Bronkoalveolar Lavaj Örneklerinde Pneumocystis jirovecii Pozitifliği ve Ampirik Tedavi Yaklaşımı
Pneumocystis jirovecii (PJ) immünosupresif hastalarda pnömoniye sebep olan fırsatçı bir maya benzeri fungustur. En riskli grup HIV-pozitif hastalardır ancak son yıllarda HIV-negatif immünosuprese hastalarda daha sık görülmektedir. Bu çalışmada Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesinde Pneumocystis jirovecii pnömonisi (PJP) ve diğer fırsatçı solunum yolu patojenleri şüphesi ile bronkoskopik örnekleri değerlendirilen hastalarda PJ polimeraz zincir reaksiyonu (PZR) pozitiflik oranı, hasta risk faktörleri, klinik ve laboratuvar bulgularını retrospektif olarak değerlendirilmiştir. Toplam 133 hastanın bronkoalveolar lavaj örneğinden PJ-PZR çalışılmış ve % 13 (17/133) oranında pozitiflik bulunmuştur. PZR pozitif hastaların % 41’inin HIV-pozitif ve % 59’unun HIV-negatif immünosuprese hastalar olduğu görülmüştür. Örnek gönderilen hastaların 72’sine ampirik trimetroprim/sülfametoksazol başlanmış, PZR pozitif hastalarla beraber toplam 38 hastada tedaviye devam edilmiştir. PJ-PZR negatif 21 hastanın dokuzunda klinik yanıt alınmıştır ve başka bir enfeksiyon etkeni gösterilememiştir. Toplam 66 hastaya hipoksik olmaları nedeniyle steroid verilmiştir. Ampirik tedavi başlanan hastaların % 24’ünde PJ-PZR pozitifliği ve % 36’sının tedaviye yanıt verdiği görülmüştür. HIV-negatif immün suprese hastalarda PJP akla gelmeli ve gerekli örnek alındıktan ve ampirik tedaviye başlandıktan sonra başka bir etken gösterilemiyorsa ve yüksek klinik şüphe varsa tedaviye devam edilebilir.
Pneumocystis jirovecii Positivity and Empirical Treatment Approach in Bronchoalveolar Lavage Samples
Pneumocystis jirovecii (PJ) is an opportunistic yeast-like fungus that causes pneumonia in immunosuppressed patients. The most risky group is HIV-positive patients, but in recent years it has been more common in HIV-negative immunosuppressed patients. In this study, PJ polymerase chain reaction (PCR) positivity rate, patient risk factors, clinical and laboratory findings were evaluated retrospectively in patients with suspected Pneumocystis jirovecii pneumonia (PJP) and other opportunistic respiratory pathogens at Marmara University Pendik Training and Research Hospital. Pneumocystis jirovecii PCR was studied from the bronchoalveolar lavage sample of a total of 133 patients, and 13 % (17/133) were positive. Forty one % of PCR positive patients were HIV-positive, and 59 % were HIV-negative immunosuppressed patients. Empirical trimethoprim/sulfamethoxazole was initiated in 72 of the patients whose specimens were sent, and treatment was continued in 38 including PCR positive patients. Clinical response was obtained in 9 of 21 PJ PCR negative patients, and no other infectious agents were shown. A total of 66 patients were given steroids because they were hypoxic. Twenty four % of patients who started empirical treatment had positive PJ PCR, and 36 % responded to the treatment. In HIV-negative immunosuppressed patients, PJP should be considered, and treatment can be continued if no other factor could be shown and there is high suspicion after taking the required specimen and starting empirical treatment.
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- ISSN: 1301-3114
- Yayın Aralığı: Yılda 3 Sayı
- Başlangıç: 1986
- Yayıncı: Antibiyotik ve Kemoterapi Derneği
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