Zylberberg H, Robert F, Le Gal F A, Dupouy-Camet J, Zylberberg L, Viard J P
Service d'Immunologie Clinique, Hôpital Necker, Paris, France.
Clin Infect Dis. 1995 Sep;21(3):680-1. doi: 10.1093/clinids/21.3.680.
We report two cases of prolonged fever in deeply immunocompromised patients with AIDS who had been receiving trimethoprim-sulfamethoxazole (TMP-SMZ) as primary prophylaxis for several months. Investigations of the cause of fever yielded normal or negative findings except that the polymerase chain reaction (PCR) for Toxoplasma gondii in the blood was positive in both cases, and PCR of the bronchoalveolar lavage fluid was positive in one case. After a few days of treatment with pyrimethamine plus clindamycin, the two patients became afebrile and the T. gondii PCR became negative. The patients probably had disseminated toxoplasmosis attenuated by TMP-SMZ. PCR examination of blood for evidence of T. gondii genome may be useful in screening for causes of unexplained fever in patients with AIDS, even those who receive prophylaxis with TMP-SMZ.
我们报告了两例患有艾滋病的深度免疫功能低下患者长期发热的病例，这些患者接受甲氧苄啶-磺胺甲恶唑（TMP-SMZ）作为主要预防用药已有数月。对发热原因的调查结果正常或呈阴性，仅两例患者血液中的弓形虫聚合酶链反应（PCR）呈阳性，其中一例患者的支气管肺泡灌洗液PCR也呈阳性。在用乙胺嘧啶加克林霉素治疗几天后，两名患者退热，弓形虫PCR结果转为阴性。这两名患者可能患有因TMP-SMZ而减轻的播散性弓形虫病。对血液进行PCR检测以寻找弓形虫基因组的证据，可能有助于筛查艾滋病患者不明原因发热的病因，即使是那些接受TMP-SMZ预防治疗的患者。
