Oladele Rita O, Otu Akaninyene A, Richardson Malcolm D, Denning David W
J Health Care Poor Underserved. 2018;29(1):107-158. doi: 10.1353/hpu.2018.0010.
Globally, Pneumocystis pneumonia (PCP) remains a common and lethal infection in both HIV-positive and HIV-negative patients, particularly in developing countries where rates of PCP increases with rising GDP. Pneumocystis jirovecii cannot be cultured in routine clinical laboratories; thus diagnosis relies on microscopy, histology, serology and/or polymerase chain reaction (PCR) of the Pneumocystis DNA. Most of these methods are expensive and require training. Accessing lower respiratory tract specimens in young children is often challenging and only PCR testing of nasopharyngeal aspirates is useful. Early treatment with high-dose co-trimoxazole is effective therapy; however, adverse reactions are common along with reports of emerging resistance. Improved outcomes are associated with adding corticosteroid to treatment in those with moderate/severe PCP, although this has not been studied in resource-poor settings. This review compares the available diagnostic techniques in relation to their suitability for use in resource-poor settings. We also addressed the non-availability of the alternative medications in these regions.
在全球范围内，肺孢子菌肺炎（PCP）在HIV阳性和HIV阴性患者中仍然是一种常见且致命的感染，尤其是在发展中国家，PCP的发病率随着GDP的增长而上升。耶氏肺孢子菌无法在常规临床实验室中培养；因此，诊断依赖于肺孢子菌DNA的显微镜检查、组织学检查、血清学检查和/或聚合酶链反应（PCR）。这些方法大多成本高昂且需要培训。获取幼儿的下呼吸道标本往往具有挑战性，只有对鼻咽抽吸物进行PCR检测才有用。早期使用高剂量复方新诺明治疗是有效的；然而，不良反应很常见，同时也有出现耐药性的报道。在中重度PCP患者中，在治疗中添加皮质类固醇与改善预后相关，尽管在资源匮乏地区尚未对此进行研究。本综述比较了现有诊断技术在资源匮乏地区的适用性。我们还讨论了这些地区替代药物的不可用性。
