Faul J L, Akindipe O A, Berry G J, Doyle R L, Theodore J
Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, California 94304-2299, USA.
J Heart Lung Transplant. 1999 Apr;18(4):384-7. doi: 10.1016/s1053-2498(98)00038-2.
In the setting of organ transplantation, prior to prophylaxis, Pneumocystis carinii pneumonia (PCP) had been a common clinical problem, particularly in heart-lung and lung recipients who receive long-term immunosuppressive therapy to prevent allograft rejection. Continuous oral trimethoprim-sulfamethoxazole (TMP-SMX) has been highly effective in preventing PCP in these patients.
In this paper we report a case of recurrent Pneumocystis carinii infection in a chronic (> 15 years) heart-lung allograft recipient on long-term TMP-SMX prophylaxis. Twice, in 1995 and again in 1998, Pneumocystis carinii infection was diagnosed by bronchoalveolar lavage (BAL), in the same patient, despite continued oral TMP-SMX (960 mg TMP/4800 mg SMX per week) prophylaxis. The subject was not lymphopenic (his CD4 count was 569/mm3) and there was no associated deterioration in pulmonary function, nor evidence of hypoxemia.
This case demonstrates that asymptomatic Pneumocystis carinii lung infections may recur in chronic heart-lung transplant recipients who take standard oral PCP prophylaxis.
在器官移植的背景下，在进行预防之前，卡氏肺孢子虫肺炎（PCP）一直是一个常见的临床问题，尤其是在接受长期免疫抑制治疗以防止移植排斥的心肺和肺移植受者中。持续口服甲氧苄啶-磺胺甲恶唑（TMP-SMX）对预防这些患者的PCP非常有效。
在本文中，我们报告了一例长期接受TMP-SMX预防的慢性（>15年）心肺移植受者复发性卡氏肺孢子虫感染病例。尽管该患者持续口服TMP-SMX（每周960毫克TMP/4800毫克SMX）进行预防，但在1995年和1998年，通过支气管肺泡灌洗（BAL）两次诊断出同一患者发生卡氏肺孢子虫感染。该患者不存在淋巴细胞减少（其CD4计数为569/mm³），肺功能也没有相关恶化，也没有低氧血症的证据。
该病例表明，接受标准口服PCP预防的慢性心肺移植受者可能会复发无症状的卡氏肺孢子虫肺部感染。
