Clinicopathological Features of Acquired Immune Deficiency Syndrome Combined with <i>Pneumocystis carinii</i> Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 QiuYuying ¹ , ZhangYingwei ¹ , ChenLulu ¹ , CaiHourong ¹ , XiaoYonglong ¹ , MengFanqing ²

1. Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China;
2. ;

Corresponding?author：

QiuYuying, Email: qiuyuying1402@sina.com

Keywords：

Acquired immune deficiency syndrome; Pneumocystis carinii; Pneumonia; CD4⁺ T lymphocyte; Lactate dehydrogenase

DOI：

10.7507/1671-6205.2016002

Video：

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Objective To summarize the clinical, radiological and pathological characteristics of acquired immune deficiency syndrome (AIDS) combined with Pneumocystis carinii pneumonia (PCP), so as to improve the clinicians' understanding of the disease. Methods The clinical data of 50 AIDS patients combined with PCP admitted between February 2006 and May 2015 were retrospectively analyzed, including medical history, physical signs, laboratory examination, chest high resolution CT (HRCT), pathological characteristics, treatment and prognosis, etc. Results The clinical features of AIDS patients combined with PCP included cough, dyspnea and fever, without obvious positive signs in the lung.The patients were divided as a mild group, a moderate group and a severe group according to the levels of PaO₂.There was significant difference among three groups in serum albumin level [(23±3) g/L vs. (30±5) g/L and (28±6) g/L, P < 0.01].There were no significant differences among three groups in CD4⁺ T lymphocyte and lactate dehydrogenase (LDH) (P > 0.05).The typical chest radiograph feature of HRCT was ground-glass shadows in both lungs, and may be associated with reticular shadows or "gravel sign" and cyst.Of 50 patients, 16 patients were diagnosed via pathology of transbronchial lung biopsy(TBLB) and only 5 patients were diagnosed via silver staining of the bronchoalveolar lavage fluid (BALF).The other patients were clinically diagnosed.100% of the patients were treated with sulfamethoxazole (SMZco), 64%with caspofungin, and 72% with glucocorticoid.All the patients relieved with no death in hospital. Conclusion When a patient got cough, dyspnea and fever, especially ground glass on HRCT in both lungs, AIDS combined with PCP should be highly considered, and diagnostic treatment with SMZco and CD4⁺ T lymphocyte measurement should be conducted as soon as possible, so as to reduce misdiagnosis and mortality.

Citation： QiuYuying, ZhangYingwei, ChenLulu, CaiHourong, XiaoYonglong, MengFanqing. Clinicopathological Features of Acquired Immune Deficiency Syndrome Combined with Pneumocystis carinii Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(1): 2-6. doi: 10.7507/1671-6205.2016002 Copy

1.	Phair J, Muoz A, Detel R, et al.The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1.Multicenter AIDS Cohort Study Group.N Engl J Med, 1990, 322:161-165.
2.	Mocroft A, Katlanla C, Johnson AM, et al. AIDS across Europe, 1994-98:the Euro SIDA study. Lancet, 2000, 356:291-296.
3.	Furrer H, Egger M, Opravil M, et al.Discontinuation of primary maIy prophylaxis against Pneumocystis carinii pneumonia in HIV-1 infected adults treated with combination antiretroviral therapy.Swiss HIV Cohort Study.N Engl J Med, 1999, 340:1301-1306.
4.	CatherinotI E, Lanternier F, Bougnoux ME, et al.Pneumocystis jirovecii pneumonia.Infect Dis Clin North Am, 2010, 24:107-138.
5.	中華醫學會感染病學分會艾滋病學組.艾滋病診療指南.中華傳染病雜志, 2011, 4:321-330.
6.	郭艷.艾滋病合并卡氏肺囊蟲肺炎的臨床與影像學進展.臨床肺科雜志, 2012, 17:1298-1299.
7.	李侗曾, 田亞昆, 李在村, 等.艾滋病合并肺孢子菌肺炎88例臨床研究.中國全科醫學, 2010, 13:735-737.
8.	喬建勤, 童朝暉, 尹玉東, 等.肺孢子菌肺炎19例臨床分析.首都醫科大學學報, 2010, 31:552-557.
9.	王煥玲, 李太生, 王愛霞, 等.艾滋病合并卡氏肺孢子菌肺炎22例臨床分析.中華內科雜志, 2005, 44:652-655.
10.	Boldt MJ, Bai TR.Utility of lactate dehydrogenase vs radiographic severity in the differential diagnosis of Pneumocystis jirovecii pneumonia.Chest, 1997, 111:1187-1192.
11.	Esteves F, Lee GH, de Sousa B, et al.(1-3)-Beta-D-glucan in association with lactate dehydrogenase as biomarkers of Pneumocystis pneumonia(Pcp) in HIV-infected patients.Eur J Clin Microbiol Infect Dis, 2014, 33:1173-1180.
12.	李宏軍.中國艾滋病影像學研究現狀與臨床應用.磁共振成像, 2010, 1:346-348.
13.	Hardak E, Brook O, Yigla M.Radiological features of Pneumocystis jirovecii pneumonia in immunocompromised patients with and without AIDS.Lung, 2010, 188:159-163.
14.	郭艷, 劉挨師.艾滋病合并卡氏肺孢子菌肺炎的CT影像學分析.中華實驗和臨床感染病雜志(電子版), 2013, 7:33-36.
15.	謝正平, 戴峰.艾滋病患者卡氏肺孢子菌肺炎的多排螺旋CT表現及鑒別診斷.中華醫院感染學雜志, 2013, 23:5674-5676.
16.	郟琴, 皮衛峰, 王妍敏, 等.肺泡灌洗液在診斷真菌性肺炎中的價值.中國呼吸與危重監護雜志, 2014, 13:569-573.
17.	Roembke F, Heinzow1 HS, Gosseling T.Clinical outcome and predictors of survival in patients with pneumocystis jirovecii pneumonia-results of a tertiary referral centre.Clin Respir J, 2014, 8:86-92.

1. Phair J, Muoz A, Detel R, et al.The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1.Multicenter AIDS Cohort Study Group.N Engl J Med, 1990, 322:161-165.
2. Mocroft A, Katlanla C, Johnson AM, et al. AIDS across Europe, 1994-98:the Euro SIDA study. Lancet, 2000, 356:291-296.
3. Furrer H, Egger M, Opravil M, et al.Discontinuation of primary maIy prophylaxis against Pneumocystis carinii pneumonia in HIV-1 infected adults treated with combination antiretroviral therapy.Swiss HIV Cohort Study.N Engl J Med, 1999, 340:1301-1306.
4. CatherinotI E, Lanternier F, Bougnoux ME, et al.Pneumocystis jirovecii pneumonia.Infect Dis Clin North Am, 2010, 24:107-138.
5. 中華醫學會感染病學分會艾滋病學組.艾滋病診療指南.中華傳染病雜志, 2011, 4:321-330.
6. 郭艷.艾滋病合并卡氏肺囊蟲肺炎的臨床與影像學進展.臨床肺科雜志, 2012, 17:1298-1299.
7. 李侗曾, 田亞昆, 李在村, 等.艾滋病合并肺孢子菌肺炎88例臨床研究.中國全科醫學, 2010, 13:735-737.
8. 喬建勤, 童朝暉, 尹玉東, 等.肺孢子菌肺炎19例臨床分析.首都醫科大學學報, 2010, 31:552-557.
9. 王煥玲, 李太生, 王愛霞, 等.艾滋病合并卡氏肺孢子菌肺炎22例臨床分析.中華內科雜志, 2005, 44:652-655.
10. Boldt MJ, Bai TR.Utility of lactate dehydrogenase vs radiographic severity in the differential diagnosis of Pneumocystis jirovecii pneumonia.Chest, 1997, 111:1187-1192.
11. Esteves F, Lee GH, de Sousa B, et al.(1-3)-Beta-D-glucan in association with lactate dehydrogenase as biomarkers of Pneumocystis pneumonia(Pcp) in HIV-infected patients.Eur J Clin Microbiol Infect Dis, 2014, 33:1173-1180.
12. 李宏軍.中國艾滋病影像學研究現狀與臨床應用.磁共振成像, 2010, 1:346-348.
13. Hardak E, Brook O, Yigla M.Radiological features of Pneumocystis jirovecii pneumonia in immunocompromised patients with and without AIDS.Lung, 2010, 188:159-163.
14. 郭艷, 劉挨師.艾滋病合并卡氏肺孢子菌肺炎的CT影像學分析.中華實驗和臨床感染病雜志(電子版), 2013, 7:33-36.
15. 謝正平, 戴峰.艾滋病患者卡氏肺孢子菌肺炎的多排螺旋CT表現及鑒別診斷.中華醫院感染學雜志, 2013, 23:5674-5676.
16. 郟琴, 皮衛峰, 王妍敏, 等.肺泡灌洗液在診斷真菌性肺炎中的價值.中國呼吸與危重監護雜志, 2014, 13:569-573.
17. Roembke F, Heinzow1 HS, Gosseling T.Clinical outcome and predictors of survival in patients with pneumocystis jirovecii pneumonia-results of a tertiary referral centre.Clin Respir J, 2014, 8:86-92.

Chinese Journal of Respiratory and Critical Care Medicine

Clinicopathological Features of Acquired Immune Deficiency Syndrome Combined with Pneumocystis carinii Pneumonia

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