Fujii Takeshi, Nakamura Tetsuya, Iwamoto Aikichi
Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Tokyo 108-8639, Japan.
J Infect Chemother. 2007 Feb;13(1):1-7. doi: 10.1007/s10156-006-0484-5. Epub 2007 Feb 26.
Pneumocystis pneumonia (PCP) remains the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). Familiarity with the clinical features of PCP is crucial for prompt diagnosis, even if the patient is unaware of their HIV serostatus. We describe herein the clinical features of 34 episodes in 32 patients with AIDS-associated PCP and review the existing literature. As for symptoms, the frequency of fever, cough, and dyspnea was 74%, 74%, and 65%, respectively, and the complete triad was present in only 14 of the 34 episodes on first examination. Median duration from onset of symptoms until diagnosis was 3 weeks, and AIDS-associated PCP tended to take an insidious clinical course. Although laboratory findings were generally nonspecific, measurement of beta-D-glucan levels in the serum or plasma was highly useful in the diagnosis of PCP. All but 1 of the patients showed beta-D-glucan levels higher than the cutoff value (median, 147 pg/ml; range, 5-6920 pg/ml). Typical radiographic features of PCP are bilateral, symmetrical ground-glass opacities, but a wide variety of radiographic findings were observed. In our patients, high-resolution computed tomography (HRCT) of the lung showed ground-glass opacities sparing the lung periphery (41% of episodes) or displaying a mosaic pattern (29%), or being nearly homogeneous (24%), ground-glass opacities associated with air-space consolidation (21%), associated with cystic formation (21%), associated with linear-reticular opacities (18%), patchily and irregularly distributed (15%), associated with solitary or multiple nodules (9%), and associated with parenchymal cavity lesions (6%).
肺孢子菌肺炎（PCP）仍然是获得性免疫缺陷综合征（AIDS）患者中最常见的机会性感染。即使患者不知道自己的HIV血清学状态，熟悉PCP的临床特征对于及时诊断至关重要。我们在此描述32例AIDS相关PCP患者的34次发作的临床特征，并回顾现有文献。至于症状，发热、咳嗽和呼吸困难的发生率分别为74%、74%和65%，在首次检查的34次发作中，仅14次出现完整的三联征。从症状出现到诊断的中位持续时间为3周，AIDS相关PCP往往呈现隐匿的临床病程。虽然实验室检查结果通常不具有特异性，但血清或血浆中β-D-葡聚糖水平的测定对PCP的诊断非常有用。除1例患者外，所有患者的β-D-葡聚糖水平均高于临界值（中位值，147 pg/ml；范围，5-6920 pg/ml）。PCP的典型影像学特征是双侧对称的磨玻璃影，但观察到多种影像学表现。在我们的患者中，肺部高分辨率计算机断层扫描（HRCT）显示磨玻璃影不累及肺周边（41%的发作）或呈现马赛克样（29%），或几乎均匀分布（24%），磨玻璃影伴有实变（21%），伴有囊性形成（21%），伴有线状网状影（18%），斑片状和不规则分布（15%），伴有孤立或多发结节（9%），以及伴有实质空洞病变（6%）。
