Chakaya J M, Bii C, Ng'ang'a L, Amukoye E, Ouko T, Muita L, Gathua S, Gitau J, Odongo I, Kabanga J M, Nagai K, Suzumura S, Sugiura Y
CRDR, KEMRI, P.O. Box 47855, Nairobi, Kenya.
East Afr Med J. 2003 Jan;80(1):30-5. doi: 10.4314/eamj.v80i1.8663.
Pneumocystis carinii pneumonia has generally been regarded to be an uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa. The reason for this has not been clear but postulates included a lack of suitable pathogenic types in the African environment, diagnostic difficulties and the more commonly held belief that African HIV infected individuals were dying early from common non-opportunistic pathogens before severe degrees of immunosuppression occured. Recently a trend has emerged at the Mbagathi district hospital whereby an increasing number of HIV infected patients are empirically treated for Pneumocystis carinii pneumonia (PCP) based on clinical and radiological features.
To determine the prevalence of PCP and clinical outcomes of HIV infected patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive diagnosis of PCP.
Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya.
Patients presenting with a sub-acute onset of cough and dyspnoea were eligible for the study if they were found to have bilateral pulmonary shadows and had negative sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was examined for cysts of P. carinii using toluidine blue stain and immunofluorescent antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria using routine procedures. Standard treatment with high dose cotrimoxazole was offered to all patients who were then followed up until discharge from hospital or death whichever came first.
Between June 1999 and August 2000 a total of 63 patients were referred for bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure, four died before the procedure could be done, one was judged too sick to undergo the procedure and three had been on cotrimoxazole for longer than five days. Thus 51 patients underwent bronchoscopy. Pneumocystis carinii stain was positive in 19 (37.2%) while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those without PCP but this difference was not statistically significant (odds ratio 0.68 (95% CI 0.35-1.32; P=0.2).
PCP was found to be common in HIV infected patients presenting with clinical and radiological features of the disease. The mortality rate for patients with a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole preventive therapy may be a useful intervention in symptomatic HIV infected patients in Kenya for the prevention of PCP and may avert deaths from this disease.
卡氏肺孢子虫肺炎通常被认为是撒哈拉以南非洲地区感染人类免疫缺陷病毒（HIV）个体中一种不常见的机会性感染。其原因尚不清楚，但推测包括非洲环境中缺乏合适的致病类型、诊断困难以及更普遍的观点认为非洲HIV感染个体在发生严重免疫抑制之前就因常见的非机会性病原体而过早死亡。最近，在内罗毕的姆巴加蒂区医院出现了一种趋势，越来越多的HIV感染患者根据临床和放射学特征接受卡氏肺孢子虫肺炎（PCP）的经验性治疗。
确定在内罗毕姆巴加蒂区医院就诊、初步诊断为PCP的HIV感染患者中PCP的患病率及临床结局。
肯尼亚内罗毕一家拥有169张床位的公立医院——姆巴加蒂区医院。
出现亚急性咳嗽和呼吸困难的患者，如果发现有双侧肺部阴影且痰涂片抗酸杆菌染色阴性，则符合本研究条件。同意接受检查且无纤维支气管镜检查禁忌证的患者进行临床评估，随后进行纤维支气管镜检查，获取支气管肺泡灌洗液（BALF）。使用甲苯胺蓝染色和免疫荧光抗体试验（IFAT）检查BALF中的卡氏肺孢子虫囊肿。还采用常规方法对BALF进行真菌、细菌和分枝杆菌检测。为所有患者提供高剂量复方新诺明标准治疗，然后对患者进行随访，直至出院或死亡，以先发生者为准。
1999年6月至2000年8月期间，共有63例患者被转诊进行支气管镜检查。其中4例拒绝接受纤维支气管镜检查，4例在检查前死亡，1例被判定病情过重无法接受检查，3例已服用复方新诺明超过5天。因此，51例患者接受了支气管镜检查。19例（37.2%）卡氏肺孢子虫染色呈阳性，51例患者中有16例（31.4%）死亡。未患PCP的患者死亡人数更多，但差异无统计学意义（比值比0.68（95%可信区间0.35 - 1.32；P = 0.2）。
在具有该疾病临床和放射学特征的HIV感染患者中，PCP很常见。初步诊断为PCP的患者死亡率很高。本研究表明，复方新诺明预防性治疗可能是肯尼亚有症状HIV感染患者预防PCP的一种有效干预措施，可避免因该病导致的死亡。
