非人类免疫缺陷病毒感染者卡氏肺孢子虫所致机械通气相关性肺炎五例

目的提高临床对非人类免疫缺陷病毒(HIV)感染者罹患卡氏肺孢子虫(PC)所致机械通气相关性肺炎(VAP)的认识。方法回顾性分析我院南楼临床部2000年10月-2003年10月收治的5例非HIV感染者PC所致VAP的临床资料。结果5例患者均为男性,年龄71-93岁,均有严重的基础疾病,均因肺部感染诱发严重呼吸衰竭,经人工气道长期应用机械通气,机械通气期间反复发生VAP,并因此长期反复应用多种广谱抗生素。5例患者均有发热,大多伴有明显的呼吸道症状,4例肺部听诊可闻及湿罗音。5例患者中有4例x线胸片显示两肺弥漫性斑片影,另1例右肺密度普遍增加;2例有网状纹理,2例胸水增加。5例患者中有4例痰找PC和PCPCR阳性;另1例痰PCPCR阳性,痰找PC阴性。5例患者HIV抗体均阴性。确诊PCP后,5例患者在原有治疗的基础上加用或单用复方新诺明(SMZeo),4例治愈,复查痰找PC和PCPCR均阴性,目前尚未发现有重新阳性者。1例死亡。结论老年、反复应用广谱抗生素或糖皮质激素、恶性肿瘤晚期者,即使没有HIV感染,在长期应用呼吸机期间,发生PC所致VAP是可能的。

Ventilator-associated pneumonia caused by Pneumocystis carinii in the non-human immunodeficiency virus infection: a report of 5 cases

Objective To comprehend ventilator-associated pneumonia (VAP) caused by pneumocystis carinii (P. carinii-VAP) in the non-human immunodeficiency virus (HIV) infected patients. Methods The clinical data of5 patients with P. carinii-VAP in the non-HIV patients from 2000 to 2003 in our hospital were reviewed. Results Five male patients, aged 71-93,had severe predisposing diseases and respiratory failure induced by lung infection. All patients were treated with mechanical ventilation and multiple antibiotics and had recurrent VAP. Fever was present in all patients together with respiratory symptoms. Moist rales were noted in four of them. X-ray showed diffusepatchy shadows in 4 patients, extensive densities in 1 cases, reticular infiltrations in 2 cases, and pleural effusion in 2 cases. Sputum (P. carinii) was found by smear staining in 4 cases as well as a positive PC PCR. The remaining case only showed a positive PC PCR. Four patients were cured after treatment with SMZco, but one patient died. Conclusion P. carinii-VAP could occur during prolonged mechanical ventilation for severe respiratory diseases, particularly in aged patients with advanced cancer or treated with glucocorticoids and broad spectrum antibiotics.