《获得性免疫缺陷综合征相关耶氏肺孢子菌肺炎的影像学诊断专家共识》解读

doi:10.19871/j.cnki.xfcrbzz.2023.02.020

摘要/Abstract

摘要： 耶氏肺孢子菌肺炎是一种全球分布的机会性感染疾病,影像学在其早期诊断及疗效监测方面发挥着至关重要的作用。为了推动我国获得性免疫缺陷综合征相关耶氏肺孢子菌肺炎的诊断与治疗工作规范、有效、安全地开展和推广应用,专家组结合循证医学对指南及标准的方法学要求,制订了《获得性免疫缺陷综合征相关耶氏肺孢子菌肺炎的影像学诊断专家共识》。本文结合相关研究,对该专家共识进行解读,内容包括该疾病的病原学、流行病学、临床表现、实验室检查、临床诊断及鉴别诊断,以提高临床医师对该疾病的认识。

关键词: 获得性免疫缺陷综合征, 耶氏肺孢子菌肺炎, 影像诊断, 专家共识, 解读

Abstract: Pneumocystis jirovecii pneumonia is a worldwide opportunistic infection disease. Imaging technology had proven to be very useful in early detecting, evaluating and surveillance on chemotherapy. For promoting the diagnosis and treatment of acquired immunodeficiency syndrome associated pneumocystis jirovecii pneumonia in our country can be worked correctly and effectively, safely and widely, the expert group use the guide of evidence-based medicine and the requirements of standard methodology to formulate Expert consensus on imaging diagnosis of acquired immunodeficiency syndrome associated pneumocystis jirovecii pneumonia. The interpretation of this expert consensus combines relevant studies,and includes the disease etiology, epidemiology, clinical manifestation, laboratory examination, clinical diagnosis and differential diagnosis. We hope that it can improve clinicians' understanding of the disease.

Key words: Acquired immunodeficiency syndrome, Pneumocystis jirovecii pneumonia, Imaging diagnosis, Expert consensus, Interpretion

中图分类号:

R512.91

瞿静, 刘晋新. 《获得性免疫缺陷综合征相关耶氏肺孢子菌肺炎的影像学诊断专家共识》解读[J]. 新发传染病电子杂志, 2023, 8(2): 91-95.

Qu Jing, Liu Jinxin. Interpretation of Expert consensus on imaging diagnosis of acquired immune deficiency syndrome associated pneumocystis jirovecii pneumonia[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(2): 91-95.

参考文献

[1] CENTERS FOR DISEASE CONTROL AND PREVENTION. Global HIV and TB. [EB/OL]. [2023-01-16]. https://www.cdc.gov/globalhivtb/images/DGHT-HIV-Factsheet.pdf
[2] SEPKOWITZ KA.Opportunistic infections in patients with and patients without Acquired Immunodeficiency Syndrome[J]. Clin Infect Dis, 2002, 34(8): 1098-1107.
[3] KAPLAN JE, HANSON D, DOWRKING MS.Epidemiology of human immunodeficiency virus associated opportunistuc infection in the United States in the era of highly active antiretroviral therapy[J]. Clin Infect Dis, 2000, 30(Suppl 1): S5-S14.
[4] 宋文艳,李宏军. 艾滋病合并卡氏肺囊虫肺炎的临床影像研究[J].医学影像学杂志,2010, 20(5):652-655.
[5] 李丹, 卢洪洲. 肺孢子菌的新命名[J]. 微生物与感染. 2008, 3(1):30-31.
[6] MATULIONYTE R, AMBROZAITIS A, PAULAUSKIENE R, et al.[Pneumocystis jirovecii pneumonia: an old disease with a new name[J]. Medicina, 2006, 42(8):643-648
[7] THOMAS CF JR, LIMPER AH.Pneumocystis Pneumonia[J]. N Engl J Med, 2004, 350(24):2487-2498.
[8] DE BOER MG, DE FIJTER JW, Kroon FP.Outbreaks and clustering of Pneumocystis pneumonia in kidney transplant recipients: a systematic review[J]. Med Mycol, 2021, 49(7):673-680.
[9] MONTES-CANO MA, CHABÉ M,FONTILLON-ALBERDI M, et al. 2009. Vertical transmission of Pneumocystis jirovecii in humans[J]. Emerg Infect Dis, 2009, 15(1):125-127.
[10] CHABÉ M, ALIOUAT-DENIS CM, DELHAES L, et al.Pneumocystis: from a doubtful unique entity to a group of highly diversified fungal species[J]. FEMS Yeast Res, 2021, 11(1):2-17.
[11] PETERSON JC, CUSHION MT.Pneumocystis: not just pneumonia[J]. Curr Opin Microbiol, 2005, 8:393-398.
[12] LE GAL S, DAMIANI C, ROUILLÉ A, et al.A cluster of Pneumocystis infections among renal transplant recipients: molecular evidence of colonized patients as potential infectious sources of Pneumocystis jirovecii[J]. Clin Infect Dis, 2012, 54(7) :e62-71.
[13] ALANIO A, BRETAGNE S.Pneumocystis jirovecii Detection in Asymptomatic Patients: What Does its Natural History Tell us[J] F1000 Faculty Rev, 2007, 23(6):739.
[14] GAJDUSEK DC.Pneumocystis carinii; etiologic agent of interstitial plasma cell pneumonia of premature and young infants[J]. Pediatrics, 1957, 19(4 Pt 1):543-565.
[15] HAY JW, OSMOND DH, JACOBSON MA.Projecting the medical costs of AIDS and ARC in the United States[J]. J Acquir Immune Defic Syndr, 1988, 1(5):466-485.
[16] BROWN GD, DENNING DW, GOW NA, et al.Hidden killers: human fungal infections[J]. Sci Transl Med, 2012, 19(4):165rv13.
[17] MASCHMEYER G, HELWEG-LARSEN J, PAGANO L, et al.ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients[J]. J Antimicrob Chemother, 2016, 71(9):2405-2413.
[18] MCKINNELL JA, CANNELLA AP, KUNZ DF, et al.Pneumocystis pneumonia in hospitalized patients: a detailed examination of symptoms, management, and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected persons[J]. Transpl Infect Dis, 2012, 14(5):510-518.
[19] BIENVENU AL, TRAORE K, PLEKHANOVA I, et al.Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients[J]. Int J Infect Dis, 2016, 46: 11-17.
[20] GARCIA GF, MOURA AS, FERREIRA CS, et al.Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression[J]. Rev Soc Bras Med Trop, 2007, 40(6):622-626.
[21] CALDERON EJ, GUTIERREZ-RIVERO S, DURAND-JOLY I, et al.Pneumocystis infection in humans: diagnosis and treatment[J]. Expert Rev Anti Infect Ther, 2010, 8(6):683-701.
[22] DURAND-JOLY I, CHABE M, SOULA F, et al.Molecular diagnosis of Pneumocystis pneumonia[J]. FEMS Immunol Med Microbiol, 2005, 45(3):405-410.
[23] BOTTEREL F, CABARET O, FOULET F, et al.2012. Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients[J]. J Clin Microbiol, 2012, 50(2):227-231.
[24] FILLAUX J, BERRY A.2013. Real-time PCR assay for the diagnosis of Pneumocystis jirovecii pneumonia[J]. Methods Mol Biol, 2013, 943:159-170.
[25] DALPKE AH, HOFKO M, ZIMMERMANN S.Development and evaluation of a real-time PCR assay for detection of Pneumocystis jirovecii on the fully automated BD MAX platform[J]. J Clin Microbiol, 2013, 51(7):2337-2344.
[26] GAGO S, ESTEBAN C, VALERO C, et al.A multiplex real-time PCR assay for identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii in samples from AIDS patients with opportunistic pneumonia[J]. J Clin Microbiol, 2014, 52(4):1168-1176.
[27] TASAKA S, HASEGAWA N, KOBAYASHI S, et al.Serum indicators for the diagnosis of pneumocystis pneumonia[J]. Chest, 2007, 131(4):1173-1180.
[28] AVIRAM G. BOISELLE PM.Imaging features of bacterial respiratory infections in AIDS[J]. Curr 0pin Pul/n Mad, 2004, 10(3):183-188.
[29] 刘德纯,李宏军.艾滋病与艾滋病毒感染者48例临床影像与病理分析[J/CD].新发传染病电子杂志,2019,4(3):152-155,159.
[30] HARDAK E, BROOK O, YIGLA M.Radiological features of Pneumocystis jirovecii Pneumonia in immunocompromised patients with AND without AIDS[J]. Lung, 2010, 188(2): 159-163.
[31] BOISELLE PM, CRANS CA JR, KAPLAN MA.The changing face of Pneumocystis carinii pneumonia in AIDS patients[J]. AJR Am J Roentgenol, 1999, 172(5):1301-1309.
[32] 赵大伟, 张可, 马大庆, 等. 艾滋病合并卡氏肺孢子菌肺炎的影像学表现[J]. 中华放射学杂志, 2002, 36(4)(4):63-65.
[33] 陆普选, 邓莹莹, 刘水腾, 等. 艾滋病合并肺孢子菌肺炎的影像学表现特征及分型[J]. 放射学实践, 2009, 24(9):948-951.
[34] FUJII T, NAKAMURA T, IWAMOTO A.Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features[J]. J Infect Chemother, 2007, 13(1):1-7.
[35] 丘金铭, 吴仁华. 肺孢子菌肺炎的影像学表现[J/CD]. 新发传染病电子杂志, 2019, 4(4):235-239.