Update on the diagnosis and treatment of Pneumocystis pneumonia.
Update on the diagnosis and treatment of Pneumocystis pneumonia.
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DOI：
10.1177/1753465810380102
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发表时间：
2011-03
影响因子：
4.3
通讯作者：
Limper AH
中科院分区：
文献类型：
--
作者：
Carmona EM;Limper AH
肺孢子虫是一种机会性真菌病原体，可在免疫功能低下的宿主中引起致命的肺炎。尽管这种生物体是在 1900 年代初发现的，但人类肺孢子虫肺炎的第一例病例最初是在第二次世界大战后的中欧早产儿和营养不良婴儿中发现的。这种不寻常的肺部感染被称为新生儿浆细胞间质性肺炎，其特征是严重的呼吸窘迫和发绀，很少或没有发烧，也没有病理性的体征。当时，仅报告了成人的轶事病例，通常这些患者患有基线恶性肿瘤，导致营养不良状态。 20 世纪 60 至 70 年代，在成人和儿童中出现了更多患有血液系统恶性肿瘤的病例，但肺孢子菌肺炎仍被认为是一种罕见疾病。然而，在 20 世纪 80 年代，随着艾滋病毒流行，肺孢子虫感染率急剧上升，并被广泛认为是一种机会性感染，可在免疫力受损的患者中引发可能危及生命的肺炎。在此期间，针对这种微生物的预防措施在高危患者中更为普遍。 20 世纪 90 年代，随着预防措施的广泛使用以及高效抗逆转录病毒治疗 (HAART) 治疗 HIV 感染者的开始，该特定人群的病例数有所下降。然而，肺孢子菌肺炎仍然是艾滋病毒感染者严重肺炎的重要原因，并且仍然被认为是艾滋病的主要疾病。尽管过去十年中艾滋病毒感染者的病例数量有所减少，但肺孢子虫肺炎仍然是患有其他免疫抑制疾病的免疫缺陷患者的一个严重问题。这主要是由于越来越多地使用免疫抑制药物来治疗骨髓和实体器官移植后的自身免疫性疾病患者以及血液和实体恶性肿瘤患者。患有血液系统疾病、实体器官和造血干细胞移植的患者是目前最容易发生这种感染的人群。然而，任何免疫力受损的患者，例如接受中等剂量口服类固醇超过 4 周的患者或接受其他免疫抑制药物的患者也面临很大的风险。
Pneumocystis is an opportunistic fungal pathogen that causes an often-lethal pneumonia in immunocompromised hosts. Although the organism was discovered in the early 1900s, the first cases of Pneumocystis pneumonia in humans were initially recognized in Central Europe after the Second World War in premature and malnourished infants. This unusual lung infection was known as plasma cellular interstitial pneumonitis of the newborn, and was characterized by severe respiratory distress and cyanosis with little or no fever and no pathognomic physical signs. At that time, only anecdotal cases were reported in adults and usually these patients had a baseline malignancy that led to a malnourished state. In the 1960–1970s additional cases were described in adults and children with hematological malignancies, but Pneumocystis pneumonia was still considered a rare disease. However, in the 1980s, with the onset of the HIV epidemic, Pneumocystis prevalence increased dramatically and became widely recognized as an opportunistic infection that caused potentially life-treating pneumonia in patients with impaired immunity. During this time period, prophylaxis against this organism was more generally instituted in high-risk patients. In the 1990s, with widespread use of prophylaxis and the initiation of highly active antiretroviral therapy (HAART) in the treatment of HIV-infected patients, the number of cases in this specific population decreased. However, Pneumocystis pneumonia still remains an important cause of severe pneumonia in patients with HIV infection and is still considered a principal AIDS-defining illness. Despite the decreased number of cases among HIV-infected patients over the past decade, Pneumocystis pneumonia continues to be a serious problem in immunodeficient patients with other immunosuppressive conditions. This is mostly due to increased use of immunosuppressive medications to treat patients with autoimmune diseases, following bone marrow and solid organ transplantation, and in patients with hematological and solid malignancies. Patients with hematologic disorders and solid organ and hematopoietic stem cell transplantation are currently the most vulnerable groups at risk for developing this infection. However, any patient with an impaired immunity, such as those receiving moderate doses of oral steroids for greater than 4 weeks or those receiving other immunosuppressive medications are at also at significant risk.