Wang Jing, Wright Terry W, Gigliotti Francis
Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 850, Rochester, NY 14642, USA.
Interdiscip Perspect Infect Dis. 2011;2011:918038. doi: 10.1155/2011/918038. Epub 2011 Aug 29.
Pneumocystis is an opportunistic fungal respiratory pathogen that causes life-threatening pneumonia (Pcp) in patients suffering from defects in cell-mediated immunity, including those with acquired immunodeficiency syndrome (AIDS) and immunosuppression secondary to chemotherapy or organ transplantation. Despite major advances in health care, the mortality associated with Pcp has changed little over the past 25 years. Pcp remains a leading cause of death among HIV infected patients, with mortality rates of 50% or higher for patients developing severe Pcp. In addition, as more potent immunosuppressive therapies are developed for chronic inflammatory diseases, more cases of Pcp are occurring in non-HIV patients and in previously unreported clinical settings. These features highlight the importance of developing a better understanding of the pathogenesis of this disease, and the need to search for new therapeutic strategies to improve the outcome of Pcp patients. Immune-mediated inflammatory responses play an important role in the pathogenesis of Pcp, and may be even more significant in determining the outcome of Pcp than direct damage due to the organism itself. In this review we will summarize the immunopathogenic mechanisms that contribute to Pcp-associated lung injury, and discuss the potential to target these pathways for adjunctive immune modulation therapy for Pcp.
肺孢子菌是一种机会性真菌呼吸道病原体，可在细胞介导免疫存在缺陷的患者中引起危及生命的肺炎（肺孢子菌肺炎），这些患者包括获得性免疫缺陷综合征（艾滋病）患者以及化疗或器官移植继发免疫抑制的患者。尽管医疗保健取得了重大进展，但在过去25年里，与肺孢子菌肺炎相关的死亡率几乎没有变化。肺孢子菌肺炎仍然是艾滋病毒感染患者的主要死因，严重肺孢子菌肺炎患者的死亡率达到50%或更高。此外，随着针对慢性炎症性疾病的更有效的免疫抑制疗法的开发，非艾滋病毒患者和以前未报告的临床环境中出现了更多肺孢子菌肺炎病例。这些特征凸显了更好地了解这种疾病发病机制的重要性，以及寻找新的治疗策略以改善肺孢子菌肺炎患者预后的必要性。免疫介导的炎症反应在肺孢子菌肺炎的发病机制中起重要作用，在决定肺孢子菌肺炎的预后方面可能比病原体本身造成的直接损害更为显著。在本综述中，我们将总结导致肺孢子菌肺炎相关肺损伤的免疫致病机制，并讨论针对这些途径进行肺孢子菌肺炎辅助免疫调节治疗所具有的潜力。
