肾移植术后患者肺孢子菌肺炎临床特征分析

目的分析肾移植术后患有肺孢子菌肺炎(PCP)患者的临床特征。方法回顾性分析2014年1月至2018年12月我院呼吸重症监护病房(RICU)收治的13例肾移植术后PCP患者。收集患者的一般资料、免疫抑制剂使用情况、肾移植术后至发病时间、症状、实验室检查、影像学特征、呼吸机使用情况、住院时间、预后等相关指标,分析其临床特征和预后。结果 13例PCP患者中,男11(84.6%)例,女2(15.4%)例,平均年龄(44.8±9.2)岁。患者肾移植术后开始使用免疫抑制剂至确诊PCP中位时间为4(3～9)月。临床表现主要为发热、干咳和气短。入RICU第1天的APACHEⅡ评分为(12±4)分。13(100%)例患者胸部CT均表现为弥漫磨玻璃影。5(38.5%)例患者巨细胞病毒IgM阳性。患者入院时氧合指数为(182.6±77.3),13(100%)例患者均使用了无创机械通气,有9(69.2%)例使用了有创机械通气。患者住院时间为12(7.5～21.5)天,住院病死率为53.8%(95%可信区间:0.225～0.852)。结论肾移植术后PCP患者病情较重,无创通气效果差,病死率较高。     

艾滋病合并肺孢子菌肺炎患者近期预后的COX回归分析

目的 分析AIDS合并肺孢子菌肺炎(PCP)患者生存及预后的影响因素,建立近期预后的预测指数.方法 回顾性分析2009年1月至2020年1月柳州市人民医院收治的409例AIDS合并PCP患者的临床资料,包括基本资料、影像学资料、实验室检查、并发症等.采用单因素及多因素COX回归分析筛选出独立预后因素,建立预后指数方程,...     

影响高龄肾移植受者预后的危险因素及预防

随着现代医学技术的不断进步,高龄已不再是肾移植的障碍.越来越多的高龄患者接受肾移植手术并取得了良好效果.多数学术组织将高龄受者定义为年龄≥65岁,然而70岁以上接受肾移植的受者也已不足为奇.     

肾移植术后耶氏肺孢子菌肺炎的临床表现及诊治分析

目的 分析探讨肾移植术后耶氏肺孢子菌肺炎(pneumocystis jiroveci pneumonia, PJP)的发病情况及临床诊治情况。方法 回顾性分析2015年1月至2021年7月首都医科大学附属北京友谊医院收治的肾移植术后PJP患者的临床表现、实验室及影像学结果以及诊治过程。结果 本研究共收录肾移植术后耶氏肺孢子菌肺炎患者34例,其中男性21例,女性13例。感染时间为肾移植术后8.5(6.0,18.0)月;主要临床表现为发热31例(占91.2%)、干咳14例(占41.2%)及喘憋13例(占38.2%);相关感染指标中(1,3)-β-D葡聚糖[147.7(60.0,258.7)pg/mL]、乳酸脱氢酶[(393.94±107.94) U/L]及C-反应蛋白[30.5(12.8,57.5)mg/L]明显升高,与出院时结果差异有显著统计学意义(P<0.01);病原学检查以痰耶氏肺孢子菌PCR检测为主,阳性率为56.7%,肺泡灌洗液(BALF)PCR、痰液、肺泡灌洗液及血液的宏基因组二代测序(macrogenomic next-generation sequencing, mN...     

肺孢子菌肺炎31例临床分析

目的探讨研究肺孢子菌肺炎患者的临床特点、影像学表现及治疗方法。方法分析在我院诊断的肺孢子菌肺炎的31例患者的临床资料。结果 31例患者中HIV/AIDS患者28例,非AIDS患者3例,其中男性22例,女9例,年龄23~75岁。主要临床表现为咳嗽,气促者28例(90.3%),发热25例(80.6%),咳痰17例(54.8%),乏力,纳差15例(48.3%),胸痛8例(25.8%),腹泻4例(12.9%),反复皮疹3例(9.6%)。3例患者行无创通气,1例因严重肺部感染,低氧血症,行有创机械通气。31例患者胸部CT均表现为典型的双肺弥漫性磨玻璃影,所有患者均选用复方磺胺甲基异噁唑治疗,对吸空气时血氧分压PaO2低于70 mmHg患者给予激素治疗。结论当AIDS患者或免疫抑制患者出现发热,咳嗽,呼吸困难,低氧血症,其胸部CT提示典型的双肺弥漫性磨玻璃影,需考虑PCP的可能,但其病原学检查困难,治疗以复方磺胺甲基异噁唑及激素治疗为主。     

艾滋病合并肺孢子菌肺炎的临床特点分析

目的探究分析艾滋病合并肺孢子菌肺炎的临床特点。方法回顾性分析了我院在2013年1月至2014年1月间收治的108例艾滋病合并肺孢子菌肺炎患者的临床资料,分析其临床特点。结果本组108例患者中,艾滋病患者的主要感染途径为血液传播,占79.63%;病程主要集中在0.5-3个月之间;首发症状以发热为主;有102例患者合并有其他感染,占94.44%,其中合并细菌性肺炎的患者较多,占93.52%;患者的体内CD4+的细胞数目普遍小于200个/mm3,其中小于50个/mm3的患者最多,有71例,占65.74%;患者行胸部CT检查多可发现弥漫浸润影或斑片状实变影;及时给予者HAART抗病毒治疗对于病情有所缓解。结论艾滋病合并肺孢子菌肺炎的病情严重,患者死亡率高,同时易并发多种感染,使治疗难度加大,患者预后较差。早期诊断艾滋病,并及时给予患者HAART抗病毒治疗,可以提高患者生活质量,延长患者寿命。     

艾滋病并发的肺孢子菌肺炎

肺孢子菌肺炎(Pneumocystis pneumonia,PCP)是耶氏肺孢子菌(Pneumocystis Jiroveci,PC)引起的肺部机会性感染.先天性免疫机能缺陷及获得性免疫机能抑制的患者是PCP的高危人群,尤其是HIV感染晚期艾滋病(AIDS)的"标志病".临床上并发于AIDS的PCP与其他病因引起的PCP有一些不同之处.我国已经处于HIV感染的快速增长期,在控制HIV感染的同时必须关注PCP.     

艾滋病合并肺孢子菌肺炎34例临床分析

目的探讨艾滋病（AIDS）合并肺孢子菌肺炎（PCP）的临床特点。方法回顾性分析我院临床诊治的34例AIDS合并PCP的临床资料。结果①PCP以男性青壮年多见,感染HIV途径主要经静脉吸毒和性传播;②以发热、进行性呼吸困难和干咳为典型症状,而体征不明显;③CD4＋T淋巴细胞计数均〈200／mm^3,平均48．6／mm^3,〈100／mm^3的患者占96．2％;④典型的影像学表现为双肺弥漫对称性的间质性渗出病变,可呈毛玻璃样、小结节样、网格状改变,胸部CT显示肺内病灶比x线胸片明显;⑤复方磺胺甲嗯唑（SMZco）治疗有效。结论PCP均见于AIDS晚期患者,是AIDS最严重和常见的肺部机会性感染,是AIDS主要致死原因。早期诊断并且及时治疗是可以控制的,甚至可以治愈。HIV／AIDS患者使用SMZco可以预防PCP发生。     

肺孢子菌肺炎诊治及研究进展

肺孢子菌肺炎（pneumocystis carinii pneumonia,PCP）是免疫功能低下人群常见的急性、亚急性致命性肺炎,其病原体原称肺孢子虫或卡氏肺囊虫（pneumocystis carinii,PC）,2002年将感染人的病原体正式称为肺孢子菌（pneumocystis jiroveci,PJ）,以纪念首次发现人体感染肺孢子菌肺炎的捷克寄生虫病学家伊诺维奇（Otto Jiroveci）。出于习惯,PJ引起的肺炎仍沿用PCP。     

Pneumocystis jirovecii pneumonia after rituximab therapy for antibody-mediated rejection in a renal transplant recipient

Abstract: We report the case of a 54-year-old woman who underwent living-related renal transplantation for end-stage renal disease from IgA nephropathy. She was subsequently diagnosed with antibody-mediated rejection (AMR) and received rituximab, a potent B-cell suppressive agent. After therapy with rituximab, she developed Pneumocystis jirovecii pneumonia (PJP) requiring hospitalization. We discuss the increasing literature for the use of rituximab for AMR and the need for PJP prophylaxis in this setting.     

Pneumocystis jirovecii pneumonia is rare in renal transplant recipients receiving only one month of prophylaxis

Prophylaxis against Pneumocystis jirovecii pneumonia (PCP) is recommended for at least 4–12 months after solid organ transplant. In our center, renal transplant recipients receive only 1 month of post‐transplant trimethoprim–sulfamethoxazole, which also may provide limited protection against Nocardia. We identified only 4 PCP cases and 4 Nocardia cases in 1352 patients receiving renal and renal‐pancreas transplant from 2003 to 2009 at the University of Michigan Health System. Two PCP cases were identified <1 year after transplant, and 2 PCP cases were identified >1 year after transplant (gross attack rate 4/1352, 0.3%). Two Nocardia cases were identified <1 year after transplant, and 2 cases were identified >1 year after transplant. All identified cases received induction therapy (7 of 8 with anti‐thymocyte globulin), whereas about one‐half of all renal transplant patients received induction therapy at our institution. No patient was treated for rejection within 6 months of PCP; 2 of 4 patients with PCP had recent cytomegalovirus infection. All patients with PCP and 3 of 4 patients with Nocardia survived. The benefits of prolonged PCP prophylaxis should be weighed against the adverse events associated with prolonged use of antimicrobials.     

Pneumocystis jirovecii pneumonia in kidney transplantation

Pneumocystis jirovecii pneumonia (PCP) remains an important cause of morbidity and mortality in immunocompromised renal transplant recipients. In recent years, PCP outbreaks in renal transplant centers have been reported in many countries. Person‐to‐person transmission between PCP patients and other recipients lacking prophylaxis is one of the possible sources of infection. To prevent infection, effective prophylaxis in susceptible patients is recommended. Trimethoprim‐sulfamethoxazole (TMP‐SMX) is the most effective drug for PCP prophylaxis, but its recommended duration of use after transplantation varies among the different guidelines. The European Renal Association recommends a prophylaxis period of 4 months after transplantation, the American Society of Transplantation (AST) 6–12 months, and the Kidney Disease Improving Global Outcomes guidelines 3–6 months. Lifelong prophylaxis with TMP‐SMX is not recommended in renal transplant recipients; however, in many cases, PCP has occurred after the recommended prophylaxis periods after transplantation. In this minireview, we discuss the risk factors including environmental‐nosocomial exposure; state‐of‐the‐art diagnosis, treatment, prophylaxis and isolation; and references to the AST 2009 guidelines with the aim of integrating our experience with PCP outbreaks into recent reports, and we discuss how renal transplant recipients can be protected from PCP.     

Late‐onset Pneumocystis jirovecii pneumonia in solid organ transplant recipients

Anti‐Pneumocystis prophylaxis is recommended for at least 6–12 months after solid organ transplantation, as most cases of Pneumocystis jirovecii pneumonia (PCP) occur during the first year post transplantation. Herein, we report 4 cases of late‐onset PCP (>1 year post transplant). PCP appeared in a range of 50–68 months post transplant. Two cases had history of humoral rejection episodes treated with rituximab, and the other 2 had low CD4+ T‐cell count (<200 cells/mm³) at the time of diagnosis. All 4 patients survived. In conclusion, although the number of cases is low, we must be aware of the possibility of late‐onset PCP in solid organ transplant patients. The role of previous use of rituximab or persistent CD4+ T‐cell lymphopenia should be addressed in future studies.     

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.     

VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report

Introduction:Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts. It is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Compared with HIV-PJP, non-HIV PJP is more likely to develop rapidly into respiratory failure, with difficult diagnosis and high mortality.Patient concerns:A 46-year-old male with membranous nephropathy was treated with oral corticosteroids and tacrolimus. He was admitted to our hospital for fever and dyspnea which developed 4 days ago. Laboratory data revealed that leukocytes were 10.99 × 10⁹/L, neutrophils 87.7%, lymphocytes 9.6%, C-reactive protein 252.92 mg/L, New coronavirus nucleic acid detection negative. CT scan of chest revealed ground-glass opacity in both lungs. He was admitted to the respiratory department of our hospital, and then transferred to ICU because of his critical condition.Diagnosis:High throughput gene detection of pathogenic microorganisms in alveolar lavage fluid showed that the detection sequence of Pneumocystis yersiniae increased significantly. The serum HIV-antibody was negative. Therefore, the patient was diagnosed as non-HIV PJP.Interventions:After admission, the patient was assisted by noninvasive ventilator and treated with compound trimethoprim-sulfamethoxazole (SMX-TMP) and caspofungin. The patient''s condition continued to deteriorate, and then underwent endotracheal intubation and veno-venous extracorporeal membrane oxygenation (VV-ECMO) combined with prone position ventilation until the lung lesion improved.Outcomes:VV-ECMO was stopped on day 12, tracheal intubation was removed after 2 days. The patient was transferred to the respiratory department on day 15, discharged after 12 days without complications. Two months later, the follow-up showed that the patient was in good condition.Conclusion:VV-ECMO combined with prone position ventilation could be a useful choice for respiratory assistance in non-HIV PJP patients.