非人类免疫缺陷病毒患者感染肺孢子菌肺炎的诊断学特征并文献复习

doi:10.3877/cma.j.issn.2095-655X.2022.04.002

中华诊断学电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 224 -228. doi: 10.3877/cma.j.issn.2095-655X.2022.04.002

感染性疾病诊治

非人类免疫缺陷病毒患者感染肺孢子菌肺炎的诊断学特征并文献复习

裴小华¹, 张涛¹, 金柯², 柏云¹, 高飞¹, 朱蓓¹, 赵卫红¹^,^†(

)

^1. 210029　南京医科大学第一附属医院（江苏省人民医院）老年肾内科
^2. 210029　南京医科大学第一附属医院（江苏省人民医院）感染病科

收稿日期:2022-07-05 出版日期:2022-11-25
通信作者: 赵卫红
基金资助:
国家重点研发计划(2018YFC2002100，2018YFC2002102); 国家自然科学基金(82171585); 江苏省干部保健课题(BJ17018); 江苏省人民医院511工程(JSPH-511A-2018-5)

Diagnostic characteristics of pneumocystis carinii pneumonia with non-human immunodeficiency virus infection and literature review

Xiaohua Pei¹, Tao Zhang¹, Ke Jin², Yun Bai¹, Fei Gao¹, Bei Zhu¹, Weihong Zhao¹^,^†()

^1. Department of Geriatric Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
^2. Department of Infectious Diseases, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

Received:2022-07-05 Published:2022-11-25
Corresponding author: Weihong Zhao

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引用本文：

裴小华, 张涛, 金柯, 柏云, 高飞, 朱蓓, 赵卫红. 非人类免疫缺陷病毒患者感染肺孢子菌肺炎的诊断学特征并文献复习[J/OL]. 中华诊断学电子杂志, 2022, 10(04): 224-228.

Xiaohua Pei, Tao Zhang, Ke Jin, Yun Bai, Fei Gao, Bei Zhu, Weihong Zhao. Diagnostic characteristics of pneumocystis carinii pneumonia with non-human immunodeficiency virus infection and literature review[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2022, 10(04): 224-228.

目的

探讨非人类免疫缺陷病毒(HIV)患者感染肺孢子菌肺炎(PCP)的诊断学特征。

方法

选择2022年3月15日南京医科大学第一附属医院老年肾内科收治的1例PCP患者的临床资料，总结非HIV患者感染PCP的诊断学特征，并复习文献综述其诊治进展。

结果

44岁女性患者，因IgA肾病接受糖皮质激素联合来氟米特治疗，以发热起病，咳嗽，无痰，HIV阴性，常规检查(包括胸部CT)无特殊异常，经广谱抗生素治疗无效。后经宏基因组二代测序技术证实病原体为肺孢子菌，遂接受复方磺胺甲噁唑、棘白菌素、丙种球蛋白等治疗。治疗过程中，患者先后发生I型呼吸衰竭、粒细胞缺少、肠道真菌感染、肝功能异常、药疹等，予相应处理后均治愈。

结论

PCP进展迅速，病原体宏基因组二代测序可降低该病的漏诊率和误诊率。复方磺胺甲噁唑仍是治疗PCP的首选药物，但副作用明显，需及时发现、合理干预。

关键词: 肺孢子菌肺炎, 肾小球肾炎，IgA, 宏基因组二代测序, 来氟米特, 糖皮质激素类

Objective

To investigate the clinical characteristics of pneumocystis carinii pneumonia (PCP) in non-human immunodeficiency virus (HIV) infected patients.

Methods

Take the clinical materials of one PCP patient as the breakthrough point, who was admitted to the Geriatric Nephrology Department of the First Affiliated Hospital of Nanjing Medical University on March 15, 2022 to summarize the key points and review literatures on progress in diagnosis and treatment of PCP in non-HIV infected patients.

Results

A 44-year-old female patient was treated with glucocorticoids combined with leflunomide for IgA nephropathy. The patient had fever onset, cough, no sputum, and HIV was negative. Routine examination (including chest CT) showed no special exception, and the patient failed to respond to broad-spectrum antibiotic treatment. After the patient was transferred to our hospital, the pathogen was confirmed to be Pneumocystis by metagenomic next-generation sequencing (mNGS), and the patient was treated with compound sulfamethoxazole, echinocandin, and gamma globulin. During the treatment, the patient developed type I respiratory failure, granulocytosis, intestinal fungal infection, abnormal liver function, drug eruption and other phenomena, which were cured after corresponding treatment.

Conclusions

PCP progresses rapidly. The mNGS of pathogen can reduce the rate of missed diagnosis and misdiagnosis of PCP. Compound sulfamethoxazole is still the first choice in the treatment of PCP, but the side effects are obvious, which needs timely detection and reasonable intervention.

Key words: Pneumocystis carinii pneumonia, Glomerulonephritis, IgA, Metagenomic next-generation sequencing, Leflunomide, Glucocorticoid

图1 肺孢子菌肺炎患者血液宏基因组二代测序结果

图2 肺孢子菌肺炎患者入院后胸部CT检查图像注：a图为2022年3月19日胸部CT检查，示两肺多发片絮模糊影伴小叶间隔增厚，两上肺为著，肺水肿可能；b图为2022年3月22日胸部CT检查，示两肺多发片絮模糊影伴小叶间隔增厚，较a图显著吸收；两侧胸腔积液；c图为2022年3月28日胸部CT检查，示两肺片絮模糊影、两侧胸腔积液基本吸收；d图为2022年4月7日胸部CT检查，示两肺磨玻璃样小结节，较前相仿，右肺下叶实性小结节，良性灶可能，左肺上叶微小钙化灶(箭头所示)

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Diagnostic characteristics of pneumocystis carinii pneumonia with non-human immunodeficiency virus infection and literature review

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Diagnostic characteristics of pneumocystis carinii pneumonia with non-human immunodeficiency virus infection and literature review