Tasaka Sadatomo
Division of Pulmonary Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Clin Med Insights Circ Respir Pulm Med. 2015 Aug 12;9(Suppl 1):19-28. doi: 10.4137/CCRPM.S23324. eCollection 2015.
Pneumocystis jirovecii pneumonia (PCP) is one of the most common opportunistic infections in human immunodeficiency virus-infected adults. Colonization of Pneumocystis is highly prevalent among the general population and could be associated with the transmission and development of PCP in immunocompromised individuals. Although the microscopic demonstration of the organisms in respiratory specimens is still the golden standard of its diagnosis, polymerase chain reaction has been shown to have a high sensitivity, detecting Pneumocystis DNA in induced sputum or oropharyngeal wash. Serum β-D-glucan is useful as an adjunctive tool for the diagnosis of PCP. High-resolution computed tomography, which typically shows diffuse ground-glass opacities, is informative for the evaluation of immunocompromised patients with suspected PCP and normal chest radiography. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for the treatment of mild to severe PCP, although it is often complicated with various side effects. Since TMP-SMX is widely used for the prophylaxis, the putative drug resistance is an emerging concern.
耶氏肺孢子菌肺炎（PCP）是人类免疫缺陷病毒感染成人中最常见的机会性感染之一。肺孢子菌在普通人群中的定植非常普遍，可能与免疫功能低下个体中PCP的传播和发展有关。尽管在呼吸道标本中显微镜下显示病原体仍然是其诊断的金标准，但聚合酶链反应已显示出高灵敏度，可在诱导痰或口咽冲洗液中检测到肺孢子菌DNA。血清β-D-葡聚糖可用作PCP诊断的辅助工具。高分辨率计算机断层扫描通常显示弥漫性磨玻璃样阴影，对于评估疑似PCP且胸部X线摄影正常的免疫功能低下患者具有参考价值。甲氧苄啶-磺胺甲恶唑（TMP-SMX）是治疗轻至重度PCP的一线药物，尽管它常伴有各种副作用。由于TMP-SMX被广泛用于预防，其潜在的耐药性是一个新出现的问题。
