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肺炎:人类免疫缺陷病毒(HIV)及非HIV免疫功能低下患者的管理综述

Pneumonia: A Review of Management in Human Immunodeficiency Virus (HIV) and Non-HIV Immunocompromised Patients.

作者信息

Ibrahim Atif, Chattaraj Asmi, Iqbal Qamar, Anjum Ali, Rehman Mohammad Ebad Ur, Aijaz Zobia, Nasir Fazila, Ansar Sadia, Zangeneh Tirdad T, Iftikhar Ahmad

机构信息

North Mississippi Medical Center, Tupelo, Mississippi, United States.

University of Pittsburgh Medical Center, McKeesport, Pennsylvania, United States.

出版信息

Avicenna J Med. 2023 Mar 24;13(1):23-34. doi: 10.1055/s-0043-1764375. eCollection 2023 Jan.

Abstract

pneumonia is an opportunistic fungal infection that was mainly associated with pneumonia in patients with advanced human immunodeficiency virus (HIV) disease. There has been a decline in pneumonia incidence in HIV since the introduction of antiretroviral medications. However, its incidence is increasing in non-HIV immunocompromised patients including those with solid organ transplantation, hematopoietic stem cell transplantation, solid organ tumors, autoimmune deficiencies, and primary immunodeficiency disorders. We aim to review and summarize the etiology, epidemiology, clinical presentation, diagnosis, and management of pneumonia in HIV, and non-HIV patients. HIV patients usually have mild-to-severe symptoms, while non-HIV patients present with a rapidly progressing disease. Induced sputum or bronchoalveolar lavage fluid can be used to make a definitive diagnosis of pneumonia. Trimethoprim-sulfamethoxazole is considered to be the first-line drug for treatment and has proven to be highly effective for pneumonia prophylaxis in both HIV and non-HIV patients. Pentamidine, atovaquone, clindamycin, and primaquine are used as second-line agents. While several diagnostic tests, treatments, and prophylactic regimes are available at our disposal, there is need for more research to prevent and manage this disease more effectively.

摘要

肺炎是一种机会性真菌感染,主要与晚期人类免疫缺陷病毒(HIV)病患者的肺炎相关。自从引入抗逆转录病毒药物以来,HIV患者中肺炎的发病率有所下降。然而,在非HIV免疫功能低下的患者中,包括实体器官移植、造血干细胞移植、实体器官肿瘤、自身免疫缺陷和原发性免疫缺陷疾病患者,其发病率正在上升。我们旨在综述和总结HIV患者和非HIV患者肺炎的病因、流行病学、临床表现、诊断和管理。HIV患者通常有轻至重度症状,而非HIV患者则表现为病情迅速进展。诱导痰或支气管肺泡灌洗液可用于明确诊断肺炎。甲氧苄啶-磺胺甲恶唑被认为是治疗的一线药物,并且已被证明对HIV和非HIV患者的肺炎预防都非常有效。喷他脒、阿托伐醌、克林霉素和伯氨喹用作二线药物。虽然我们有几种诊断测试、治疗方法和预防方案可供使用,但仍需要更多研究以更有效地预防和管理这种疾病。

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