免疫功能低下宿主巨细胞病毒肺炎

Cytomegloviral pneumonia in immunocompromised status.

巨细胞病毒是引起免疫功能低下宿主肺部感染最常见的病原之一,在临床上起病急、进展快,如不能及时诊断和干预,往往会在短期内发展为急性肺损伤甚或急性呼吸窘迫综合征及多器官功能衰竭,病死率高,预后差。实验室病毒学检测对早期诊断具有重要作用。在治疗上除了对症支持、保证氧合外,早期应用更昔洛韦抗病毒联合静脉丙种球蛋白,在一定程度上可改善预后,降低病死率。除非有明确细菌感染的指征或有创呼吸治疗,一般不主张给予联合抗生素治疗,以避免治疗进一步复杂化。

Cytomegalovirus is the most common pathogen resulting in pulmonary pneumonia in the immunocompromised host. The clinical manifestation of cytomegaloviral pneumonia shows acute onset of illness and rapid progress. It will develop to acute lung injury or acute respiratory distress syndrome in several days if delaying the diagnosis and proper intervention. It also shows high mortality and poor prognosis. It plays a very important role for the laboratory pathogen assay to make the confirmed diagnosis. Regarding to the therapeutic strategies, early administration of gancyclovir with intravenous immunoglobin is a recommended cocktail intervention,which could improve the prognosis and decrease the mortality. Combination of antibiotics is usually not recommended except with confirmed bacterial infection or invasive mechanical ventilation in order to refrain from making a further complicated situation.