Laboratory And Clinical Diagnosis Research Of Pneumocystis Jiroveci Pneumonia

Objective: To compare the sensitivity and stability of Wright-Giemsa's stained, nested PCR asssy(PC-ITS-PCR) to detect the Pneumocystis Jiroveci in patients with Pneumocystis Jiroveci Pneumonia, and to explore the diagnosis of PCP concerning clinical manifestation.Methods: Collect the sputum, tracheal discharge, bronchoalveolar lavage fluid and specimen of lung tissue from patients with AIDS, kidney transplant, lung cancer and bronchitis, Wright-Giemsa's stained was used to detect the organism in sputum, lung impression preparation and bronchoalveolar lavage fluid(BALF). Pneumocystis jiroveci DNA in sputum, lung tissue and BALF were detected by nested PCR method using PC-ITS primers. Retrieve incidence of PCP in china through literature involving portion of gender and age, feature and endemic distribution incorporated the data of this research to explore clinical diagnosis of PCP.Result: In this study, detection rate of Wright-Giemsa's stained is 32.39%, while the sensitivity of PCR is 61.97%. (x~2=11.30, p<0.01),there is significant difference.. Through literature retrieval we find domestic PCP cases between 2001-2007 are mostly AIDS complicating PCP (82.10%), male are more than female and mortality is 13.08%. Patients with AIDS complicating PCP account for 97.37% of death. Invasion regions are mostly Henan, Guangxi, Hunan and Guangdong; 6 cases of Pneumocystis Jiroveci Pneumonia are confirmed in this research (male 5,femal l)and all are improved and discharged after treatment.Conclusion: The Wright-Giemsa's stained to detect PC is simple t but the specificity is low while nested PC-ITS-PCR method has higher sensitivity than that of the Wright-Giemsa's stained and has higher sensitivity and specificity than PCR with single primer. Nested PC-ITS-PCR is the first time used to detect PCP in the research in Patients with AIDS in Qingdao while premier PC-ITS is highly sensitive to PC and applicable to detect clinical patients. The result is accurate and fast, so nested PC-ITS-PCR should be recommended. In china, most cases of PCP are Patients with AIDS complicating. According to data at present and our analysis in this research, patients with he following findings can be diagnosed AIDS complicating PCP (a) HIV infection, (b) CD4~+<200/μl (c)fever, cough, expectoration accompanying tachypnea, progressive dyspnea, cyanosis, decreasing saturation of blood oxygen (d) X-ray of chest revealing interstitial pneumonia or/and CT showing ground glass change of lung. (e) effective treatment by trimethoprirn-sulfamethoxazole...