[1]张实,刘刚,王美菊,等.拟诊卡氏孢子虫和(或)巨细胞病毒性肺炎患者病原微生物学筛查及治疗策略[J].第三军医大学学报,2015,37(19 ):1976-1980.
 Zhang Shi,Liu Gang,Wang Meiju,et al.Microbial screening and therapeutic strategies for tentative diagnosis of Pneumocystsis carinii pneumonia and/or cytomegalovirus pneumonia[J].J Third Mil Med Univ,2015,37(19 ):1976-1980.
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拟诊卡氏孢子虫和(或)巨细胞病毒性肺炎患者病原微生物学筛查及治疗策略(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
37卷
期数:
2015年第19期
页码:
1976-1980
栏目:
论著
出版日期:
2015-10-15

文章信息/Info

Title:
Microbial screening and therapeutic strategies for tentative diagnosis of Pneumocystsis carinii pneumonia and/or cytomegalovirus pneumonia
作者:
张实刘刚王美菊李琦
第三军医大学新桥医院重症医学科
Author(s):
Zhang Shi Liu Gang Wang Meiju Li Qi

Department of Critical Medicine, Xinqiao Hospital, Third Military Medical University, Chongqing, 40037, China

关键词:
肺孢子虫 巨细胞病毒 病原微生物筛查 治疗策略
Keywords:
Pneumocystsis carinii pneumonia cytomegalovirus microbial screening therapeutic strategy
分类号:
R446.5; R563.1
文献标志码:
A
摘要:

目的      通过病原微生物学筛查及对照实验两个方面,为拟诊卡氏肺孢子虫(pneumocystsis carinii pneumonia,PCP)和(或)巨细胞病毒(cytomegalovirus,CMV)性肺炎患者寻找最佳诊疗策略。      方法      192例拟诊患者肺组织标本及BALF标本微生物学镜检,ELISA检测患者血清CMV抗体;荧光定量PCR检测患者血清巨细胞病毒DNA含量。将仅CMV阳性和仅PCP阳性的患者分为两组,一组为覆盖PCP和CMV的联合治疗组,一组为仅覆盖PCP或CMV的单独治疗组,比较两组的住院时间及“14 d内病情缓解率”。      结果      微生物学检验阳性患者共136人;其中仅CMV阳性17人;仅PCP阳性21人;PCP与CMV均阳性98人。联合治疗组住院时间显著短于单独治疗组(W=162.5,P=0.006),联合治疗组“14 d内病情缓解率”显著高于单独治疗组(χ2=6.454,P=0.011)。      结论      PCP与CMV混合感染多见,单独PCP或CMV一项感染少见;覆盖PCP和CMV的联合治疗效果更好。

Abstract:

Objective      To investigate optional therapeutic strategies for suspected Pneumocystsis carinii pneumonia (PCP) and/or cytomegalovirus (CMV) pneumonia by microbial screening and control experiment.       Methods      Microbial screening included 3 parts, which were microbiological microscopy for patients’ lung specimens and bronchoalveolar lavage fluid (BALF), detection of serum CMV antibody by ELISA and detection of serum CMV DNA content by fluorescence quantitative PCR. The patients who were positive to only CMV or PCP were respectively divided into 2 groups, that is, the combined treatment group and the single treatment group (CMV or PCP as corresponded). The length of hospital stay and the remission rate after 14 days'treatment were compared between the 2 groups.       Results      There were totally 136 positive patients, including 17 only positive to CMV, 21 only to PCP and 98 with double positive of PCP and CMV. The length of hospital stay were shorter in the combined treatment group than the single treatment groups (W=162.5, P=0.006). The remission rate were also obviously higher in the former than the latter groups (χ2=6.454, P=0.011).       Conclusion      It is quite common for mixed infection of PCP and CMV pneumonia, but rare for single infection. So, the combined treatments are more effective than the single one.

参考文献/References:

[1]Lange B, Neumann S, Hirsch H H, et al. Prevention of infections in immune deficiency[J]. Dtsch Med Wochenschr, 2014, 139(40): 1999-2002.
[2]Huber L C, Isenring B D, Schuurmans M M. Diagnosis, therapy and prevention of respiratory virus infections in lung transplant recipients[J]. Praxis (Bern 1994), 2014, 103(8):  453-459.
[3]Coelho L, Veloso V G, Grinsztejn B, et al. Trends in overall opportunistic illnesses, Pneumocystis carinii pneumonia, cerebral toxoplasmosis and Mycobacterium avium complex incidence rates over the 30 years of the HIV epidemic:  a systematic review[J]. Braz J Infect Dis, 2014, 18(2):  196-210.
[4]Musallam N, Bamberger E, Srugo I, et al. Legionella pneumophila and Pneumocystis jirovecii coinfection in an infant treated with adrenocorticotropic hormone for infantile spasm:  case report and literature review[J]. J Child Neurol, 2014, 29(2): 240-242.
[5]Kizilarslanoglu M C, Aksoy S, Yildirim N O, et al. Temozolomide-related infections:  review of the literature[J]. J BUON, 2011, 16(3): 547-550.
[6]Stern A, Green H, Paul M, et al. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients[J]. Cochrane Database Syst Rev, 2014, 10: CD005590.
[7]Capocci S, Lipman M. Respiratory infections in HIV-infected adults:  epidemiology, clinical features, diagnosis and treatment[J]. Curr Opin Pulm Med, 2013, 19(3):  238-243.
[8]Maschmeyer G, Carratala J, Buchheidt D, et al. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded):  updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)[J]. Ann Oncol, 2015, 26(1):  21-33.
[9]Costiniuk C T, Fergusson D A, Doucette S, et al. Discontinuation of Pneumocystis jirovecii pneumonia prophylaxis with CD4 count <200 cells/μL and virologic suppression:  a systematic review[J]. PLoS One, 2011, 6(12):  e28570.
[10]Lowe D M, Rangaka M X, Gordon F, et al. Pneumocystis jirovecii pneumonia in tropical and low and middle income countries:  a systematic review and meta-regression[J]. PLoS One, 2013, 8(8): e69969.
[11]孙培培, 童朝晖. 肺孢子菌肺炎的诊断和治疗进展[J]. 中华结核和呼吸杂志, 2012, 35(10): 775-776.
[12]Hayes G E, Denning D W. Frequency, diagnosis and management of fungal respiratory infections[J]. Curr Opin Pulm Med, 2013, 19(3): 259-265.
[13]Church J A, Fitzgerald F, Walker A S, et al. The expanding role of co-trimoxazole in developing countries[J]. Lancet Infect Dis, 2015, 15(3): 327-239.
[14]Tu G W, Ju M J, Xu M, et al. Combination of caspofungin and low-dose trimethoprim/sulfamethoxazole for the treatment of severe Pneumocystis jirovecii pneumonia in renal transplant recipients[J]. Nephrology (Carlton), 2013, 18(11): 736-742.
[15]Gilroy S A, Bennett N J. Pneumocystis pneumonia[J]. Semin Respir Crit Care Med, 2011, 32(6): 775-782.
[16]ten-Berge I J, van-Lier R A. The interaction between cytomegalovirus and the human immune system[J]. Immunol Lett, 2014, 162(2 Pt B): 141-144.
[17]Fernandez-Ruiz M, Kumar D, Humar A. Clinical immune-monitoring strategies for predicting infection risk in solid organ transplantation[J]. Clin Transl Immunology, 2014, 3(2): e12.
[18]Lucin P, Mahmutefendic H, Blagojevic-Zagorac G, et al. Cytomegalovirus immune evasion by perturbation of endosomal trafficking[J]. Cell Mol Immunol, 2015, 12(2):  154-169.
[19]Roman A, Manito N, Campistol J M, et al. The impact of the prevention strategies on the indirect effects of CMV infection in solid organ transplant recipients[J]. Transplant Rev (Orlando), 2014, 28(2): 84-91.
[20]Gullett J C, Nolte F S. Quantitative nucleic acid amplification methods for viral infections[J]. Clin Chem, 2015, 61(1): 72-78.
[21]Tong L X, Worswick S D. Viral infections in acute graft-versus-host disease:  a review of diagnostic and therapeutic approaches[J]. J Am Acad Dermatol, 2015, 72(4): 696-702.
[22]Soderberg-Naucler C. Treatment of cytomegalovirus infections beyond acute disease to improve human health[J]. Expert Rev Anti Infect Ther, 2014, 12(2): 211-222.
[23]Masur H, Brooks J T, Benson C A, et al. Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents:  Updated Guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America[J]. Clin Infect Dis, 2014, 58(9):  1308-1311.
[24]Prevention Committee of the Japanese Society for Tuberculosis; Treatment Committee of the Japanese Society for Tuberculosis. Treatment guidelines for latent tuberculosis infection[J]. Kekkaku, 2014, 89(1): 21-37.

更新日期/Last Update: 2015-09-28