Blaas S
Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstraße 68, 93093, Donaustauf, Deutschland.
Z Rheumatol. 2017 Nov;76(9):761-766. doi: 10.1007/s00393-017-0390-5.
Pneumocystis jirovecii pneumonia plays an increasing role in patients with autoimmune disorders, due to more intensive immunosuppressive therapy. Humans seem to be the most important pathogen reservoir. Diseases are probably caused by airborne new infections. Cough, subfebrile temperature and dyspnea on exertion are the leading symptoms. In addition to imaging, in particular high-resolution computed tomography, pathogen detection by staining methods or molecular genetic methods plays the decisive role. Trimethoprim and sulfamethoxazole (TMP-SMX) is the most important medication for treatment. Adjuvant corticosteroid treatment is sometimes recommended, but evidence for benefits in patients with rheumatological disorders is not well documented. For patients on high-dose systemic corticosteroid treatment or intensive combined immunosuppression, primary prophylaxis is recommended by many experts. TMP-SMX remains the first-choice preventive treatment in these patients.
由于免疫抑制治疗强度增加，耶氏肺孢子菌肺炎在自身免疫性疾病患者中所起的作用越来越大。人类似乎是最重要的病原体储存宿主。疾病可能由空气传播的新感染引起。咳嗽、低热和劳力性呼吸困难是主要症状。除影像学检查，特别是高分辨率计算机断层扫描外，通过染色方法或分子遗传学方法进行病原体检测起着决定性作用。甲氧苄啶和磺胺甲恶唑（TMP-SMX）是最重要的治疗药物。有时推荐辅助性皮质类固醇治疗，但在风湿性疾病患者中获益的证据尚无充分记录。对于接受高剂量全身皮质类固醇治疗或强化联合免疫抑制治疗的患者，许多专家建议进行一级预防。TMP-SMX仍是这些患者的首选预防性治疗药物。
