Powierska-Czarny Jolanta, Gospodarek Eugenia, Czerwionka-Szaflarska Mieczysława
Zakład Mikrobiologii AM w Bydgoszczy.
Pol Merkur Lekarski. 2004 Nov;17(101):534-7.
Pneumocystis carinii is an opportunistic eukaryotic pathogen most common causing pneumonia in immunocompromised host. DNA P. carinii f. sp. hominis has been frequently detected in air samples collected from environments of P. carinii pneumonia (PCP) patients and nasal swabs samples from contact health care workers and family. Epidemiological studies suggested not-only the possibility of person-to-person infection transmission. First hypothesis of reactivation latent infection of the causing the new episode of PCP based on serological studies. Recently findings based molecular studies has suggested new acquired infection may to be cause of many cases of PCP. Early diagnosis, therapy and effective prophylaxis of PCP is a very important strategy to reduce morbidity and mortality among infected patients. The combination of trimethoprim (TMP) and sulfamethoxazole (SMX) is effective for prophylaxis and treatment P. carinii pneumonia. Empiric therapy in immunocompromised host also including AIDS patients with anti-Pneumocystis prophylaxis is also not recommended. Both dapsone and sulfamethoxazole act inhibiting the folate biosynthetic enzyme DHPS. Mutations identified in P. carinii in gene coding this enzyme are associated with resistance to sulfonamide. P. carinii may also developing resistance to atovaquone, second-line therapeutic and prophylactic agent.
卡氏肺孢子菌是一种机会性真核病原体，最常见于免疫功能低下的宿主中引起肺炎。在从卡氏肺孢子菌肺炎（PCP）患者环境中采集的空气样本以及接触医护人员和家属的鼻拭子样本中，经常检测到卡氏肺孢子菌人型变种的DNA。流行病学研究不仅表明了人传人感染传播的可能性。基于血清学研究，首次提出了潜伏感染再激活导致PCP新发病例的假说。最近基于分子研究的发现表明，新获得的感染可能是许多PCP病例的病因。早期诊断、治疗和有效预防PCP是降低感染患者发病率和死亡率的非常重要的策略。甲氧苄啶（TMP）和磺胺甲恶唑（SMX）联合使用对预防和治疗卡氏肺孢子菌肺炎有效。不建议对免疫功能低下的宿主进行经验性治疗，包括对艾滋病患者进行抗肺孢子菌预防。氨苯砜和磺胺甲恶唑均通过抑制叶酸生物合成酶二氢蝶酸合酶（DHPS）起作用。在编码该酶的卡氏肺孢子菌基因中鉴定出的突变与对磺胺类药物的耐药性有关。卡氏肺孢子菌也可能对二线治疗和预防药物阿托伐醌产生耐药性。
