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Management of Pneumocystis carinii pneumonia in patients with conventionally caused immune suppression


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Title: Management of Pneumocystis carinii pneumonia in patients with conventionally caused immune suppression
Other Titles: AIDS以外の免疫抑制患者におけるニューモシスチスカリニ肺炎の管理
Authors: Katsumata, Tatsuya / Kohno, Shigeru / Koga, Hironobu / Yoshitomi, Yuko / Matsuda, Haruko / Mitsutake, Kotaro / Higashiyama, Yasuhito / Miyazaki, Yoshitsugu / Hara, Kohei
Authors (alternative): 勝又, 達哉 / 河野, 茂 / 古賀, 宏延 / 吉富, 裕子 / 松田, 治子 / 光武, 耕太郎 / 東山, 康仁 / 宮崎, 義継 / 原, 耕平
Issue Date: 15-Dec-1991
Publisher: 日本熱帯医学会 / Japanese Society of Tropical Medicine
Citation: 日本熱帯医学会雑誌, vol.19(4), pp.347-355; 1991
Abstract: AIDS以外の免疫抑制状態に,ニューモシスチスカリニ肺炎を発症した,10症例に臨床的検討を加えた。発症様式では,成人T細胞白血病の2例は前駆症状が長かったが,他の症例では急性の発症を示した。発症時の胸部レントゲンでは,全例において両側ぴまん性の陰影を認めた。確定診断は,8例において経気管支的肺生検,または気管支肺胞洗浄によって2例において剖検によってなされた。診断時には,LDHの値は発症前の値に比べて高度に上昇しており,肺胞気動脈血酸素分圧較差も高度に開大しており,これらの値が早期診断に有用であることが示唆された。他の日和見感染の合併は,5例に認められた。治療においては,ぺンタミジンとST合剤の併用は,副作用は少なかったものの,有効率も低かった。コルチコステロイドは,補助療法として有用と考えられた。 / Ten non-AIDS patients with Pneumocystis carinii pneumonia were studied. While the 2 patients with adult T cell leukemia had longer prodromes, the other 8 patients had acute onset. At presentation a chest radiograph revealed an abnormal bilateral diffuse shadow in all cases. In 8 patients, diagnostic material was obtained by transbronchial lung biopsy and/or bronchoalveolar lavage, and in 2 patients at postmortem. At the time of diagnosis the serum lactate dehydrogenase value was much higher than prior to the acute illness, and the AaDO2 gradient was highly increased: These appear to be useful as markers for an initial diagnosis. Other opportunistic organisms were isolated in 5 patients. The concomitant use of pentamidine and cotrimoxazole was relatively well tolerated, but with a high incidence of treatment failure. Corticosteroids appeared to be effective as an adjunctive therapy.
URI: http://hdl.handle.net/10069/22401
ISSN: 03042146
Rights: Japanese Society of Tropical Medicine
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/22401

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