| Objective: To analyze the clinical features of PCP(Pneumocystis pneumonia)in 3non-AIDS patients,and to analyze the clinical features and related diagnosis and treatment plan of this disease.To improve the majority of medical staff of the disease awareness.Methods: Three cases of Pneumocystis pneumonia diagnosed by the First Affiliated Hospital of Dalian Medical University was reported,and the clinical cases reported in China from January 2010 to October 2016 were retrieved.Results: This article reported the first case of ITP(immune thrombocytopenia,immune thrombocytopenia)complicated with pneumococcal pneumonia cases,After the experience of anti-PCP treatment patients improved;The second case is renal transplantation after pneumococcal pneumonia,although the active rescue but still due to the merger of serious complications and death;The third case is diffuse parenchymal lung disease cases,and ultimately due to severe lung disease,respiratory failure increased death.This paper reviewed the previous reports of non-HIV / AIDS cases of PCP,clinical features are summarized below: 143 patients,the ratio of male to female was 1.47: 1,The age distribution was 6 months to 73 years,mean(45.5 ± 14.69years);All patients had varying degrees of progressive dyspnea,fever,and / or cough,The mean time from onset to acute exacerbation and respiratory failure was(6 ± 2.47)days;The underlying diseases included 24 cases of Ig A nephropathy(22.02%),21 cases of nephrotic syndrome(19.27%),19 cases of connective tissue disease(19.47%),15cases of organ transplantation(13.76%),13 cases of hematological disease(11.93%),17 cases of Other cases(15.60%);98% of patients had received hormonal,immunosuppressive and / or radiochemotherapy before PCP;54 cases of patients referred to drug regimens:48 patients were treated with glucocorticoid(88.89%),19 patients treated with mycophenolate(35.19%),14 patients treated with cyclophosphamide(25.93%),6 patients treated with cyclosporine(11.11%),5 patients treated with(9.26%),3 patients treated with tripterygium wilfordii(5.56%),3 patients treated with rituximab(5.56%),1 patients treated with hydroxychloroquine(1.85%),and 1 patients treated with methotrexate(1.85%).All patients had varying degrees of fever,progressive dyspnea,and / or cough,from the onset of the disease to acute exacerbations and respiratory failure,the longest is 12 days,the shortest is 2 days,the average is 6 ± 2.47 days.Fifty-two patients had a physical examination,no obvious abnormalities in 26 cases(50%);In 66 cases of blood gas analysis,39 cases of type I respiratory failure(59.09%);59 cases of(1,3)-?-D glucan test(G test),of which 41 cases were positive,the positive rate was 69.49%;40 patients had sputum culture results,the results showed that there were 6 strains of Acinetobacter baumannii(15.00%),6 strains of Pseudomonas aeruginosa(15.00%),4 strains of Staphylococcus aureus(10.00%),2 strain Klebsiella pneumoniae(5.00%);Thirty patients had viral test results,including 10 cases of cytomegalovirus(33.33%),3 cases of EB virus(10.00%),1 case of influenza virus(3.33%);There were 118 cases of chest imaging,of which 111 cases showed multiple or diffuse ground-glass opacities(94.07%),18 cases of solid shadow(15.25%),14 cases of pleural effusion(11.86%),22 cases of lobular interval thickening(18.64%),6 cases of tracheobronchial dilatation(5.08%),6cases of mediastinal and / or subcutaneous emphysema(5.08%),10 cases of small airbag shadow(8.47%);Sulfamethoxazole or caspofungin was selected for the treatment of pathogens,with an overall mortality rate of 14.88%.113 cases reported the diagnosis of PCP method,including clinical diagnosis of 56 cases,accounting for 49.56%,etiology confirmed 57 cases,accounting for 50.44%.118 cases referred to the outcome after treatment,which improved 98 cases,the effective rate of 80.99%;death in 18 cases,the mortality rate of14.88%;5 cases to give up treatment,accounting for 4.13%;40 patients mentioned hospital stay,up to 69 days,the shortest 12 days,the average length of stay was 23.74 ±11.80 days.Conclusion: Non-HIV/AIDS Pneumocystis carinii pneumonia occurred in patients receiving long-term immunosuppressive therapy,the signs and disease severity does not match,Clinical symptoms and imaging changes lack of specificity,rapid progression of the disease,often with respiratory failure,critical condition,but if the early diagnosis and early treatment,mortality can be significantly reduced. |
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