Thomas C F, Limper A H
Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA.
Semin Respir Infect. 1998 Dec;13(4):289-95.
Pneumocystis carinii causes severe pneumonia in immunocompromised hosts. Although this most commonly occurs in patients with the acquired immunodeficiency syndrome (AIDS), other groups of immunocompromised patients without AIDS are also at risk for P. carinii pneumonia. These patients have solid or hematologic malignancies, organ transplantation, or inflammatory conditions requiring chronic immunosuppressive drugs, particularly corticosteroids. There are important differences in the clinical presentation of P. carinii pneumonia in patients with and without AIDS. P. carinii causes an acute fulminate pneumonia in patients without AIDS while patients with AIDS have more insidious involvement. The organism burden and lung inflammatory response are markedly different between these groups, contributing to substantial differences in clinical presentation, outcome, and mortality. The diagnosis of P. carinii pneumonia remains challenging for primary care physicians and specialists alike. The specific diagnosis of P. carinii pneumonia requires demonstration of the organism from a clinically relevant source, such as sputum, bronchoalveolar lavage fluid, or lung tissue. Alternative methods to diagnose P. carinii pneumonia are currently investigational and are an active area of research. The rapid and specific diagnosis of P. carinii pneumonia allows institution of specific treatment and improvement in patient outcome.
卡氏肺孢子菌可在免疫功能低下的宿主中引发严重肺炎。虽然这在获得性免疫缺陷综合征（艾滋病）患者中最为常见，但其他非艾滋病免疫功能低下患者群体也有患卡氏肺孢子菌肺炎的风险。这些患者患有实体瘤或血液系统恶性肿瘤、接受过器官移植，或患有需要长期使用免疫抑制药物（尤其是皮质类固醇）的炎症性疾病。艾滋病患者和非艾滋病患者的卡氏肺孢子菌肺炎临床表现存在重要差异。卡氏肺孢子菌在非艾滋病患者中引发急性暴发性肺炎，而艾滋病患者的病情进展则更为隐匿。这两组患者的病原体负荷和肺部炎症反应明显不同，导致临床表现、预后和死亡率存在显著差异。对于初级保健医生和专科医生而言，卡氏肺孢子菌肺炎的诊断仍然具有挑战性。卡氏肺孢子菌肺炎的明确诊断需要从临床相关样本（如痰液、支气管肺泡灌洗液或肺组织）中检测到该病原体。目前，诊断卡氏肺孢子菌肺炎的替代方法仍处于研究阶段，是一个活跃的研究领域。卡氏肺孢子菌肺炎的快速明确诊断有助于开展针对性治疗并改善患者预后。
