Pneumocystis carinii: infection in AIDS.
Pneumocystis carinii: infection in AIDS.
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卡氏肺囊虫：艾滋病感染。
DOI：
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发表时间：
1987
期刊：
影响因子：
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通讯作者：
H. Masur
中科院分区：
文献类型：
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作者：
Suffredini Af;H. Masur
超过65%的艾滋病患者最终会发展为卡氏肺囊虫肺炎（PCP），每次发作的死亡率为10-50%。这种微生物不能可靠地培养，血清学检测诊断不准确，疾病的症状通常很微妙，标准治疗与明显的毒性有关。在1981年之前，PCP感染的报告主要发现于因早产、蛋白质营养不良、先天性免疫缺陷综合征、肿瘤和器官移植而导致免疫缺陷的患者。在所有艾滋病患者中，63%以PCP为艾滋病的初始表现。与其他免疫抑制性疾病患者相比，艾滋病患者的症状持续时间更长，呼吸频率更低，室内空气动脉氧压更高（所有这些都与较差的生存率相关）。重要的是建立一个具体的诊断，而不是经验治疗PCP；可用的诊断工具包括胸片-67柠檬酸镓扫描肺功能测试组织染色纤维支气管镜检查和必要时开放肺活检。常用的治疗方法是甲氧苄啶-磺胺甲恶唑；60-75%的艾滋病患者会对其产生不良反应，而非艾滋病患者的这一比例为14%。停药后效果消失。替代疗法包括异硫代戊脒- α -二氟甲基鸟氨酸氨苯砜和甲氨酰胺。一般来说，在严重呼吸衰竭之前进行早期治疗干预与较好的预后相关；需要气管插管和机械通气的患者预后较差。单Kaposis肉瘤患者的中位累积生存期（基于1981-1984年纽约市1391名艾滋病患者）为125周，Kaposis和PCP患者为61周，PCP患者为35周。当药物治疗明显不能给病人带来好处时，控制疼痛、呼吸困难或其他不适的支持性护理就成为治疗目标。
Over 65% of AIDS patients will ultimately develop pneumocystis carinii pneumonia (PCP) and each episode carries a 10-50% mortality rate. This organism cannot be reliably cultured serologic testing for diagnosis is imprecise symptoms of the illness are frequently subtle and standard therapies are associated with significant toxicities. Prior to 1981 reports of PCP infection were found primarily in patients with immunologic deficiencies due to premature birth protein malnutrition congenital immunodeficiency syndromes neoplasms and organ transplantation. Among all AIDS patients 63% presented with PCP as their initial manifestation of AIDS. When compared to patients with other immunosuppressive diseases AIDS patients have a longer duration of symptoms lower respiratory rate and higher room air arterial oxygen tension (all of which are associated with a poorer rate of survival). It is important to establish a specific diagnosis of PCP rather than treat empirically; diagnostic tools available include chest radiograph gallium-67 citrate scans pulmonary function testing tissue stains fiberoptic bronchoscopy and if necessary open lung biopsy. Usual therapy is trimethoprim-sulfamethoxazole; 60-75% of AIDS patients will develop adverse reactions to it as opposed to 14% of non-AIDS patients. Effects resolve upon discontinuation of the drug. Alternate therapies include pentamidine isethionate alpha difluoromethylornithine dapsone trimetrexate and carbutamide. In general early therapeutic intervention prior to severe respiratory failure is associated with a better prognosis; patients who need endotracheal intubation and mechanical ventilation have a poor prognosis. Median cumulative survival (based on 1391 AIDS patients NYC 1981-1984) for patients with Kaposis sarcoma alone was 125 weeks with Kaposis and PCP 61 weeks and with PCP alone 35 weeks. When it is apparent that medical therapy offers little benefit to the patient supportive care to control pain dyspnea or other discomforts becomes the therapeutic goal.