艾滋病并发肺部感染

AIDS complicated by lung infection
Acquired immunodeficiency syndrome (AIDS, AIDS) or human immunodeficiency virus (HIV) infection, T lymphocyte impairment (suppression type TS cells increased and assisted-TH cells reduced insufficiency), easy to secondary infection. Some countries and regions for Pneumocystis carinii (Pneumocystis, PC) and cytomegalovirus infection found, followed by atypical mycobacterium infection; while in developing countries, while tuberculosis (TB see below) the most common. This paragraph on the PC mainly caused by pneumonia.
Pneumocystis carinii pneumonia (Pneumocystis carinii pneumonia, PCP) by Pneumocystis (PC) caused by, protozoan parasites in the alveoli, the adult alveolar epithelial adhesion, when the host immune deficiency, it is caused by pneumonia. Accompanied by other immune deficiency diseases such as leukemia, lymphoma, cancer, organ transplants or the use of anti-cancer chemotherapy drugs, such as adrenocorticotropic hormone immunosuppressants, and can also be secondary to PCP.
Pathological examination revealed alveolar septal cell infiltration (milk to plasma cell-based child care, child and adult patients with lymphocyte predominance, we can see that macrophages or eosinophils), resulting in alveolar septal thickening, alveolar epithelial hyperplasia, leading to alveolar - capillary block the expansion of alveolar space, full of bubble-like honeycomb material, and the collapse of structures containing the body, such as epithelial cells exfoliated. Cryptosporidium in intralesional often cytomegalovirus, fungi, Mycobacterium, Toxoplasma gondii, such as co-exist.
AIDS patients with lung involvement in a few weeks or months, that is systemic non-specific symptoms such as fever, fatigue,纳差, suffering from weight loss and so on. PCP onset ease gradually, respiratory symptoms dry cough, shortness of breath, was sexually heavier, the nose flap, rapid pulse, cyanosis and so on, the retina may have棉絮状spots at the bottom of the lung could be heard and the sound of wet and dry啰. Some patients have oral candidiasis and herpes simplex virus perianal ulcers caused. One week after onset, X-ray showed diffuse interstitial lung cord-like, granular spots shadow, since the proliferation of hilar outward weeks later integration into云雾状nodules. Apex and lung at the end of less involved. Hilar lymph nodes may be a result of the merger or fungal infection Cryptococcus increases. There are thin-walled empty lungs, accompanied with pleural effusion or pneumothorax. These lung X-ray findings of no specific, a small number of patients with lung X-ray normal.
Peripheral blood white blood cell count normal or slightly higher. Eosinophils may be increased. Pulmonary function tests CO diffusing capacity, tidal volume and lung volume decreased. Blood gas analysis often hypoxemia, PaCO2 normal or slightly lower. If no treatment, many died of respiratory failure.
The diagnosis depends mainly on detection of pathogens. Respiratory secretions smear detection rate is very low, can be guided ultrasonic spray sputum examination. Fiberbronchoscope fluid precipitation pathogen detection rate by about 60% -80%, bronchoalveolar lavage or biopsy specimens by fiberbronchoscope positive rate of up to 90%. When necessary, percutaneous lung biopsy or lung biopsy for definite diagnosis. Specimens can be used Giemsa, rapid tar stained purple and so on. Serum antigen, antibody test little clinical value, and bronchoalveolar lavage fluid, lung biopsy specimens, biopsy or printed film to monoclonal antibody detection can improve the detection sensitivity, but the price is not high enough Aung and specificity. Use of the PC-clone DNA fragment probe for diagnostic tests have high specificity and sensitivity of the trunk. Have been diagnosed HIV infection or AIDS patients with the aforementioned clinical, X-ray and laboratory data, can make his diagnosis.
So far there is no specific treatment of AIDS, its treatment of pulmonary infection in the same general opportunistic infections, including supportive therapy, such as oxygen, water and electrolyte balance to correct disorders, such as blood transfusion. The treatment of choice for PCP Pentamidine (pentamidine) 4mg/kg • d, intramuscular injection or intravenous treatment two weeks. Local injection may have induration or hematoma, if one uses a large dose can cause kidney, pancreas damage, such as urticaria. Intravenous drug side effects are decreased blood pressure, sweating, shortness of breath, palpitations, chest tightness, dizziness, nausea, vomiting. PCP can also be used cotrimoxazole (SMZ100mg/kg, TMP20mg/kg) sub-2 intravenous drip. SMZ-TMP Deputy reaction neutropenia, fever, rash and liver toxicity. In addition, use of chlorine lincomycin (first-dose intravenous infusion of 0.6g, followed by a 0.3-0.45g, daily oral 4th).