老年卡氏肺孢子菌肺炎的诊断和治疗

Diagnosis and Treatment of Pneumocystis Carinii Pneumonia in aged Patients

目的提高对老年人群患卡氏肺孢子菌肺炎(PCP)的诊治和认识。方法对二例老年PCP患者的诊断和治疗经过进行总结和讨论。结果二例老年PCP患者经临床体格检查、影像学检查和痰标本涂片姬姆萨(或甲紫色蓝)染色查到卡氏肺孢子菌(PC)或PCR(+)而获诊。一例PCP患者选用复方磺胺甲口恶唑(SMZco)治愈,另一例初用SMZco后因为发生不良反应而改用卡泊芬净治愈。结论PCP是在老年肺癌或长期住院机械通气患者易患的机会性感染,通过痰标本PCR检测阳性或痰涂片染色查到PC而确诊,应与其他肺炎做鉴别诊断。PCP治疗首选SMZco,当SMZco发生不良反应或者失败时可改用卡泊芬净治疗。

Objective To deepen our understanding of diagnoses and treatment of pneumocystis carinii pneumonia （PCP） in aged patients. Methods We reviewed the diagnosis and treatment of two aged patients with PCP. Results The two aged patients were given final diagnosis when pneumocystis carinii （PC） or PCR （ ＋ ） was discovered by clinical features, radiographic abnormalities and sputum specimen smear Giemsa stain （or grocott）. One case was treated with SMZco, the other with caspofungin due to side reaction of SMZco. Conclusion PCP is a kind of opportunistic infection which has vulnerability for aged patients with lung cancer and MV patients with long - term hospitalization. It can be given a final diagnosis by positive PCR in sputum specimen or PC discovered in sputum smear staining. Differential diagnosis should be done between PCP and other kinds of pneumonia. SMZco is the first choice in the treatment of PCP, but caspofungin can be used when SMZco fails or produces side reaction.