Pneumocystis pneumonia in patients with HIV infection:: clinical manifestations, laboratory findings, and radiological features
Pneumocystis pneumonia in patients with HIV infection:: clinical manifestations, laboratory findings, and radiological features
复制标题
DOI：
10.1007/s10156-006-0484-5
复制
发表时间：
2007-02-01
影响因子：
2.2
通讯作者：
Iwamoto, Aikichi
中科院分区：
文献类型：
--
作者：
Fujii, Takeshi;Nakamura, Tetsuya;Iwamoto, Aikichi
肺囊虫性肺炎（PCP）仍然是获得性免疫缺陷综合征（艾滋病）患者最常见的机会性感染。熟悉PCP的临床特征对于及时诊断至关重要，即使患者不知道自己的HIV血清状态。我们在此描述32例艾滋病相关PCP患者34次发作的临床特征，并回顾现有文献。在症状方面，发烧、咳嗽和呼吸困难的频率分别为74%、74%和65%，在首次检查的34次发作中，只有14次出现完整的三联征。从症状出现到诊断的中位持续时间为3周，与艾滋病相关的PCP往往采取潜伏的临床过程。虽然实验室结果通常是非特异性的，但血清或血浆中p - d -葡聚糖水平的测量对PCP的诊断非常有用。除1例患者外，其余患者p - d -葡聚糖水平均高于临界值（中位数为147pg/ml；范围为5-6920pg/ml）。PCP的典型x线表现为双侧对称的磨玻璃浊影，但x线表现也多种多样。在我们的患者中，肺高分辨率计算机断层扫描（HRCT）显示磨玻璃影不覆盖肺周围（41%），或显示马赛克模式（29%），或几乎均匀（24%），磨玻璃影伴气腔实变（21%），伴囊性形成（21%），伴线状网状影（18%），斑片状和不规则分布（15%），伴单发或多发结节（9%），并伴有实质腔病变（6%）。
Pneumocystis pneumonia (PCP) remains the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). Familiarity with the clinical features of PCP is crucial for prompt diagnosis, even if the patient is unaware of their HIV serostatus. We describe herein the clinical features of 34 episodes in 32 patients with AIDS-associated PCP and review the existing literature. As for symptoms, the frequency of fever, cough, and dyspnea was 74%, 74%, and 65%, respectively, and the complete triad was present in only 14 of the 34 episodes on first examination. Median duration from onset of symptoms until diagnosis was 3 weeks, and AIDS-associated PCP tended to take an insidious clinical course. Although laboratory findings were generally nonspecific, measurement of P-D-glucan levels in the serum or plasma was highly useful in the diagnosis of PCP. All but I of the patients showed P-D-glucan levels higher than the cutoff value (median, 147pg/ml; range, 5-6920pg/ml). Typical radiographic features of PCP are bilateral, symmetrical ground-glass opacities, but a wide variety of radiographic findings were observed. In our patients, high-resolution computed tomography (HRCT) of the lung showed ground-glass opacities sparing the lung periphery (41% of episodes) or displaying a mosaic pattern (29%), or being nearly homogeneous (24%), ground-glass opacities associated with air-space consolidation (21%), associated with cystic formation (21%), associated with linear-reticular opacities (18%), patchily and irregularly distributed (15%), associated with solitary or multiple nodules (9%), and associated with parenchymal cavity lesions (6%).