Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Pharmacy, Alberta Health Services, Edmonton, Alberta, Canada.
Expert Opin Pharmacother. 2021 Aug;22(12):1579-1592. doi: 10.1080/14656566.2021.1915989. Epub 2021 Apr 19.
: (PJ) is an opportunistic fungal pathogen that can cause severe pneumonia in immunocompromised hosts. Risk factors for pneumonia (PJP) include HIV, organ transplant, malignancy, certain inflammatory or rheumatologic conditions, and associated therapies and conditions that result in cell-mediated immune deficiency. Clinical signs of PJP are nonspecific and definitive diagnosis requires direct detection of the organism in lower respiratory secretions or tissue. First-line therapy for prophylaxis and treatment remains trimethoprim-sulfamethoxazole (TMP-SMX), though intolerance or allergy, and rarely treatment failure, may necessitate alternate therapeutics, such as dapsone, pentamidine, atovaquone, clindamycin, primaquine and most recently, echinocandins as adjunctive therapy. In people living with HIV (PLWH), adjunctive corticosteroid use in treatment has shown a mortality benefit.: This review article covers the epidemiology, pathophysiology, diagnosis, microbiology, prophylaxis indications, prophylactic therapies, and treatments.: TMP-SMX has been first-line therapy for treating and preventing pneumocystis for decades. However, its adverse effects are not uncommon, particularly during treatment. Second-line therapies may be better tolerated, but often sacrifice efficacy. Echinocandins show some promise for new combination therapies; however, further studies are needed to define optimal antimicrobial therapy for PJP as well as the role of corticosteroids in those without HIV.
（PJ）是一种机会性真菌病原体，可导致免疫功能低下宿主发生严重肺炎。肺炎（PJP）的危险因素包括 HIV、器官移植、恶性肿瘤、某些炎症或风湿性疾病，以及导致细胞介导免疫缺陷的相关治疗和情况。PJP 的临床症状是非特异性的，明确诊断需要直接在下呼吸道分泌物或组织中检测到该病原体。预防和治疗的一线治疗仍然是复方磺胺甲噁唑（TMP-SMX），尽管不耐受或过敏，以及罕见的治疗失败，可能需要替代治疗，如氨苯砜、喷他脒、阿托伐醌、克林霉素、伯氨喹，最近还有棘白菌素类药物作为辅助治疗。在 HIV 感染者（PLWH）中，辅助使用皮质类固醇治疗已显示出死亡率的益处。
这篇综述文章涵盖了肺炎球菌的流行病学、病理生理学、诊断、微生物学、预防指征、预防治疗和治疗。TMP-SMX 作为治疗和预防肺孢子菌的一线治疗方法已有数十年的历史。然而，其不良反应并不少见，特别是在治疗期间。二线治疗可能更容易耐受，但往往牺牲疗效。棘白菌素类药物在新的联合治疗中显示出一定的前景；然而，仍需要进一步的研究来确定 PJP 的最佳抗菌治疗方案，以及皮质类固醇在无 HIV 患者中的作用。
