管理耶氏肺孢子菌肺炎的儿童接受化疗。
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Shankar SM,纳尼亚JJ
管理耶氏肺孢子菌肺炎的儿童接受化疗。
Paediatr药物。2007;9 (5):301 - 9。
- PubMed ID
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17927302 (在PubMed]
- 文摘
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耶氏肺孢子菌(原名囊虫)肺炎(PCP)是一种严重的机会性感染和癌症在儿童和青少年。这是儿童最常见的死因之前接受化疗的卡式肺囊虫肺炎预防作为标准的照顾儿童白血病的一部分。卡式肺囊虫肺炎的发病率显著降低自启动的预防;然而,突破情况下继续发生。血液恶性肿瘤,脑瘤需要延长皮质类固醇治疗,造血干细胞移植,长期中性粒细胞减少,淋巴细胞减少是最重要的卡式肺囊虫肺炎的危险因素在儿童感染艾滋病毒。的白血病患儿,15 - 20%的可能在没有预防措施的情况下开发卡式肺囊虫肺炎。感染p;在生命早期发生在大多数人。然而,临床上明显的疾病几乎只发生在免疫功能受损者。呼吸困难、咳嗽、缺氧和发烧的卡式肺囊虫肺炎是最常见的表现症状。胸片和高分辨率CT扫描的胸部展现特有的毛玻璃模式。 Induced sputum analysis and bronchoalveolar lavage are the diagnostic procedures of choice. Gomori's methenamine-silver stain, Geimsa or Wright's stain, and monoclonal immunofluorescent antibody stains are most commonly used to make a diagnosis. However, identification of P. jiroveci DNA using polymerase chain reaction assays in bronchoalveolar lavage fluid is more sensitive. Trimethoprim-sulfamethoxazole (TMP-SMZ; cotrimoxazole) is the recommended drug for the treatment of PCP. Patients who are intolerant of TMP-SMZ or who have not responded to treatment after 5-7 days of therapy with TMP-SMZ should be treated with pentamidine. A short course of corticosteroids is recommended for moderate to severe cases of PCP within the first 72 hours after diagnosis. Mutations in the dihydropteroate synthetase gene may confer resistance to TMP-SMZ; however, the clinical relevance of these mutations is not well established. TMP-SMZ is the most commonly used agent for prophylaxis. Myelosuppression is the most important adverse effect of TMP-SMZ and the most frequent cause for choosing alternative prophylactic agents in children undergoing chemotherapy. Alternative agents for chemoprophylaxis include dapsone, aerosolized pentamidine, and atovaquone. Alternative prophylactic agents must be used in patients developing myelosuppression secondary to TMP-SMZ or dapsone.