艾滋病合并肺孢子菌肺炎1例的诊断治疗探讨

耶氏肺孢子菌肺炎（Pneumocystis jiroveci pneumonia,PJP,但习惯上仍简称PCP）常发生于未经高效抗反转录病毒药物治疗（highly active antiretroviral drugs therapy,HAART）的艾滋病（acquired immunodeficiency syndrome,AIDS）患者及PCP一级预防（即CD4＋T淋巴细胞计数〈200×10^5/L的患者接受抗PCP的预防性化疗）广泛应用之前,     

艾滋病合并卡氏肺孢子菌肺炎的诊断方法研究进展

卡氏肺孢子菌肺炎是由卡氏肺孢子菌引起的一种呼吸系统机会性感染,作为AIDS、器官移植、肿瘤、化疗等免疫功能低下患者的并发症越来越突出,对其做出正确、及时的诊断也越来越重要。该文就卡氏肺孢子菌的病原学及PCP的实验诊断、影像学诊断方法的研究概况和进展作一综述。     

人肺孢子菌肺炎治愈1例

1 资料与方法 1.1 临床资料 患者,男性,36岁,因间断发热伴活动后气短1月余就诊。患者1个月前“感冒”后出现胸闷、活动后喘憋,休息后缓解。伴间断发热。当地医院给予先锋必和阿齐霉素静滴20余天,效果不佳。10余天前咳嗽、咳痰加重,痰色白,量少,不黏,易咳出,无咳血。伴双肋部胸痛,与咳嗽有关。仍间断发热,体温最高39．7℃,伴膝关节、后背部游走性疼痛。既往史：1998年肾活检确诊为慢性肾小球肾炎,膜性增生性肾小球肾炎,IgA肾病（Ⅳ～Ⅴ级）,慢性肾功能不全（代偿期）。     

卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎

目的探讨卡泊芬净联合复方磺胺甲噁唑(TMP-SMX)治疗艾滋病合并肺孢子菌肺炎(PCP)的疗效。方法回顾性总结分析9例艾滋病合并肺孢子菌肺炎的临床资料,包括临床特点及诊疗经过。结果 9例患者临床诊断PCP成立,经卡泊芬净联合TMP-SMX抗PCP治疗后,除1例死亡(老年患者合并慢性支气管炎病史)外,其余8例均得到满意疗效。结论卡泊芬净联合TMP-SMX治疗艾滋病合并PCP,可达到良好的治疗效果。     

肺孢子菌肺炎辅助诊断方法研究进展

肺孢子菌肺炎是AIDS、器官移植受者、抗肿瘤放、化疗等各类继发或原发性免疫机能低下人群最常见的机会感染性疾病。通过显微镜检发现肺孢子菌是诊断肺孢子菌肺炎的金标准。但是,由于肺孢子菌主要寄生于肺泡腔内,目前临床采用的病原学检测方法或受到创伤性取材方法的限制或受病原体检出率极低的困惑。而目前盛行的基因检测方法因其操作过程的复杂及昂贵的费用难以适应临床应用。探索和建立敏感、特异的、可以从非创伤性标本中诊断肺孢子菌肺炎的快速诊断方法为临床之急需。学者们对肺孢子菌的主要表面糖蛋白及葡聚糖等菌体组分及其抗体等的检测方法进行了不断的探索,取得了一定进展。我们就该领域的研究进展及其在肺孢子菌肺炎辅助诊断方面的意义进行了综述。     

耶氏肺孢子菌与宿主免疫防御相互作用

肺孢子菌肺炎(Pneumocystis pneumonia,PCP)是由酵母样真菌耶氏肺孢子菌(Pneumocystis jirovecii,Pj)引起的肺炎,是免疫缺陷患者重要的致死原因。Pj一般不导致系统性感染,仅在肺部繁殖,引发严重损害肺换气功能的间质性肺炎。Pj通过主要表面糖蛋白(major surface glycoprotein,MSG)的抗原转换,逃避宿主免疫系统清除,而宿主利用dectin-1识别β-(1,3)-D-葡聚糖(beta-1,3-D-glucan,BG)、甘露糖受体识别MSG,启动天然免疫反应,继而CD4+T细胞聚集活化,调控细胞免疫和体液免疫。分泌干扰素γ的细胞毒型CD8+Tc1细胞有助于控制Pj感染,特异性抗体有助于调理加强吞噬细胞清除Pj,而聚集的中性粒细胞和非Tc1CD8+T细胞与肺损伤有关。血浆BG水平可以辅助诊断PCP,而支气管肺泡灌洗液中白介素8的水平与肺损伤及死亡预后有关。     

非HIV人群感染耶氏肺孢子菌肺炎的诊治研究进展CSCD

耶氏肺孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)是由耶氏肺孢子菌(Pneumocystis jirovecii,PJ)引起的急性或亚急性肺炎,最初可能表现为呼吸困难,发热,干咳,严重时导致死亡[1]。它是一种机会性感染,发生于免疫功能缺陷或低下的宿主,是人类免疫缺陷病毒(human immunodeficiency virus,HIV)最常见的并发症之一,也常发生于血液系统恶性肿瘤、实体肿瘤、实体器官或造血干细胞移植、自身免疫性疾病、炎症性疾病及治疗使用免疫抑制剂、化疗药物、生物制剂的非HIV免疫低下人群。     

非HIV相关卡氏肺孢子菌肺炎(NH-PCP)患者的临床特点分析

目的:采用病例对照研究的方法,总结非-HIV相关卡氏肺孢子菌肺炎(NH-PCP)的临床特点,为此类患者的临床诊治提供经验.方法:回顾性分析了302医院住院的NH-PCP患者,及在Pubmed、CHKD和万方数据库中检索到的NH-PCP患者共202例,选择65例HIV相关卡氏肺孢子菌肺炎(HIV-PCP)患者作为对照研究,比较分析前者在临床表现、病程、预防、治疗及预后等方面的特征,为今后此类疾病的临床诊治提供经验.结果:与HIV-PCP组对比,NH-PCP组采用预防性治疗的比例低(5.24％ vs.29.2％,P＜0.001);确诊后开始抗感染治疗的时间晚(5.19±0.95天VS.1.1±0.27天,P＜0.005);两组患者应用激素治疗的比例无统计学差异(69.3％ vs.76.9％,P=0.238),病死率无统计学差异(36.6％ vs.27.7％,P=0.487).结论:NH-PCP组患者采取预防治疗的比例低,开始抗感染治疗的时间也较HIV-PVP延迟.这提示我们,重视NH-PCP的风险预测,给予积极的预防治疗及PCP经验性早期治疗至关重要.     

肺孢子菌肺炎小鼠模型建立及免疫学评价

目的 构建肺孢子菌肺炎(Pneumocystis pneumonia, PCP)小鼠模型并进行免疫学评价。方法 采用重度联合免疫缺陷(severe combined immunodeficiency, SCID)小鼠气管滴注肺孢子菌构建PCP模型,通过实时荧光定量PCR及肺组织六胺银染色进行病原学鉴定,通过苏木素-伊红染色评估肺组织损伤程度,通过免疫荧光染色和流式细胞术进行免疫学评价。结果 模型组小鼠感染6周后,肺组织肺孢子菌rRNA拷贝数显著高于假手术组,六胺银染色可见肺孢子菌滋养体和包囊,肺组织肺泡壁增厚,肺间质增宽,大量Gr-1⁺中性粒细胞CD68⁺巨噬细胞浸润,中性粒细胞活化标志物髓过氧化物酶(myeloperoxidase, MPO)和巨噬细胞活化标志物一氧化氮合酶(inducible nitric oxide synthase, iNOS)活化水平显著升高,肺内及肺泡灌洗液的中性粒细胞和单核细胞数量及比例显著高于对照组和假手术组。结论 采用SCID小鼠进行气管滴注肺孢子菌能构建稳定的PCP小鼠模型,该模型表现出与临床相似的免疫学特...     

肺孢子菌肺外感染的临床表现和诊治研究进展CSCD

肺孢子菌肺炎(Pneumocystis pneumonia,PCP)是HIV患者最常见的机会性感染,临床上肺外组织肺孢子菌感染少见且容易误诊,多为个案报道。本文通过文献检索和分析,总结宿主肺外感染肺孢子菌的临床表现及诊治结果。结果表明肺外孢子菌感染的临床表现多不典型,但可以累及单个或多个系统,PCR技术及宏基因检测可有助于早期诊断并提高重症患者救治的成功率。治疗上仍以复方磺胺甲噁唑治疗为首选,尽早识别肺孢子菌肺外感染和提高多系统受累患者的救治受到临床关注。     

Interstitial pneumonia in immunocompetent laboratory rats caused by natural infection with Pneumocystis carinii

Pneumocystis (P.) carinii is known to cause fatal pneumonia in immunocompromised rats. Cases of P. carinii interstitial pneumonia in immunocompetent rats have been shown histologically to present with perivascular lymphoid cuffs, which have previously been attributed to rat respiratory virus. This study aims to determine the prevalence and pathological characteristics of P. carinii in immunocompetent laboratory rats in experimental facilities in Japan. An epidemiological survey for this agent was performed using PCR to assess 1,981 immunocompetent rats from 594 facilities in Japan. We observed that 6 of the 1,981 rats (0.30%) from 4 out of 594 facilities (0.67%) were positive for P. carinii without infection of other known pathogens. Gross pulmonary lesions were found in 4 of the 6 affected rats. The lungs of these rats contained scattered dark red/gray foci. Histopathologically, the lungs exhibited interstitial pneumonia with lymphoid perivascular cuffs: Pneumocystis cysts were observed using Grocott’s methenamine silver stain. To our knowledge, this report is the first to reveal the prevalence of natural P. carinii infection in immunocompetent laboratory rats in Japan.     

中药补骨脂及鸦胆子对大鼠卡氏肺孢子虫肺炎的防治研究

目的探讨中药补骨脂及鸦胆子对大鼠卡氏肺孢子虫肺炎的防治效果。方法用地塞米松皮下注射建立大鼠卡氏肺孢子虫肺炎动物模型,用补骨脂、鸦胆子及两者合剂治疗实验鼠,观察其肺脑组织病理、肺脑组织和血清中MDA(丙二醛)、XOD(黄嘌呤氧化酶)、GSH(谷胱甘肽)等指标变化。结果补骨脂、鸦胆子及合剂治疗实验大鼠体重明显回升,与模型对照差异有显著性(P<005);各治疗组的包囊减少率均高于60%,合剂治疗组不优于各单独治疗组,鸦胆子及合剂治疗组清除氧自由基能力较强。结论鸦胆子及补骨脂对大鼠卡氏肺孢子虫肺炎具有一定疗效。     

Analysis of Pneumocystis carinii Cyst Wall I. Evidence for an Outer Surface Membrane

ABSTRACT. It has long been thought that the cyst form of Pneumocystis carinii , which can resist host defenses and antimicrobial drugs, is responsible for relapses of P. carinii pneumonia. The thick wall of the cyst is immunogenic and rich in glucosyl/mannosyl and N-acetyl-D-glucosamine residues. In this study we have demonstrated the presence of a hitherto unreported outer membrane in the cyst wall of P. carinii . This membrane was detected by a combination of techniques, including transmission electron microscopy, freeze-fracture electron microscopy, and membrane labeling with fluorescent lipid analogs following treatment of P. carinii cysts from infected rats for 30 min with Zymolyase, a β-1–3 glucanase. As in gram-negative bacteria and blue-green algae, this 2nd membrane may have an important role in osmoregulation and nutrient utilization; it may also mediate the interaction of P. carinii with its host and serve as a target for drug therapy.     

Plasminogen activator production in a rat model of Pneumocystis carinii pneumonia

Several studies have indicated that the serine protease urokinase-plasminogen-activator (uPA) is an important factor in host defense against pulmonary pathogens. To gain a better insight into the role of uPA in Pneumocystis carinii (P. carinii) pneumonia (PCP), we evaluated PA production in alveolar macrophages (AMs) obtained from rats with steroid-induced PCP. Treatment with cortisone acetate favored PCP in 91% of rats. In the bronchoalveolar lavage (BAL) samples of immunosuppressed rats both with and without PCP, we observed a decrease in uPA activity as well as a decrease in cell number. Urokinase-PA production by AMs was reduced in rats treated with cortisone alone. However, an increase in cell-associated uPA was observed in rats with PCP. This increase appears to be produced in response to P carinii infection. In fact, when AMs obtained from untreated healthy or immunosuppressed uninfected rats were challenged with P carinii, a significant increase in PA activity in cell lysates was observed, though a lower response was obtained in cortisone-treated animals. Our results suggest that healthy AMs respond to the presence of P carinii with an increase in uPA production and that this response in immunodepressed rat-AMs is partially impaired.     

艾滋病合并侵袭性肺真菌病的诊治

近年来,侵袭性真菌感染的发病率不断增加,其中肺真菌感染居首位,己成为免疫功能下降或缺陷宿主常见的死亡原因。艾滋病是经典免疫功能缺陷性疾病,合并真菌感染时需及时识别、治疗,以降低其病死率。国内、外各种有关侵袭性真菌感染诊治指南的不断问世,极大地提高了临床医生对侵袭性真菌病的认识和诊治水平。该文就艾滋病常见侵袭性肺真菌病:肺念珠菌病、肺孢子菌肺炎、肺马内菲青霉病、肺隐球菌病、肺曲霉病的诊断及治疗进展进行综述。