Пневмоцистная пневмония: клинические и микробиологические аспекты

Клиническая Микробиология и Антимикробная Химиотерапия. 1999; 1(1):12-22

​ Каражас Н.В., Дехнич А.В.
пневмоцисты пневмоцистная пневмония грибы иммунитет лечение пневмонии
Раздел
Болезни и возбудители
Тип
Журнальная статья
Публикация
Клиническая Микробиология и Антимикробная Химиотерапия. 1999; 1(1):12-22

Аннотация

Клиническое значение Pneumocystis carinii как возбудителя пневмонии установлено в 1942 г. До недавнего времени большинство специалистов относило P.carinii к простейшим. Однако сейчас имеются бесспорные доказательства принадлежности этого микроорганизма к грибам. До появления иммуносупрессивной терапии и СПИДа пневмоцистная пневмония была редким заболеванием, отмечавшимся преимущественно у недоношенных новорожденных. Основным звеном в развитии пневмоцистной пневмонии является нарушение числа и/или функции Т-лимфоцитов. Однако состояние гуморального иммунитета, по видимому, также играет определенную роль. Для диагностики пневмоцистной пневмонии необходима визуализация микроорганизма в клиническом материале. Основной метод диагностики – бронхоальвеолярный лаваж. Используются также индуцированное отделение мокроты, трахеальная аспирация, трансбронхиальная биопсия, открытая биопсия легких. Препаратом выбора как для терапии, так и для профилактики пневмоцистной пневмонии с 1975 г. является ко тримоксазол. Активностью против P.carinii обладают также пентамидин, атоваквон, триметрексат, дапсон и др. Ведется разработка новых антипневмоцистных препаратов, таких, как пневмокандины, бенаномицины, сордарины, селективные ингибиторы дигидрофолатредуктазы.

  • 1. Allegra C.J. et al. Trimetrexate for the traetment of P.carinii pneumonia in patients with acquired immunodeficiency syndrome //N.Engl.J.Med.– 1987.– Vol.317.– P.978 –985.
  • 2. Barone S.R. et al. Increased survival of young infants with P.carinii pneumonia and acute respiratory failure with early steroid administration //Clin.Infect.Dis.–1994.– Vol.19.– P.212 –213.
  • 3. Cadranel J. et al. Site directed bronchoalveolar lavage and transbronchial biopsy in HIV infected patients with pneumonia //Amer.J.Resp.Crit.Care Med.– 1995.– Vol.152.– P.1103 –1106.
  • 4. Centers for Disease Control. Pneumocystis pneumonia – Los Angeles //MMWR.– 1981.– Vol.30.– P.250 –252.
  • 5. Cirioni O. et al. In vitro activity of terbinafine,atovaquone and co trimoxazole against Pneumocystis carinii //J.Antimicrob.Chemother.–1995.–Vol.36.– P.740 –742.
  • 6. Cirioni O. et al. In vitro activity of lytic peptides alone and in combination with macrolides and inhibitors of dihydrofolate reductase against Pneumocystis carinii // J.Antimicrob.Chemother.– 1998.– Vol.42.– P.445 –451.
  • 7. Contini C. et al. Structural changes in rat Pneumocystis carinii surface antigens after terbinafine administration in experimental P.carinii pneumonia //J.Antimicrob. Chemother.–1999.– Vol.43.– P.301 –304.
  • 8. De Luccia A.J., Walsh T.J. Antifungal peptides:novel ther Antimicrob. Agent Chemother.–1999.–Vol.1.– P.1 –11.
  • 9. Dube M.P., Sattler F.R. Pneumocystis //D.Armstrong, J.Cohen,eds.Infectious Diseases.–1999.– Vol.8.– P.30.1 –30.6.
  • 10. Edman J.C. et al. Ribosomal RNA sequences shows Pneumocystis carinii to be member of the fungi //Nature. –1988.– Vol.334.– P.519 –522.
  • 11. Gangjee A. et al. Selective Pneumocystis carinii dihydrofolate reductase inhibitors:design, synthesis, and biological evaluation of new 2,4 diamino 5 substituted furo [2,3 d ] pyrimidines //J.Med.Chem.– 1998.– Vol.41.– P.1263 –1271.
  • 12. Gigliotti F. et al. Immunisation with Pneumocystis carinii gpA is immunogenic but not protective in a mouse model of P.carinii pneumonia //Infect.Immun.– 1998.– Vol.66.– P.3179 –3182.
  • 13. Gordon S.M. et al. Should prophylaxis for Pneumocystis carinii pneumonia in solid organ transplant recipients ever be discontinued?//Clin.Infect.Dis.–1999.– Vol.28.– P.240 –246.
  • 14. Hadley W.K., Valerie L. Pneumocystis //P.R.Murray et al.,eds.Manual Clin.Microbiol.–1995.– Vol.62.– P.738 –748.
  • 15. Helweg Larsen J. et al. Clusters of Pneumocystis carinii pneumonia:analysis of person to person transmission by genotyping //Q.J.Med.– 1998.– Vol.91.– P.813 –820.
  • 16. Herreros E. et al. Sordarins:in vitro activities of new antifungal deriates against pathogenic yeasts, Pneumocystis carinii,and filamentous fungi // Antimicrob.Agents Chemother.–1998.– Vol.42.– P.2863 –2869.
  • 17. Huang L. et al. Performance of an algorithm to detect P.carinii pneumonia in symptomatic HIV persons // Chest.– 1999.– Vol.115.– P.1025 –1032.
  • 18. Huges W.T. et al. P.carinii pneumonitis in children with malignancies //J.Pediatr.–1973.–Vol.82.– P.404 –415.
  • 19. Huges W.T. et al. Comparison of pentamidine isethionate and trimethoprim sulfamethoxazole in the treatment of P.carinii pneumonia //J.Pediatr.– 1978.– Vol.92.– P.185.
  • 20. Huges W.T. et al. Prevention of P.carinii pneumonitis in AIDS patients with weekly dapsone //Lancet.–1990.– Vol.2.– P.1066.
  • 21. Huges W.T., Killmar J.T. Synergistic anti P.carinii effects of erythromycin and sulfisoxazole //J.Acquir. Immune Defic.Syndr.– 1991.– Vol.4.– P.532 –537.
  • 22. Huges W.T. et al. Comparison of atovaqoune (566C80) with trimethoprim sulfamethoxazole to treat of P.carinii pneumonia in patients with AIDS //N.Engl.J.Med.– 1993.– Vol.328.– P.1521.
  • 23. Huges W.T., Anderson D.C. Pneumocystis carinii pneumonia //R.D.Feigin, J.D.Cherry, eds.Textbook of Pediatric Infectious Diseases.– 1998.– P.2490 –2499.
  • 24. Huges W.T. Pneumocystis carinii pneumonia //S.L.Gorbach, J.G.Bartlett, N.B.Blacklow, eds.Infectious Diseases.–1998.– P 601 –605.
  • 25. Huges W.T. et al. Effects of aerosolized synthetic surfactant, atovaquone, and combination of these on murine Pneumocystis carinii pneumonia //J.Infect.Dis.–1998. –Vol.177.– P.1046 –1056.
  • 26. Horowitz H.W., Wormser G.P. Atovaquone compared with dapsone to prevent Pneumocystis carinii pneumonia //N.Engl.J.Med.– 1999.– Vol.340.– P 1512 –1513.
  • 27. Kaplan J.E. et al. Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus infected adolescent and adult in the United States: reassessment of indications for chemoprophylaxis // J.Infect.Dis.–1998.– Vol.178.– P.1126 –1132.
  • 28. Kazanjian P. et al. Pneumocystis carinii mutations associated with sulfa and sulfone prophylaxis failures in AIDS patients //AIDS.– 1998.– Vol.12.– P.873 –878.
  • 29. Kirby H.B. et al. P.carinii pneumonia treated with pyrimethamine and sulfadiazine //Ann.Intern Med.– 1971.– Vol.75.– P.505 –509.
  • 30. Koneman E.W. et al. Pneumocystis carinii //E.W.Koneman et al.,eds.Color Atlas and Textbook of Diagnostic Microbiology.– 1997.– Vol.19.– P.1140 –1143.
  • 31. Levine S.J. et al. Diagnosis of Pneumocystis carinii pneumonia by multiple lobe, site – directed bronchoalveolar lavage with immunofluorescent antibody staining in HIV – infected patients receiving aerosolized pentamidine prophylaxis //Amer.Rev.Respir.Dis.– 1992.– Vol.146. –P.838 –843.
  • 32. Lipschik G.Y. et al. Improved diagnosis of Pneumocystis carinii infection by polymerase chain reaction on induced sputum and blood //Lancet.– 1992.– Vol.340.– P.203 –206.
  • 33. Mateos S. et al. Elevated non transferrin bound iron in the lungs of patients with Pneumocystis carinii pneumonia //J.Infect.– 1999.– Vol.38.– P.18 –21.
  • 34. Mazars E., Dei Cas E. Epidemiological and taxonomic impact on Pneumocystis biodiversity //FEMS Immunol. Med.Microbiol.–1998.– Vol.22.– P.75 –80.
  • 35. Mcintosh K. et al. Toxicity and efficacy of daily vs.weekly dapsone for prevention of P.carinii pneumonia in children infected with human immunodeficiency virus // Pediatr.Infect.Dis.J.– 1999.– Vol.18.– P.432 –439.
  • 36. Meduri G.U. et al.Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections //Chest. –1991.– Vol.100.– P.1272 –1276.
  • 37. Meuwissen J.H.E. et al. Parasitologic and serologic observations of infection with Pneumocystis in humans // J.Infect.Dis.–1977.– Vol.136.– P.43 –49.
  • 38. O’Donnell W.J. et al. Clearance of Pneumocystis carinii cysts in acute P.carinii pneumonia –assessment by serial sputum induction //Chest.–1998.–Vol.114.– P.1264 –1268.
  • 39. Pascale J.M. et al. Intranasal immunization confers protection against murine Pneumocystis carinii lung infection //Infect.Immun.– 1999.– Vol.67.– P.805 –809.
  • 40. Peglow S.L. et al. Serologic responses to Pneumocystis carinii antigens in health and disease //J.Infect.Dis.– 1990.– Vol.161.– P.296 –306.
  • 41. Petty B.G. et al. Escalating multiple dose safety and tolerance study of oral WR6026 in HIV infected subjects // J.Acquir.Immune Defic.Syndr.Hum.Retrovirol.–1999. –Vol.21.– P 26 –32.
  • 42. Pixley F.J. et al. Mitochondrial gene sequences show fungal homology for Pneumocystis carinii //Mol.Microbiol. –1991.– Vol.5.– P 1347 –1351.
  • 43. Powles M.A. et al. Efficacy of MK 991 (L 743,872), a semisyntetic pneumocandin,in murine models of Pneumocystis carinii //Antimicrob.Agents Chemother. –1998.– Vol.42.– P 1985 –1989.
  • 44. Rabadonirina M. et al. Detection of Pneumocystis carinii DNA in blood samples from human immunodeficiency virus infected patients by nested PCR //J.Clin. Microbiol.–1999.– Vol.37.– P.127 –131.
  • 45. Sandhu G.S. et al. Laboratory diagnosis of Pneumocystis carinii infections by PCR directed to genes coding for mitochondrial 5S and 28S ribosomal RNA //Diagn. Microbiol.Infect.Dis.– 1999.– Vol.33.– P.157 –162.
  • 46. Schmatz D.M. et al. Treatment of Pneumocystis carinii pneumonia with 1,3 b glucan synthesis inhibitors // Proc.Natl.Acad.Sci.–1990.– Vol.87.– P.5950 –5954.
  • 47. Stringer J.R., Cushion M.T. The genom of Pneumocystis carinii //FEMS Immunol.Med.Microbiol.–1998.– Vol.22.– P 15 –26.
  • 48. Tamburrini E. et al. Potential impact of Pneumocystis carinii genetic diversity on the molecular detection in human host //FEMS Immunol.Med.Microbiol.–1998. –Vol.22.– P.37 –49.
  • 49. Theus S.A. et al. Immunization with the major surface glycoprotein of Pneumocystis carinii elicits a protective response //Vaccine.– 1998.– Vol.16.– P 1149 –1157.
  • 50. Toma E. et al. Clindamycin with primaquine vs.trimethoprim sulfamethoxazole therapy for mild and moderately severe Pneumocystis carinii pneumonia in patients with AIDS //Clin.Infect.Dis.–1998.– Vol.27. –P.524 –530.
  • 51. Walzer P.D. Pneumocystis carinii //G.L. Mandell, J.E. Bennett, R. Dolin, eds.Mandell, Douglas and Bennett ’s. Principles and Practice of Infectious Diseases.– 1995.– P.2475 –2487.
  • 52. Weverling G.J. et al. Discontinuation of Pneumocystis carinii prophylaxis after star of highly active antiretroviral therapy in HIV –1 infection //Lancet.– 1999.– Vol.353.– P 1293 –1298.
  • 53. Wakefield A.E. Genetic heterogeneity in Pneumocystis carinii //FEMS Immunol.Med.Microbiol.–1998.– Vol.22.–P.5 –13.
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