The pneumocystose is a “opportunist infection” due to a Micro-organisme, Pneumocystis carinii (nowadays called Pneumocystis jiroveci ). The infestation with P. carinii is very current in the general population, about 70%, but leads to a lung disease only when the rate of lymphocytes T CD4+ circulating is lower than 200/ml. The two types of patients concerned are grafted under Immunosuppresseur S and the HIV positive patients HIV at the stage AIDS.
Clinical signs
The inaugural signs are discrete and not very specific: introduction of a cough dries which is raised little by little, accompanied by Fièvre and deterioration of the general state.At a patient known HIV presenting these signs it is immediately necessary to evoke the pneumocystose.
At a known patient not HIV but presenting this table and not answering a traditional antibiotic treatment of bacterial Pneumonia, it is necessary to carry out a serology HIV.
In the absence of treatment, the evolution is made towards a table of diffuse Pneumonie interstitial with respiratory Insuffisance acute.
Diagnosis
- thoracic radiography even the scanner: diffuse, bilateral alvéolo-interstitial images and with prevalence perished-hilaire.
- the biological diagnosis: direct description of Pneumocystis jiroveci in a bronchoalveolar liquid of Washing.
Treatment
- the treatment prophylaxic is containing Co-trimoxazole as soon as the rate of lymphocytes T CD4+ reaches the threshold of 200/ml. In the event of Allergy to the Co-trimoxazole, disease prevention is done by Aérosol S monthly magazines of Pentamidine.
- the curative treatment calls also upon the Co-trimoxazole (or with the Pentamidine) but with very strong amounts, relayed by a treatment of maintenance to weaker amounts until the restoration of the Immune system.
See too
- AIDS
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