Department of Paediatrics and Child Health, Steve Biko Academic Hospital, Pretoria, South Africa.
Pediatr Crit Care Med. 2012 Sep;13(5):516-9. doi: 10.1097/PCC.0b013e31824ea143.
Acute severe pneumonia with respiratory failure in human immunodeficiency virus-infected and -exposed infants carries a high mortality. Pneumocystis jiroveci is one cause, but other organisms have been suggested to play a role. Our objective is to describe the coinfections and treatment strategies in a cohort of human immunodeficiency virus-infected and -exposed infants with respiratory failure and acute respiratory distress syndrome, in an attempt to improve survival.
Prospective intervention study.
Steve Biko Academic Hospital, Pretoria, South Africa.
Human immunodeficiency virus-exposed infants with respiratory failure and acute respiratory distress syndrome were recruited into the study.
All infants were treated with routine therapy for Pneumocystis jiroveci and bacterial coinfection. However, in addition, all infants received ganciclovir from admission until the cytomegalovirus viral load result was demonstrated to be <log 4.
Routine investigations included human immunodeficiency virus polymerase chain reaction, cytomegalovirus viral load, blood culture, C-reactive protein, and white cell count. Tracheal aspirates for Pneumocystis jiroveci detection, bacterial culture, tuberculosis culture, and viral identification were performed.
Sixty-three patients met the recruitment criteria. The mortality rate was 30%. Pneumocystis jiroveci was positive in 33% of infants, while 38% had cytomegalovirus viral load ≥log 4. Only 7.9% of infants had a positive tuberculosis culture. Nineteen deaths occurred, 13 of which had a cytomegalovirus viral load ≥log 4. Bacterial coinfection and CD4 count were not predictors of mortality.
A case fatality rate of 30% is achievable if severe pneumonia with respiratory failure and acute respiratory distress syndrome is managed with a combination of antibiotics and ventilation strategies. Cytomegalovirus infection appears to be associated with an increased risk of death in this syndrome. This may, however, be a marker of as yet undefined pathology.
人类免疫缺陷病毒（HIV）感染和暴露的婴儿发生急性重症肺炎合并呼吸衰竭，死亡率较高。卡氏肺孢子虫是一个病因，但也有其他病原体被认为起作用。我们的目的是描述呼吸衰竭和急性呼吸窘迫综合征的 HIV 感染和暴露婴儿的合并感染和治疗策略，以提高生存率。
前瞻性干预研究。
南非比勒陀利亚史蒂夫·比科学术医院。
呼吸衰竭和急性呼吸窘迫综合征的 HIV 暴露婴儿被纳入研究。
所有婴儿均接受卡氏肺孢子虫和细菌合并感染的常规治疗。然而，除此之外，所有婴儿在入院后至巨细胞病毒病毒载量结果显示<log4 时，均接受更昔洛韦治疗。
常规检查包括 HIV 聚合酶链反应、巨细胞病毒病毒载量、血培养、C 反应蛋白和白细胞计数。进行了卡氏肺孢子虫检测、细菌培养、结核培养和病毒鉴定的气管抽吸。
63 名患者符合纳入标准。死亡率为 30%。33%的婴儿卡氏肺孢子虫阳性，38%的婴儿巨细胞病毒病毒载量≥log4。只有 7.9%的婴儿结核培养阳性。19 例死亡，其中 13 例巨细胞病毒病毒载量≥log4。细菌合并感染和 CD4 计数不是死亡的预测因素。
如果严重肺炎合并呼吸衰竭和急性呼吸窘迫综合征采用抗生素和通气策略联合治疗，可实现 30%的病死率。在这种综合征中，巨细胞病毒感染似乎与死亡风险增加相关。然而，这可能是尚未明确的病理的标志物。
