Takei Haruka, Ishiwada Naruhiko, Hishiki Haruka, Takeshita Kenichi, Naito Sachiko, Endo Mamiko, Shimojo Naoki
Department of Pediatrics, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo ku, Chiba City, Chiba, 260-8677, Japan.
Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, 1-8-1 Inohana Chuo ku, Chiba City, Chiba, 260-8677, Japan.
J Infect Chemother. 2019 Jun;25(6):477-479. doi: 10.1016/j.jiac.2019.01.016. Epub 2019 Feb 21.
Detecting Pneumocystis jirovecii by bronchoalveolar lavage or lung biopsy is the gold standard for diagnosis of P. jirovecii pneumonia (PJP); however, these techniques are not always applicable in children because of their high invasiveness. We report two pediatric cases of PJP diagnosed by polymerase chain reaction (PCR) of gastric lavage that were successfully treated. To date, there are no reported cases of using PCR of gastric lavage to diagnose PJP. On the day of PJP onset, both the infants required respiratory support and infiltrative shadows were observed in both lung fields on chest radiography. Furthermore, their (1 → 3)-β-D glucan levels were elevated. P. jirovecii was detected by PCR of gastric lavage and trimethoprim-sulfamethoxazole was administered for 3 weeks, following which their condition improved. They were long-term steroid users, but without any prophylaxis. PCR of gastric lavage in cases of suspected PJP may help in confirming the diagnosis in children who have mild to moderate airway symptoms, or have difficulty with invasive examination like bronchoscopy.
通过支气管肺泡灌洗或肺活检检测耶氏肺孢子菌是诊断耶氏肺孢子菌肺炎（PJP）的金标准；然而，由于其高侵入性，这些技术在儿童中并不总是适用。我们报告了两例通过胃灌洗聚合酶链反应（PCR）诊断为PJP的儿科病例，并成功治愈。迄今为止，尚无使用胃灌洗PCR诊断PJP的报道。在PJP发病当天，两名婴儿均需要呼吸支持，胸部X线检查显示双肺野有浸润影。此外，他们的（1→3）-β-D葡聚糖水平升高。通过胃灌洗PCR检测到耶氏肺孢子菌，并给予甲氧苄啶-磺胺甲恶唑治疗3周，随后病情好转。他们长期使用类固醇，但未进行任何预防。对于疑似PJP的病例，胃灌洗PCR可能有助于确诊那些有轻度至中度气道症状或难以进行支气管镜等侵入性检查的儿童。
