Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; Department of Hematology and Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan.
J Infect Chemother. 2019 Nov;25(11):920-924. doi: 10.1016/j.jiac.2019.06.007. Epub 2019 Jul 9.
The clinical characteristics of Pneumocystis jirovecii pneumonia (PCP) in patients with immunodeficiency virus (HIV) infection (HIV-PCP) differ from those in patients without HIV infection (non-HIV-PCP). We analyzed 31 adult HIV-PCP cases and 44 non-HIV-PCP cases between 2008 and 2018. The symptomatic period before the diagnosis was shorter in non-HIV-PCP (5 [3-8] days vs. 29 [14-55] days, P < 0.001) and the overall survival rate was lower in the non-HIV-PCP group (P = 0.022). Serum β-D glucan positivity (72.7% vs. 93.5%, P = 0.034) and Grocott stain positivity for Pneumocystis jirovecii in the bronchoalveolar lavage fluid (4.3% vs. 73.3%, P < 0.001) were significantly lower in the non-HIV-PCP group. This difficulty in laboratory diagnosis possibly resulted in the administration of concurrent antibiotics such as quinolones and macrolides (56.8% vs. 19.4% P = 0.002) in the non-HIV-PCP group. The adverse effects due to trimethoprim-sulfamethoxazole were more frequently observed in HIV-PCP (86.2% vs. 35.3%, P < 0.001). The duration of discontinuation of trimethoprim-sulfamethoxazole was 11 [8-14.5] days in HIV-PCP cases. Co-administration of adjunctive corticosteroid therapy did not mitigate hypersensitivity to trimethoprim-sulfamethoxazole. Our analysis indicated that the characteristics of PCP in patients with or without HIV was quite different. HIV-positive patients with PCP should be monitored closely to avoid adverse effects due to trimethoprim-sulfamethoxazole. Because positivity polymerase chain reaction test for P. jirovecii remained high (91.7%), it is suggested that bronchofiberscopy is warranted for diagnosis of PCP in HIV-negative patients.
卡氏肺孢子菌肺炎（PCP）在人类免疫缺陷病毒（HIV）感染患者（HIV-PCP）中的临床特征与在无 HIV 感染患者（非 HIV-PCP）中的不同。我们分析了 2008 年至 2018 年间 31 例成人 HIV-PCP 病例和 44 例非 HIV-PCP 病例。非 HIV-PCP 患者的症状前潜伏期更短（5[3-8]天 vs. 29[14-55]天，P<0.001），非 HIV-PCP 组的总体生存率更低（P=0.022）。血清β-D 葡聚糖阳性率（72.7% vs. 93.5%，P=0.034）和支气管肺泡灌洗液中卡氏肺孢子菌的改良 Gomori 银染色阳性率（4.3% vs. 73.3%，P<0.001）在非 HIV-PCP 组中显著降低。非 HIV-PCP 组中，由于难以进行实验室诊断，可能导致同时使用了喹诺酮类和大环内酯类抗生素（56.8% vs. 19.4%，P=0.002）。HIV-PCP 中更频繁地观察到由于使用复方磺胺甲噁唑而引起的不良反应（86.2% vs. 35.3%，P<0.001）。HIV-PCP 患者停用复方磺胺甲噁唑的时间为 11[8-14.5]天。辅助皮质类固醇治疗的联合应用并未减轻对复方磺胺甲噁唑的过敏反应。我们的分析表明，HIV 阳性和 HIV 阴性患者的 PCP 特征差异很大。HIV 阳性 PCP 患者应密切监测，以避免因复方磺胺甲噁唑引起的不良反应。由于卡氏肺孢子菌聚合酶链反应检测阳性率仍然很高（91.7%），建议对 HIV 阴性患者进行支气管纤维镜检查以诊断 PCP。
