Analysis of emergency management of 50 acquired immunodeficiency syndrome patients with pneumocystis carinii pneumonia

Abstract

Objective To improve the emergency management of acquired immunodeficiency syndrome (AIDS) patients complicated with pneumocystis carinii pneumonia (PCP). Methods From November 2017 to February 2019, the clinical data including epidemiology, clinical symptoms, laboratory examination and imaging features of 50 AIDS patients complicated with PCP admitted to Beijing Ditan Hospital, Capital Medical University were collected and analyzed, respectively. All patients were treated with trimethoprim sulfamethoxazole (TMP-SMZ) or glucocorticoid. Blood gas analysis was performed before treatment and after 6 h, 12 h, 24 h, 48 h and 72 h of treatment, respectively. Dynamic changes of oxygen partial pressure (PaO2), alveolar artenal oxygen partial pressure difference (A-aDO2) and oxygenation index (OI) at different time points before and after treatment were analyzed to evaluate the effect of emergency treatment. Results Among the 50 csaes, 36 cases had a clear epidemiological history characterized by fever, dry cough and progressive dyspnea. The absolute counts of T lymphocytes and CD4+ T lymphocytes in peripheral blood were significantly declined. The computed tomography (CT) of chest indicated diffuse ground glass opacity. Nine cases were methenamine silver-stained positive in bronchoalveolar lavage fluid. There were 47 cases who were treated with TMP-SMZ combined with intravenous or oral glucocorticoid, while the remaining 3 cases with treatment of TMP-SMZ alone. After emergency management, PaO2 and OI increased with the treatment time, whereas A-aDO2 decreased. Conclusions AIDS complicated with PCP had typical epidemiological characteristics, clinical and imaging manifestations. TMP-SMZ should be used as early as possible to reduce the mortality once clinical PCP is considered. TMP-SMZ combined with corticosteroid is effective in the treatment of patients with severe PCP. Key words: Acquired immunodeficiency syndrome; Pneumocystis pneumonia; Trimethoprim sulfamethoxazole; Glucocorticoid; Emergency management