Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Cell Infect Microbiol. 2023 Mar 16;13:1132472. doi: 10.3389/fcimb.2023.1132472. eCollection 2023.
(PJ) is an opportunistic pathogenic fungus, and PJ pneumonia (PJP) is a commonly problem in HIV-positive patients. While PJP is not caused by HIV, it generally advances rapidly and can quickly lead to severe respiratory failure. To improve pediatricians' understanding of the condition and aid early accurate diagnoses and therapy, we examined the clinical characteristics of five instances of non-HIV related PJP (NH-PJP) in children and the efficacy of metagenomic next-generation sequencing (mNGS) in its diagnosis.
From January 2020 to June 2022, five children with NH-PJP were admitted to the PICU of the First Affiliated Hospital of Zhengzhou University. We retrospectively summarize the clinical presentation, previous histories, routine laboratory findings, treatment, outcome of regression, and results of mNGS in these five children.
Five male children between the ages of 11 months and 14 years had an acute onset on NH-PJP, three of the children had chest tightness after activity, shortness of breath and paroxysmal dry cough, - and two had high fever and dry cough. All five of the children had several flocculent high-density pictures in both lungs at the beginning of the disease, and lung auscultation revealed coarse breath sounds in both lungs, one of which was accompanied by a modest quantity of dry rales. PJ nuclear sequences were found in one patient and four patients' blood and alveolar lavage fluid. All five children were treated with Trimethoprim-sulfamethoxazole (TMP-SMX) in combination with Caspofungin and corresponding symptomatic treatment. Four patients were cured and one patient died.
Children commonly encounter an initial exposure to NH-PJP, which manifests as a high fever, dry cough, chest discomfort, dyspnea that worsens over time, fast disease progression, and a high death rate. The clinical presentation of children with PJ infection should be taken into consideration along with the results for diagnose. mNGS has higher sensitivity and a shorter detection period compared to identification of PJP.
（PJ）是一种机会性致病真菌，PJ 肺炎（PJP）是 HIV 阳性患者常见的问题。虽然 PJP 不是由 HIV 引起的，但它通常进展迅速，可迅速导致严重的呼吸衰竭。为了提高儿科医生对该病的认识，并帮助早期进行准确的诊断和治疗，我们研究了五例非 HIV 相关 PJP（NH-PJP）患儿的临床特征，以及宏基因组下一代测序（mNGS）在其诊断中的作用。
2020 年 1 月至 2022 年 6 月，5 例 NH-PJP 患儿入住郑州大学第一附属医院 PICU。我们回顾性总结了这 5 例患儿的临床表现、既往病史、常规实验室检查结果、治疗、病情缓解情况以及 mNGS 结果。
5 例男性患儿年龄 11 个月至 14 岁，NH-PJP 急性起病，3 例活动后胸闷、气促、阵发性干咳，2 例高热、干咳。5 例患儿初发时均在双肺可见数处絮状高密度影，肺部听诊双肺粗湿啰音，其中 1 例伴有少量干性啰音。1 例患儿血和肺泡灌洗液中检出 PJ 核序列，4 例患儿血和肺泡灌洗液检出。5 例患儿均给予复方磺胺甲噁唑（TMP-SMX）联合卡泊芬净及相应对症治疗，4 例治愈，1 例死亡。
儿童初次接触 NH-PJP 时，通常表现为高热、干咳、胸部不适、呼吸困难逐渐加重、病情进展迅速、死亡率高。儿童 PJ 感染的临床表现应与诊断结果一起考虑。mNGS 与鉴定 PJP 相比，具有更高的灵敏度和更短的检测周期。
