This is the 3776th article of Da Medical Care
I. What is Pneumocystis pneumonia (PCP)
Pneumocystis pneumonia, referred to as PCP, also known as Pneumosporidium carinii pneumonia, Pneumocystis carinii pneumonia, is an interstitial plasma cell pneumonia caused by Pneumocystis pneumocystis, which is a conditional lung infectious disease. Before the 1950s, the disease was only seen in premature infants and malnourished infants, and in the past decade, with the application of immunosuppressants, the popularization of tumor chemotherapy, especially the emergence of HIV infection, the incidence of PCP has increased significantly, and has become the most common opportunistic infection and the main cause of death in HIV-infected patients.
Second, the clinical manifestations of PCP are mainly divided into
Popular type
It occurs mainly in preterm infants, infants and young children with insufficient nutrition, and infants with congenital immunodeficiency. This type of disease begins slowly, first with anorexia, diarrhea, and low-grade fever, followed by gradual cough, dyspnea, progressive exacerbation of symptoms, and an untreated case fatality rate of 20% to 50%.
Sporadic type (modern type)
There are children and adults, the onset is more acute, dry cough at the beginning, rapid onset of high fever, shortness of breath, cyanosis, progressive dyspnea is an important clinical manifestation, and there are few signs of the lungs, there may be hepatosplenomegaly. From onset to diagnosis, typical presentation can be diagnosed within 1 to 2 weeks, while atypical patients often have delayed diagnosis, affecting prognosis. Patients receiving high-dose hormone therapy have a short duration of illness and may die within 4 to 8 days. Symptoms are severe, but there are fewer pulmonary signs, most patients have no abnormalities in lung auscultation, and the untreated case fatality rate is almost 100%.
Third, the main treatment methods
General treatment
Despite the high mortality rate, if it can be diagnosed early and treated early, it will get a better treatment response, and most patients can recover. Patients should be bed rest, strengthen nutrition, correct water and electrolyte disorders, have difficulty breathing for active oxygen therapy, oxygen through the nose or mask, severe hypoxia is preferred noninvasive ventilator assisted ventilation, poor results require endotracheal intubation or tracheostomy invasive ventilator assisted ventilation, but because such patients are mostly immunosuppressed people, the incidence of ventilator-related pneumonia is high, which seriously affects the prognosis. At present, there are also many successful cases of extracorporeal membrane oxygenation (ECMO) in China. For AIDS complicated with pneumocystis pneumonia and severe diffuse lesions of the lungs, it is recommended to actively use glucocorticoid therapy, such as prednisolone, methylprednisolone, etc.; but for non-AIDS patients with pneumoconiosis pneumonia, whether to use glucocorticoids requires a doctor to make specific judgments according to the specific conditions of the patient.
Treatment of the cause
The antibiotic of choice is sulfamethoxazole/trimethoprim (compound sulfamethoxazole, TMP/SMZ), or a combination or single use of ventamidine, atovaquone, and peranquine/clindamycin, depending on individual differences. However, due to regional and drug supply related issues, caspofenin combined with clindamycin in clinical applications has also become an alternative.
4. Efficacy evaluation and prognosis judgment
During treatment, close observation and dynamic evaluation are required, and some patients will continue to worsen their symptoms in the early stages of treatment, and are not used as a basis for ineffective treatment. Clinical options are generally evaluated one week after treatment. No improvement within 8 days of treatment suggests a poor prognosis. Overall, the prognosis of such patients is poor and the mortality rate is high, which may be related to the pre-existing underlying disease and immunosuppressive state of easy mixed infection and difficult to control.
Fifth, how to prevent
Pay attention to the isolation of immunosuppressed people from patients to prevent cross-infection. In patients at risk of developing Pneumodia carinii pneumonia infection, pharmacological prophylaxis can be applied, which can effectively prevent the potential infection from turning into a clinical disease and recurrence after treatment.
Author: Department of Emergency Medicine, Second Affiliated Hospital of Xi'an Jiaotong University
Chief Physician Pei Honghong guidance
Department of Emergency Medicine, Second Affiliated Hospital of Xi'an Jiaotong University
Nurse Zheng Xin wrote