从多种感染,如淋巴瘤复杂的肺囊感染的经验教训:一个案例报告
Huaichong Wang1, Yuying Lang1, Xinjun Cai1
1Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, People's Republic of China.
这一案例研究突出了一个淋巴瘤患者,患有Pneumocystis jirovecii肺炎 (PJP). 有效的治疗包括调整trimethoprim-sulfamethoxazole (TMP-SMX) 与caspofungin,证明在复杂淋巴瘤病例中成功管理PJP.
科学领域:
- 在瘤学瘤学.
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
背景情况:
- 淋巴瘤患者面临着机会性感染的高风险,例如Pneumocystis jirovecii肺炎 (PJP).
- 淋巴瘤中的PJP可以迅速发展为呼吸衰竭和死亡.
- 有效的PJP诊断和治疗,包括替代trimethoprim-sulfamethoxazole (TMP-SMX) 的替代方案,至关重要.
研究的目的:
- 为了呈现PJP复杂的淋巴瘤病例.
- 为了说明调整PJP药物的挑战和策略,以获得最佳的患者反应.
- 突出元基因组下一代测序 (mNGS) 在诊断共感染中的作用.
主要方法:
- 甲基因组下一代测序 (mNGS) 支气管支气管洗液 (BALF) 用于病原体检测.
- 经验治疗使用美罗,TMP-SMX和抗结核药物.
- 顺序调整PJP治疗方案,包括TMP-SMX与米卡丁,然后TMP-SMX与卡斯波丁,并添加teicoplanin.
- 多学科团队讨论治疗决策.
主要成果:
- 在BALF.中,mNGS检测到了Pneumocystis jirovecii (PJ) 和Mycobacterium tuberculosis (MTB) 两种病毒.
- 最初的治疗导致了药物诱导的肝毒性和胃肠道不良反应.
- 将PJP治疗修改为用caspofungin和teicoplanin的TMP-SMX,导致发烧正常化和感染在30天内消失.
- 计算机断层扫描 (CT) 证实肺部透物完全消失.
结论:
- 在复杂病例中,BALF-NGS对于快速PJP诊断非常有价值.
- 对于MTB的mNGS读数需要与其他方法进行确认,以排除载体状态.
- 与 caspofungin 结合的 TMP-SMX 是这种淋巴瘤患者的 PJP 的有效治疗方案,与含有 micafungin 的 TMP-SMX 不同.
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