RESULTS: Thirty-three cases were identified with 18 survivors (54.5%) and 15 non-survivors (45.5%). Twenty-five of the 33 patients were intubated for their first episode of PCP, with 16 survivors (64%), whereas the remaining eight patients were intubated for their second episode of PCP, with two survivors (25%). We were not able to identify any parameters that predicted survival, although the serum lactate dehydrogenase level was useful in following the response to treatment. CONCLUSION: It is our belief that there is a reasonable chance of survival for patients requiring mechanical ventilation for PCP. We question the wisdom of avoiding intubation and mechanical ventilation altogether in patients with PCP due to the presumption of fatality in this clinical situation.     

艾滋病合并卡氏肺孢子虫肺炎的临床特点及诊断方法

目的　探讨艾滋病合并卡氏肺孢子虫肺炎 (PCP)的临床特点和诊断方法。方法　对1 999～ 2 0 0 1年经痰聚合酶链反应 (PCR)确诊的 1 2例艾滋病合并PCP进行分析。结果　 (1 )合并结核病 4例 ,细菌性肺炎 1例。 (2 )痰PCR阳性 1 2例 ,其中血PCR阳性 9例 ,姬姆萨染色阳性 6例 ,六胺银染色阳性 5例。 (3) 1 2例CD+ 4(5～ 1 55)× 1 0 6 /L ,平均CD+ 4(51± 48)× 1 0 6 /L ;其中CD+ 4<(1 0 0× 1 0 6 ) /L1 0例 (83 % ) ,CD+ 4<(50× 1 0 6 ) /L 9例 (75 % ) ;CD+ 4/CD+ 8:0 .0 1～ 0 .2 9。结论　 (1 )PCP是艾滋病晚期常见的合并症 ,常常合并其它机会性感染如结核等。 (2 )痰PCR阳性 +典型的临床表现可以确诊PCP。     

艾滋病合并肺孢子菌肺炎22例临床分析

目的探讨AIDS合并肺孢子菌肺炎(PCP)的临床特点,以提高对PCP的认识。方法回顾性分析我院22例AIDS合并PCP的临床资料,并进行相关文献复习。结果(1)22例患者中,男性占72·7%,年龄(35·0±9·4)岁。感染HIV途径主要经输血(54·5%)和性传播(27·3%);(2)最常见的临床表现为发热(21例)、进行性加重的呼吸困难(20例)、咳嗽(16例)、咳痰(12例)及体重下降(18例)。68·2%(15例)患者肺呼吸音正常或稍粗。外周PaO2<60mm Hg(1mm Hg=0·133kPa)者占63·6%(14例);(3)均为AIDS晚期患者,外周血CD4 T淋巴细胞(3~148)×106/L,其中<100×106/L者占90%(18/20)。CD4 /CD8 <0·20者占95%(19/20);(4)常见的胸部影像学表现为双侧肺间质纹理改变(19/22)和斑片影(14/22);(5)治疗药物主要为复方磺胺甲唑(SMZco)(100%)和肾上腺糖皮质激素(86·4%)。治愈13例、自动放弃5例、死亡4例。死亡患者CD4 T淋巴细胞计数明显低于治愈组(P=0·07)。结论PCP主要发生于AIDS晚期患者;临床遇有发热、呼吸困难、低氧血症、体重下降来诊的青壮年患者,胸部影像学提示间质纹理改变或斑片影,应警惕AIDS合并PCP的可能;临床怀疑AIDS合并PCP时应尽早给予SMZco治疗。     

Pulmonary complications in patients with AIDS: a report from a Beijing hospital

OBJECTIVE: The aim of this study was to improve the awareness of pulmonary complications in patients with AIDS. METHODOLOGY: Nine patients with AIDS with pulmonary involvement from March 1992 to March 2000 were analysed. RESULTS: Of the nine cases, there were eight cases complicated with Pneumocystis carinii pneumonia (PCP). The clinical presentation of PCP was fever (8/8), dyspnoea on exertion or at rest (7/8), and hypoxaemia with a mean PaO2 of 58 mmHg. Chest X-ray films showed bilateral diffuse interstitial or alveolar infiltrates. Pulmonary tuberculosis, tuberculous lymphadenitis and bronchial fungal infection were found in three cases. CONCLUSIONS: AIDS patients are at high risk of suffering from pulmonary complications, of which PCP is most common. If young patients who were healthy in the past suddenly suffered from pneumonia and respiratory failure, PCP should be considered. When opportunistic pulmonary infection is diagnosed under special circumstances, one should be alert to the possibility of AIDS and examine serum antihuman immunodeficiency virus (HIV) antibody.     

Progression of HIV infection in the post-HAART era among a cohort of HIV+ Greek haemophilia patients

AIM: The study aims to describe the course of HIV-1 infection in the pre- and post-HAART period in a cohort of HIV+ haemophilia patients followed up for up to 21 years. METHODS: The cohort includes 158 haemophilic men with known seroconversion dates followed up prospectively for a median time of 12 and 5.7 years in the pre- (1980-96) and post-HAART period (1997-2003), respectively. RESULTS: The risk of developing AIDS was lowered by 56% in the post- as compared to the pre-HAART period. Of the 158 patients 69 developed AIDS in the pre-HAART period while of the 59 subjects still alive and AIDS free on 1/1/1997 six developed AIDS. The rate of PCP (12.0 cases per 1000 person-years) and NHL (5.4 cases per 1000 person-years), the most common causes of AIDS diagnosis in the pre-HAART era, were remarkably reduced in the post-HAART era (both rates: 2.8 cases per 1000 person-years). On the contrary, the corresponding risk for non-AIDS deaths was fourfold increased in the post-HAART period. Of the 38 non-AIDS related deaths in both periods, 13 occurred post-HAART. The predominant cause of non-AIDS mortality in both periods was end-stage liver disease (ESLD) (7 pre- and 4 post-HAART). The rate of non-AIDS related cancers was also increased during the post-HAART period. CONCLUSION: In this haemophilia cohort the risk of AIDS has substantially reduced in the post-HAART period, but the rate of non-AIDS mortality tended to increase. Among haemophilia subjects, due to the high rates of HCV/HIV coinfection, ESLD, the predominant cause of non-AIDS mortality, will become an increasingly important clinical problem.     

Pneumocystis carinii pneumonia as the first presentation of HIV infection in patients older than fifty

A significant increase in the number of elderly patients first diagnosed with HIV infection at the time of presentation with an AIDS-related opportunistic infection has recently been reported. This suggests a significant delay in the diagnosis of HIV infection. Few data are available describing such cases and their outcome. We restrospectively reviewed records of all elderly patients (> 50 years of age) admitted to a New York City hospital over a 3-year period with confirmed Pneumocystis carinii pneumonia (PCP). The mean age was 57.9 +/- 6.6 years. In 80% (8 of 10 cases), the diagnosis of HIV infection was made at presentation with PCP. The mean CD4 count was 34.2 +/- 39.2/mm3 (1-117/mm3), indicating advanced AIDS. The clinical presentation of PCP was similar to that in younger patients. With prompt and appropriate therapy, a 70% survival rate for this hospitalization was achieved, similar to that reported in younger age groups. The diagnosis of HIV infection was not considered until presentation with PCP at an advanced stage of AIDS in 80% of these elderly patients, thus delaying institution of HIV treatment and counseling. Early consideration of HIV infection in the elderly is of importance because of the rising number of AIDS cases in this age group.     

艾滋病肺部合并症六例分析

目的　提高对艾滋病肺合并症的认识。方法　对１９９２ 年３ 月～１９９７ 年８ 月间诊断的６例艾滋病患者进行分析。结果　并发卡氏肺囊虫性肺炎（ Ｐ Ｃ Ｐ）５ 例（ 其中１ 例为艾滋病首发表现） ,其临床表现为发热（５／５） ,呼吸困难（４／５） 和低氧血症（５／５） ,平均动脉血氧分压为５８ ｍｍ Ｈｇ（１ ｍｍ Ｈｇ ＝０１３３ ｋ Ｐａ ） ,胸部 Ｘ 片显示,两肺弥漫间质或肺泡性浸润。另有支气管真菌感染、肺结核和淋巴结结核各１ 例（ 痰抗酸杆菌阳性、结核菌素试验阴性） 。结论　艾滋病容易发生各种肺合并症,尤以 Ｐ Ｃ Ｐ多见。对既往身体健康的青壮年,如突然发生肺炎和呼吸衰竭应警惕 Ｐ Ｃ Ｐ 发生。对特定情况下发生的肺机会性感染应警惕艾滋病,并及时检查血抗人类免疫缺陷病毒（ Ｈ Ｉ Ｖ） 抗体。