新型冠状病毒感染康复期确诊耶氏肺孢子菌肺炎16例临床特征分析

Clinical features of 16 cases of Pneumocystis jiroveci pneumonia during convalescence of novel coronavirus infection

目的 通过分析新型冠状病毒感染(COVID-19)康复期确诊耶氏肺孢子菌肺炎(Pneumocystis jiroveci pneumonia,PJP)的临床特征,以提高临床医师对该病的诊治水平。方法 回顾性分析2022年12月—2023年4月郑州大学第二附属医院就诊的COVID-19康复期经宏基因组二代测序(mNGS)确诊为PJP的16例患者的临床资料。结果 16例患者中,9例男性,7例女性,中位年龄68岁,主要症状为咳嗽、咯痰、胸闷、发热,胸部CT多发肺部磨玻璃影,部分可见肺囊肿。14例曾经糖皮质激素治疗,15例淋巴细胞计数均降低,均存在不同程度的免疫抑制。16例患者肺泡灌洗液mNGS均检测出耶氏肺孢子菌,9例检测出合并其他病原体。16例患者均使用复方磺胺甲唑(TMP-SMZ)联合卡泊芬净治疗,其中12例病情逐渐好转,4例病情恶化死亡。结论 COVID-19康复期患者存在免疫抑制具有发生PJP的风险,需早诊断、早治疗。复方磺胺甲唑是治疗PJP的首选药物,也可联合卡泊芬净治疗。

Objective To investigate the clinical characteristics of Pneumocystis jiroveci pneumonia(PJP)in patients recovering from COVID-19.Methods The clinical data of 16 patients diagnosed with PJP by metagenomic next-generation sequencing(mNGS)during COVID-19 recovery were retrospectively analyzed in the Second Affiliated Hospital of Zhengzhou University from December 2022 to April 2023.Results The 16 patients included 9 males and 7 females(median age of 68 years).The main symptoms were cough,sputum,chest tightness,and fever.Chest CT revealed multiple pulmonary ground glass opacities and pulmonary cysts in some patients.Prior glucocorticoid use was found in 14 patients.Lymphopenia was found in 15 patients who had different degrees of immunosuppression.Pneumocystis jirovecii was detected from alveolar lavage fluid in 16 patients by mNGS.Other pathogens were also detected in 9 patients.All the 16 patients were treated with trimethoprim-sulfamethoxazole and caspofungin.The disease improved in 12 patients.The remaining 4 patients died.Conclusions The immunosuppression during COVID-19 recovery contributes to the risk of PJP infection,which requires early detection and treatment.Trimethoprim-sulfamethoxazole is the first choice for the treatment of PJP,and combination treatment with caspofungin is appropriate if necessary.