Pneumocystis carinii pneumonia

Overview Pneumocystis carinii pneumonia (pneumocystis carinii pneumonia PC P), also known as Pneumocystis carinii pneumonia, also known as plasma cell interstitial pneumonia (interstitial plasma cell pneumon ia), is a rare pneumonia, occurring mainly in the lower immunization of children. Etiology of pathogen Pneumocystis carinii, the trophozoites and cysts, mainly found in the lungs. Protozoa belonging to the past that, Recently, scholars based on their ultrastructure and pneumocystis carinii ribosomal RNA species development analysis : Pneumocystis carinii is a fungus. 1951 Vanek initial report, the premature infant plasma cell interstitial pneumonia cases investigated see such Pneumocystis carinii. As recent decades wider use of immunosuppressive drugs and chemotherapy for cancer patients, the disease most common than in the past. Especially in the past 10 years acquired immune deficiency disease (AIDS AIDS), after PCP more widespread concern. According to CDC information on the 1981 ~ 1990 reported a total 1,200 cases of children with AIDS. The most common and most serious opportunistic infections PCP incidence rate of 39%. In adult AIDS patients can be as high as 80%. Pneumocystis carinii disease occurred in five patients : ① premature and newborn babies; ② innate immune defect or secondary immunodeficiency poor children; ③ malignancies such as leukemia, lymphoma patients; ④ organ transplant recipients immunosuppressant treatment of children; ⑤ children with AIDS in the 1950s, Beijing has found in a small number of cases of PCP. Mid-1980s, Beijing Children's Hospital has reported 16 cases of PCP occurred in children with leukemia in remission. According to animal models and patient observation proved PCP occurred with the T-lymphocyte immune dysfunction related to the close, Where abroad that the current CD4 (helper T cell) count less than 200/mm3 when PCP very dangerous, But this standard for a particular age children who do not apply within. Pathological changes visible extensive lung involvement heavier, texture and color as liver. Alveolus and bronchioles were filled with foam-like substance is necrosis larvae and immune globulin is a mixture. Alveolar septal a plasma cell and lymphocyte infiltration, resulting in alveolar septal thickening, up to the normal 5 ~ 20 times, occupy the entire lung volume 3 / 4. Cyst at the beginning of the alveolar macrophages interval cytoplasm, then the alveolar cyst containing exfoliated cells, into the alveolar space; or encapsulation of spore-proliferation and mature, packet-wall rupture emit spores become free trophozoites into the alveolar space. Alveolar exudation which plasma cells, lymphocytes and tissue cells. A clinical performance. Symptoms and signs can be divided into two types : ① infantile : mainly occurred in a six-month small baby. is a plasma cell interstitial pneumonia, the slow onset, symptoms do the job well, irritability, dry cough, breathing rate and cyanosis. and the fever is not significant. Auscultation rales small 1 ~ 2 weeks of gradually increasing difficulty in breathing. Small signs of pulmonary and respiratory distress symptoms of a serious attitude, one characteristic of the disease. Course of 4 ~ 6 weeks, if not for about 25% ~ 50% of children with death. ② children Type : mainly occurs in a variety of reasons to lower the immune function in children with sudden episode, and the baby-differences for almost all patients had fever. In addition, the common symptoms of accelerated respiration, cough, cyanosis, three Au, nose fan and diarrhea. And course quickly, not more treatment died. 2.X ray examination showed bilateral diffuse granular shadow, since hila to extend the ground glass-like, As with bronchial inflatable, after cable line into dense, irregular unit makes massive impact. Lasting late emphysema, the lung around some more obvious. Can be associated with pneumomediastinum and pneumothorax. Since the diagnosis relies on lessons from tracheal or lung biopsy specimen might see within a bubble-like pulmonary eosinophilic material flat area rich in protozoa. Urotropine use of silver nitrate staining, can be found in diameter see six black-brown 8μm round or oval-shaped capsule, in cells. In recent years, some high-saline aerosol inhalation pathogen detection rate increase. Also bronchoalveolar lavage and bronchial lung biopsy found when carinii rate is about 90% Cysticercosis staining Toluiding a blue, six azomethine Central Bank, Grdm-Wright. Grimss and immunofluorescent antibody staining. In recent years, it was detected by ELISA IgG antibody pneumocystis carinii and latex agglutination test particulate antigen investigation cysticercosis, or molecular biology techniques such as PCR for the rapid early diagnosis. Therapy for the treatment of pathogens. Formamidine formerly used pentane (pentamidine isothionate) 100 ~ 150 mg / (m2 d) or 4 ~ 5 mg / (kg · d), intramuscular injection 10 ~ 14 days. Can be inhaled, the early application of the drug, at least 60% of children can be cured, However, about half of children, there will be serious adverse side effects occurred as local aseptic abscess, skin rash, low blood pressure, nausea, vomiting, dizziness, low blood sugar, low blood calcium, giant David anemia, thrombocytopenia, neutropenia and liver and kidney dysfunction, and so on. Currently, for the preferred drug Trimethoprim (TMP) 20 mg / (kg d) sulfamethoxazol (SMZ) 100 mg / (kg · d), 2 pm service, even serving two weeks, its efficacy and pentane Acetamiprid 80 cents, However, adverse side effects than the rare performance of the skin and gastrointestinal tract allergic reaction. Also advocated SMZCo100mg / (kg · d) two weeks later commuted to half reuse two weeks. later reduced to 1 / 4 the volume used in conjunction with February, the effective rate was 75%, the drug can prevent the chemical agent, Application of immunosuppressive agents in the prevention of high-risk patients with the disease, its dose of TMP5mg / (kg · d) and SMZ25mg / (kg · d), 2 hours, both oral or even weekly services three days, four days stopped once, for six months. Supportive therapy including injecting gammaglobulin or placenta globulin can enhance immunity. Necessary oxygen. If the application of adrenocortical hormones that occur in the course of the disease, required reductions or withdrawal. For the prevention of the disease in high-risk children with cross-infection, recently advocated the implementation of respiratory isolation until the end of treatment. Auxiliary WBC normal or slightly higher, about half of cases decreased lymphocyte, eosinophil mildly higher. Blood gas analysis showed significant hypoxemia and alveolar-arterial oxygen pressure increased, lung function test can be seen sexual receded. Differential diagnosis with the disease need to bacterial pneumonia, viral pneumonia, fungal pneumonia. ARDS and lymphocytic interstitial pneumonitis (LIP) differential phase. LIP especially with the disease are prone to AIDS patients with more difficult to identify, but a sustained chronic LIP, a dry cough and rales mainly generalized lymph node enlargement and increased salivary glands, in lung biopsy specimens were found EBV-DNA1 and PCP not identified. Prognosis poor prognosis. Foreign reports CFR 10% ~ 50%, an average of 40%. But recently held that the positive and timely treatment, the cure rate can be as high as 70%.