Overview
Pneumocystis carinii is a bronchopulmonary disease caused by the fungus Candida. Clinical manifestations are similar to those of bronchitis and tuberculosis, which are cough, sputum, mucus or gelatinous sputum, sometimes with blood in the sputum, and fever, fatigue, chest tightness, dyspnea, etc. in some cases.
Etiology
Candida Geospora belongs to the class of imperfect fungi, from the family of pedunculated spores, Geospora, whose nutrient cells are fungal filaments, which are easy to cleave into arthrospores. There are no germinating spores and ascospores. The fungus can invade through the respiratory tract, oral cavity and skin, and invade the skin mucosa and internal organs, most often involving the lungs and intestinal tract. Patients are often immunocompromised when the infection occurs and the disease develops.
Symptoms
Clinical manifestations are similar to those of bronchitis and tuberculosis, including cough, sputum, mucus-like or gelatinous sputum, sometimes with blood in the sputum, fever, fatigue, chest tightness, dyspnea, etc., and wet rales can be detected at the bottom of the two lungs on auscultation. Those with extreme weakness and obvious suppression of the immune mechanism may develop sepsis, causing multiple infections of the skin, oral mucosa, and intestinal tract. Erythematous itching of the skin, subcutaneous abscesses, leukoplakia of the oral mucosa, as well as abdominal pain, diarrhea, and mucopurulent bloody stools.
Examination
1. Pathogenetic examination
(1) Direct microscopic examination Sputum, mucous membrane leukoplakia, biopsy tissue, treated with 10% potassium hydroxide and then directly smeared for microscopic examination, rectangular arthrospores (4 μm × 8 μm) or rounded spores (4-8 μm in diameter) can be seen, with positive Gram’s stain, and there is no gap between two arthrospores.
(2) Bacterial culture On glucose peptone agar medium, fast growing at room temperature, colonies are membranous, moist, grayish-white and sticky. The morphology of microscopic examination is the same as that of direct microscopic examination, and sometimes bud tubes can be seen emerging from one corner of the arthrospores.
(3) Animal inoculation No pathogenicity.
2. Skin test
Some cases may show a positive test for leucodermin.
3. Blood tests
The total number of leukocytes and the percentage of neutrophils are markedly elevated. Patchy infiltration with smooth edges in the lung field, and some cases may have thin-walled cavities.
4. Chest X-ray signs are mainly
Diagnosis
Clinical signs and symptoms of the disease are not specific, and Candida can be detected in the oral cavity and intestinal tract of normal people. Therefore, in addition to the repeated detection of the organisms or spores, the diagnosis of the disease must be combined with other clinical data, including the underlying disease, the status of the immune mechanism, etc., and exclude tuberculosis, bacterial, viral, mycoplasma bronchitis and pneumonia, as well as other fungal diseases before a determination can be made. Positive skin test can be used as an auxiliary diagnosis.
Differential diagnosis
Tuberculosis, bacterial, viral, mycoplasma bronchitis and pneumonia, and other fungal diseases should be differentiated.
Complications
In patients with extreme physical weakness and suppressed immune system, septicemia of Geomyces may occur, causing multiple infections of the skin, oral mucosa, and intestinal tract.
Treatment
Pharmacological treatment is carried out on the basis of actively improving the body’s immune function. The main drugs are: potassium iodide, ketoconazole and fluconazole. There are also reports that aerosol inhalation of ketoconazole solution has some efficacy on this disease.