Evolving Health Effects of Pneumocystis One Hundred Years of Progress in Diagnosis and Treatment
Evolving Health Effects of Pneumocystis One Hundred Years of Progress in Diagnosis and Treatment
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DOI：
10.1001/jama.2009.880
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发表时间：
2009-06-24
影响因子：
120.7
通讯作者：
Masur, Henry
中科院分区：
文献类型：
--
作者：
Kovacs, Joseph A.;Masur, Henry
2009年是首次描述肺孢子虫的100周年，肺孢子虫是一种在最初50年的大部分时间里被忽视的生物体，但随后被认为是免疫功能低下患者，特别是感染人类免疫缺陷病毒（HIV）的患者的重要病原体。我们报告一位慢性淋巴细胞白血病患者，尽管接受适当的抗肺孢子虫治疗，仍死于肺孢子虫肺炎。尽管PCP的诊断、治疗和预防方面取得了重大进展，降低了其发生率并改善了预后，但在HIV感染患者和接受免疫抑制药物治疗的患者中仍然可以看到PCP。肺孢子虫属包括一个真菌家族，每种真菌似乎只能感染1种宿主。肺孢子虫分布于世界各地。免疫活性宿主清除感染，无明显临床后果。肺孢子虫已在慢性阻塞性肺病等其他疾病患者中发现，尽管其临床影响尚不确定。免疫功能低下的患者由于再感染和潜在感染的可能再激活而发病。在HIV感染患者中，CD 4计数可预测发生PCP的风险，但此类可靠的标志物不适用于其他免疫功能低下的人群。在大多数PCP患者中，可以使用最近开发的分型技术确定多种肺孢子虫菌株。由于肺孢子虫不能培养，诊断依赖于通过比色或免疫荧光染色或聚合酶链反应检测有机体。甲氧苄啶-磺胺甲恶唑是治疗和预防五氯苯酚的首选药物方案，尽管也有一些替代品。皮质类固醇是低氧血症患者的重要辅助治疗。JAMA. 2009; 301（24）：2578-2585
2009 marks the 100th anniversary of the first description of Pneumocystis, an organism that was ignored for much of its first 50 years but that has subsequently been recognized as an important pathogen of immunocompromised patients, especially patients infected with human immunodeficiency virus (HIV). We present a patient with chronic lymphocytic leukemia who died from Pneumocystis pneumonia (PCP) despite appropriate anti-Pneumocystis therapy. Although substantial advances in diagnosis, treatment, and prevention of PCP have decreased its frequency and improved prognosis, PCP continues to be seen in both HIV-infected patients and patients receiving immunosuppressive medications. Pneumocystis species comprise a family of fungi, each of which appears to be able to infect only 1 host species. Pneumocystis has a worldwide distribution. Immunocompetent hosts clear infection without obvious clinical consequences. Pneumocystis has been identified in patients with other diseases such as chronic obstructive pulmonary disease, although its clinical impact is uncertain. Immunocompromised patients develop disease as a consequence of reinfection and possibly reactivation of latent infection. In patients with HIV infection, the CD4 count is predictive of the risk for developing PCP, but such reliable markers are not available for other immunocompromised populations. In the majority of patients with PCP, multiple Pneumocystis strains can be identified using recently developed typing techniques. Because Pneumocystis cannot be cultured, diagnosis relies on detection of the organism by colorimetric or immunofluorescent stains or by polymerase chain reaction. Trimethoprim-sulfamethoxazole is the preferred drug regimen for both treatment and prevention of PCP, although a number of alternatives are also available. Corticosteroids are an important adjunct for hypoxemic patients. JAMA. 2009; 301(24):2578-2585