Carella E, Moschini G L, Romanelli F, Bossalini G, Alberici F, Viale P, Ratti G
Servizio di Radiologia, Ospedale Civile, Piacenza.
Radiol Med. 1997 May;93(5):532-8.
We studied retrospectively 132 episodes of infectious pneumonias in 89 patients examined from 1990 to 1995. Pneumocystis carinii was found to be the most common cause of pneumonia (33 patients). The other causes were: Streptococcus pneumoniae (15), Mycobacterium tuberculosis (14), Pseudomonas aeruginosa (8), Staphylococcus aureus (5), Cytomegalovirus (4), Haemophilus influentiae (4), Mycobacterium avium intracellulare (2), Klebsiella pneumoniae (2), E. coli (2), Serratia marcescens (1). No etiologic agent was found in 40 cases. We stress the need of a more frequent use of invasive diagnostic procedures in the study of focal lung consolidations because this radiologic sign is highly aspecific and may be caused by too many different pathogenic agents, needing different therapies-i.e., Streptococcus pneumoniae (15 cases), Pseudomonas aeruginosa (8), Staphylococcus aureus (5), Klebsiella pneumoniae (2), Escherichia coli (2), Pneumocystis carinii, Serratia marcescens and Haemophilus influentiae (1). Since there is an increase in mortality among patients treated with empiric antibiotic therapy, we stress the need of the routinary use of bronchoalveolar lavage in HIV+ patients with lung consolidation to perform specific therapy. Moreover, Pneumocystis carinii is by far the most frequent cause of diffuse interstitial infiltrates, and PCP has very suggestive clinical (dyspnea), radiologic (diffuse perihilar interstitial infiltrates; ground glass opacities; pneumatoceles) and laboratory (CD3+CD4 < 200/mcl; LDH > 600 UI/dl; PO2 < 70 mmHg) patterns, always related to the discovery of Pneumocystis carinii in escreatum. Thus, we decided to treat 15 patients with specific therapy for Pneumocystis carinii pneumonia with the above diagnostic algorithm, obtaining in all of them complete clinical and radiologic recovery. To conclude, in critical patients, invasive procedures should be performed only in the cases in which PCP is clinically improbable.
我们回顾性研究了1990年至1995年间对89例患者进行检查的132例感染性肺炎。发现卡氏肺孢子虫是肺炎最常见的病因（33例患者）。其他病因包括：肺炎链球菌（15例）、结核分枝杆菌（14例）、铜绿假单胞菌（8例）、金黄色葡萄球菌（5例）、巨细胞病毒（4例）、流感嗜血杆菌（4例）、鸟分枝杆菌胞内复合群（2例）、肺炎克雷伯菌（2例）、大肠杆菌（2例）、黏质沙雷氏菌（1例）。40例未发现病原体。我们强调在局灶性肺实变的研究中需要更频繁地使用侵入性诊断程序，因为这种放射学征象特异性很差，可能由太多不同的病原体引起，需要不同的治疗方法，即肺炎链球菌（15例）、铜绿假单胞菌（8例）、金黄色葡萄球菌（5例）、肺炎克雷伯菌（2例）、大肠杆菌（2例）、卡氏肺孢子虫、黏质沙雷氏菌和流感嗜血杆菌（1例）。由于经验性抗生素治疗的患者死亡率增加，我们强调对合并肺实变的HIV阳性患者常规使用支气管肺泡灌洗以进行特异性治疗的必要性。此外，卡氏肺孢子虫是迄今为止弥漫性间质浸润最常见的病因，卡氏肺孢子虫肺炎有非常典型的临床（呼吸困难）、放射学（弥漫性肺门周围间质浸润；磨玻璃影；肺气囊）和实验室（CD3 + CD4＜200/μl；乳酸脱氢酶＞600 U/dl；动脉血氧分压＜70 mmHg）表现，这些总是与在痰液中发现卡氏肺孢子虫有关。因此，我们决定用上述诊断算法对15例卡氏肺孢子虫肺炎患者进行特异性治疗，所有患者均实现了临床和放射学的完全康复。总之，对于重症患者，仅在临床不太可能是卡氏肺孢子虫肺炎的情况下才应进行侵入性检查。
