Saksasithon S, Sungkanuparph S, Thanakitcharu S
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
J Med Assoc Thai. 2003 Jul;86(7):612-6.
Pneumocystis carinii pneumonia (PCP) can occur in immunocompromised patients without HIV infection. Risk factors, clinical features, treatment outcomes, and factors related to mortality in these patients may be useful clinical data for physicians who care for these patients.
A retrospective study of PCP patients without HIV infection at Ramathibodi Hospital, from 1994 to 2001, was conducted. Only cases with microbiological and/or pathological proven were included.
There were 19 patients with 42.1 per cent males and a mean age of 44.6 years. All patients had underlying immunocompromised diseases. 94.7 per cent of the cases received immunosuppressive drugs. PCP occurred at a mean duration of 26.4 months after the diagnosis and treatment of underlying diseases. Common clinical presentations of PCP were progressive dyspnea, fever, and non-productive cough. All patients had abnormal chest radiography with a majority of bilateral interstitial infiltration (63.2%). Diagnosis of PCP was confirmed with microbiological examination from bronchoalveolar larvage (84.2%) and pathological diagnosis from transbronchial biopsy (15.8%). Almost all of the cases (94.7%) were treated with co-trimoxazole. Ten patients (52.6%) had concomitant bacterial pneumonia or fungal pneumonitis. Overall mortality rate was 36.8 per cent. Mortality was significantly higher in patients who needed mechanical ventilation (p = 0.006). There was a trend toward a higher mortality rate in patients with concomitant pulmonary diseases (p = 0.09).
PCP may complicate a variety of immunocompromised states especially autoimmune diseases and hematologic malignancy. Patients who receive corticosteroids and/or cytotoxic drugs should receive primary PCP prophylaxis. The mortality rate is high especially in severe cases that need mechanical ventilation. Intensive care and close monitoring are needed for these patients.
卡氏肺孢子虫肺炎（PCP）可发生于未感染HIV的免疫功能低下患者。这些患者的危险因素、临床特征、治疗结果以及与死亡率相关的因素，对于照料这些患者的医生而言，可能是有用的临床资料。
对1994年至2001年在拉玛蒂博迪医院的非HIV感染的PCP患者进行了一项回顾性研究。仅纳入微生物学和/或病理学确诊的病例。
有19例患者，男性占42.1%，平均年龄为44.6岁。所有患者均有潜在的免疫功能低下疾病。94.7%的病例接受了免疫抑制药物治疗。PCP发生于基础疾病诊断和治疗后的平均26.4个月。PCP的常见临床表现为进行性呼吸困难、发热和干咳。所有患者胸部X线检查均异常，大多数为双侧间质性浸润（63.2%）。通过支气管肺泡灌洗的微生物学检查确诊PCP的占84.2%，经支气管活检的病理学诊断确诊的占15.8%。几乎所有病例（94.7%）均接受了复方新诺明治疗。10例患者（52.6%）合并细菌性肺炎或真菌性肺炎。总体死亡率为36.8%。需要机械通气的患者死亡率显著更高（p = 0.006）。合并肺部疾病的患者死亡率有升高趋势（p = 0.09）。
PCP可能使多种免疫功能低下状态复杂化，尤其是自身免疫性疾病和血液系统恶性肿瘤。接受皮质类固醇和/或细胞毒性药物治疗的患者应接受PCP原发性预防。死亡率很高，尤其是在需要机械通气的严重病例中。这些患者需要重症监护和密切监测。
