Kaur Ravinder, Katariya Priyanka, Dhakad Megh Singh, Mehra Bhanu, Jhamb Urmila, Dubey A P
Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India.
Department of Microbiology, Maulana Azad Medical College and Associated Lok Nayak Hospitals, New Delhi 110002, India.
Case Rep Infect Dis. 2016;2016:9206707. doi: 10.1155/2016/9206707. Epub 2016 Dec 13.
pneumonia (PJP) is one of the major infections in patients with impaired immunity. The entity is common in HIV-seropositive individuals but quite very rare in HIV-seronegative individuals especially children. We report here a case of 16-week-old HIV-seronegative infant with chief complaint of chronic cough of one month of evolution. Sweat chloride test for diagnosis of cystic fibrosis was positive. Bronchoalveolar lavage (BAL) fluid was collected and was isolated on culture. Empirical antibiotic regimen comprising ceftriaxone and azithromycin was initiated that was switched to meropenem as per antimicrobial susceptibility report, but the patient did not improve. Subsequently, an immunofluorescence staining of BAL fluid was performed and cysts were detected. Following a laboratory confirmation of pneumonia, cotrimoxazole was added and the clinical condition of the patient significantly improved. This is an unusual case wherein unsuspected PJP occurred and since signs and symptoms of the patient persisted even after the initiation of antimicrobial therapy for infection and resolved only after treatment for PJP was started, it suggests a causative role of rather than colonization/contamination.
肺孢子菌肺炎（PJP）是免疫功能受损患者的主要感染之一。该疾病在HIV血清阳性个体中很常见，但在HIV血清阴性个体尤其是儿童中非常罕见。我们在此报告一例16周大的HIV血清阴性婴儿，主要症状为持续一个月的慢性咳嗽。诊断囊性纤维化的汗液氯化物试验呈阳性。收集支气管肺泡灌洗（BAL）液并进行培养分离。开始使用包括头孢曲松和阿奇霉素的经验性抗生素治疗方案，根据抗菌药敏报告改为美罗培南，但患者病情未改善。随后，对BAL液进行免疫荧光染色，检测到囊肿。实验室确诊为肺孢子菌肺炎后，加用复方新诺明，患者临床状况明显改善。这是一例罕见病例，未被怀疑的肺孢子菌肺炎发生，且患者的症状和体征在开始针对感染的抗菌治疗后仍持续存在，仅在开始治疗肺孢子菌肺炎后才得以缓解，这表明肺孢子菌肺炎起致病作用而非定植/污染。
