Department of Paediatrics, Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.
Pediatr Infect Dis J. 2011 Jan;30(1):33-8. doi: 10.1097/INF.0b013e3181fcabe4.
HIV infection is a major risk factor for death in childhood pneumonia in HIV-endemic regions. Improved case management and preventive strategies require better understanding of the impact of HIV on causes, clinical presentation, and outcome.
A prospective, clinical descriptive study of Malawian infants and children with severe pneumonia included blood culture and nasopharyngeal aspiration for diagnosis of pneumocystis pneumonia (PcP). A select group with consolidation on chest radiograph, and without severe hypoxia or hyperinflation, also had lung aspirate taken for culture and identification of bacterial deoxyribonucleic acid by real-time polymerase chain reaction (PCR).
There were 327 study patients with a median age of 11 months (range, 2 months-14 years). HIV prevalence was 51%. There were 58 cases of confirmed bacterial pneumonia, of which the most common bacterial isolates were Streptococcus pneumoniae and Salmonella typhimurium. Of the 54 lung aspirates, only 2 were positive on culture but 27 were positive for bacterial deoxyribonucleic acid by PCR. PcP was confirmed in 16 patients, and was associated with young age, severe hypoxia, HIV infection, and a very poor outcome. The overall case-fatality rate was 10% despite presumptive therapy for PcP and routine broad-spectrum antibiotic treatment appropriate for local antimicrobial susceptibility data. Most of the deaths occurred in infants of 2 to 6 months of age and PcP was associated with 57% of these deaths.
PcP is a major barrier in reducing the case-fatality rate of severe pneumonia in infants of HIV-endemic communities. The use of PCR on lung aspirate specimens greatly increased the diagnostic yield.
在艾滋病毒流行地区，艾滋病毒感染是儿童肺炎死亡的一个主要危险因素。为了改进病例管理和预防战略，需要更好地了解艾滋病毒对病因、临床表现和结果的影响。
对马拉维患有严重肺炎的婴儿和儿童进行了一项前瞻性临床描述性研究，包括血培养和鼻咽抽吸以诊断卡氏肺孢子虫肺炎（PcP）。对胸部 X 线片有实变且无严重低氧血症或过度充气的选定组患者，还进行了肺抽吸物培养和实时聚合酶链反应（PCR）鉴定细菌脱氧核糖核酸。
共有 327 名研究患者，中位年龄为 11 个月（范围为 2 个月至 14 岁）。艾滋病毒流行率为 51%。有 58 例确诊细菌性肺炎，最常见的细菌分离株为肺炎链球菌和鼠伤寒沙门氏菌。54 份肺抽吸物中，只有 2 份培养阳性，但 27 份 PCR 检测细菌脱氧核糖核酸阳性。16 例患者确诊为卡氏肺孢子虫病，与年龄较小、严重低氧血症、艾滋病毒感染和预后极差有关。尽管对卡氏肺孢子虫病进行了经验性治疗，并且根据当地抗菌药物敏感性数据常规使用了广谱抗生素治疗，但总的病死率仍为 10%。大多数死亡发生在 2 至 6 个月大的婴儿中，卡氏肺孢子虫病与其中 57%的死亡有关。
卡氏肺孢子虫病是降低艾滋病毒流行社区严重肺炎病死率的一个主要障碍。对肺抽吸物标本进行 PCR 检测大大提高了诊断率。
