White D A
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Semin Thorac Cardiovasc Surg. 1995 Apr;7(2):78-87.
Pneumonia in the immunocompromised patient remains a significant cause of morbidity and mortality. These patients are susceptible to a wide variety of organisms, but specific infections tend to occur in well defined settings. The type of infection can be predicted based on the nature and severity of the immune defect, past patient exposures, chemotherapy given, radiographic presentation, and acuteness of illness. New treatments, including growth factors, the oral antifungal agents, and antiviral drugs, such as ganciclovir and acyclovir, have improved management and prognosis in some cases. However, some problems have increased with a significant risk of spontaneous pneumothorax now seen with Pneumocystis carinii infection. Bronchoscopy with bronchoalveolar lavage plays a major role in diagnosis, particularly for P carinii and cytomegalovirus infection. However, open lung biopsy remains essential for diagnosis in some settings. Surgical resection for control of hemoptysis and for removal of residual foci of disease also are an integral part of management of pulmonary fungal infections in the immunosuppressed patient.
免疫功能低下患者的肺炎仍然是发病和死亡的重要原因。这些患者易受多种病原体感染，但特定感染往往发生在明确的情况下。可根据免疫缺陷的性质和严重程度、患者既往接触史、所接受的化疗、影像学表现以及疾病的急性程度来预测感染类型。包括生长因子、口服抗真菌药物以及更昔洛韦和阿昔洛韦等抗病毒药物在内的新治疗方法，在某些情况下改善了治疗和预后。然而，一些问题有所增加，现在卡氏肺孢子虫感染存在自发性气胸的重大风险。支气管镜检查及支气管肺泡灌洗在诊断中起主要作用，特别是对于卡氏肺孢子虫和巨细胞病毒感染。然而，在某些情况下，开胸肺活检对于诊断仍然至关重要。手术切除以控制咯血和清除残留病灶也是免疫抑制患者肺部真菌感染管理的一个组成部分。
