Ziefer A, Abramowitz J A
Department of Tropical Diseases, School of Pathology, South African Institute for Medical Research, Johannesburg.
S Afr Med J. 1989 Oct 7;76(7):308-13.
Pulmonary histopathological and clinical changes associated with Pneumocystis carinii pneumonia (PCP) were found to be less severe in 10 HIV-positive patients (group A) with acquired immunodeficiency syndrome (AIDS) than in 8 patients (group B) with other immune deficiencies. Lung biopsies from group A showed minimal thickening of the alveolar walls from oedema and slight mononuclear cell infiltration, while in group B alveolar wall thickening was more prominent with distinct mononuclear cell infiltration and evidence of diffuse alveolar damage and interstitial fibrosis. Infection with P. carinii cysts was heavy in 60%, moderate in 30% and mild in 10% in group A patients v. heavy in 0%, moderate in 14% and mild in 86% in group B patients. These findings appear to suggest that AIDS/PCP presents with a heavy parasite load but only minimal histopathological changes that are reversible and that atypical change as observed in PCP in other immune deficiencies are caused by previous or concomitant insults other than pneumocystosis. Milder propagation of P. carinii in HIV-negative patients may be because there is a lack of undamaged type I pneumocytes to which trophozoites probably need to be attached at a certain developmental stage.
研究发现，10例患有获得性免疫缺陷综合征（AIDS）的HIV阳性患者（A组）与肺孢子菌肺炎（PCP）相关的肺部组织病理学和临床变化，比8例患有其他免疫缺陷的患者（B组）要轻。A组的肺活检显示，肺泡壁因水肿而仅有轻微增厚，并有轻微的单核细胞浸润，而B组的肺泡壁增厚更为明显，有明显的单核细胞浸润以及弥漫性肺泡损伤和间质纤维化的迹象。A组患者中，60%的卡氏肺孢子虫囊肿感染严重，30%为中度感染，10%为轻度感染；而B组患者中，严重感染的比例为0%，中度感染为14%，轻度感染为86%。这些发现似乎表明，AIDS/PCP患者体内寄生虫负荷很重，但组织病理学变化却很轻微且可逆，而在其他免疫缺陷患者的PCP中观察到的非典型变化是由除肺孢子虫病之外的先前或伴随损伤引起的。卡氏肺孢子虫在HIV阴性患者中传播较轻，可能是因为缺乏未受损的I型肺泡上皮细胞，而滋养体在某个发育阶段可能需要附着于这些细胞。
