pentamidine吸入予防中にカリニ肺炎を発症したAIDS症例の臨床的検討

Clinical Study on Pneumocystis carinii Pneumonia in HIV-infected Patients Receiving Aerosol Pentamidine Prophylaxis

　pentamidine吸入予防中にカリニ肺炎を発症したAIDS症例6例の臨床像を解析した．カリニ肺炎発症予防中の症例では14例中2例（14.3％），再発予防中の症例では8例中4例（50.0％）にカリニ肺炎を発症した．カリニ肺炎発症時には末稍血CD4陽性リンパ球数の平均は5.8／μl,LDHの平均は867.5IU／l,CRPの平均は7.6mg／dl，動脈血酸素分圧の平均は70.4Torrであった．胸部画像所見は両側気胸，上肺野優位の混合性陰影，胸水貯留を伴う片側間質性陰影など非典型的な症例が多かった．治療経過は2例がsulfamethoxazole—trimethoprim内服，4例がpentamidine点滴静注でカリニ肺炎は治癒した．また，pentamidine点滴静注を施行した症例のうち2例は後に2週に1回のpentamidine吸入に変更したが，再発を認めなかった．HIV感染者ではpentamidine吸入中でもカリニ肺炎の発症に注意すべきである．

Pneunzocystis carinii pneumonia (PCP) is one of themost common opportunistic diseases in patients withHIV infection. As the incidence of PCP increases in HIV-infected patients with absolute CD4 lymphocyte count ofless than 200 cells/μl, such patients should receive treat-ment for the prevention of PCP. Aerosol pentamidine isone of the prophylaxes against PCP.

We have already encountered 6 cases in which PCPoccurred in HIV-seropositive patients receiving aerosolpentamidine prophylaxis. Two cases (14.3%) of PCPoccurred in 14 patients without prior episode of PCP and4 cases (50.0%) of PCP occurred in 8 patients who hadsuffered one prior episode of PCP. The mean CD4 cellcount was 5.8 cells/μl, serum LDH level was 867.5 IU/l,serum CRP level was 7.6mg/dl and PaO₂ was 70.4 Torrat the onset of PCP. The chest radiographic presenta-tion of PCP often indicated non-typical findings such asspontaneous pneumothorax, infiltrates predominating inthe upper lung field and unilateral infiltrates with pleu-ral effusion. However, the clinical condition improved inall patients after receiving oral sulfamethoxazole-trimethoprim or intravenous pentamidine. Although 2patients received 300mg of aerosol pentamidine twicemonthly after then, they suffered no recurrence of PCP.

These results suggest that we should be on the alert todetect the occurrence of PCP even in HIV-infectedpatients receiving aerosolized pentamidine prophylaxis.