肺孢子蟲肺炎與肺結核在慢性咳嗽病人中的相關性

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肺孢子蟲肺炎好發於免疫缺陷 (immunodeficiency) 病人,於一般健康病人當中 並不多見,但鑒於有研究曾經指出肺孢子蟲肺炎有偽裝成肺結核的臨床症狀 出現,及共同感染肺孢子蟲與肺結核的情形,加上國內曾對學齡前兒童普檢 肺孢子蟲血清抗體,其血清流行率高達 56.6% ,是促成本次對於慢性咳嗽病 人篩檢肺孢子蟲感染的最大因素。

自 2001 年 5 月至 2001 年 8 月間陸續在台北市慢性病防治院以隨機方式採集 2 06 支慢性咳嗽病人痰液檢體,以傑母沙染色法 (Giemsa stain) 進行肺孢子蟲 (Pneumocystis carinii) 鏡檢,陽性或疑似之檢體利用照相機拍照進行二次確認

, 206 支作業完成之檢體中 42 支呈現肺孢子蟲陽性反應,總體陽性率為 20.3 9 %;肺結核菌的培養則屬台北市慢性病防治院的業務範圍,在經由兩個月 的培養之後, 203 支檢體中 13 支培養出肺結核菌,總體陽性率為 6.40 %;經 由交叉比對之後,有 2 支檢體呈現雙重感染 (dual infection) 的現象。

經由這次的調查顯示,在這些懷疑為肺結核的慢性咳嗽病人中,事實上有高 達 19.42 % (40/206) 的病人是單一感染肺孢子蟲,比 5.42 % (11/203) 的病人 單一感染肺結核高出許多,由於肺孢子蟲肺炎與肺結核同樣是肺部疾病,臨 床症狀極易混淆,容易造成誤診,所以本篇研究建議醫院檢驗部門或醫師在 民眾因疑似肺結核就診時,除了做有關肺結核菌的檢查或培養之外,肺孢子 蟲的鏡檢也是需要納入考量的。

肺孢子蟲肺炎與肺結核在慢性咳嗽病人中的相關 性

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Pneumocystis carinii pneumonia (PCP) prefers to occur in patients with immunodeficie ncy than normal ones. Recent studies pointed out that PCP might masquerade pulmonar y tuberculosis and PCP and pulmonary tuberculosis might dual infect in lung. In additio n, the seroprevalence of P. carinii infection among preschool children in central Taiwan was up to 56.6%. These all pushed us to make this study of investigating the PCP infect ion among the patients with chronic cough.

Since May to August 2001, we had collected 206 random specimens of sputum successi vely from Taipei Municipal Hospital for Chronic Diseases. By means of Giemsa stainin g for first confirming P. carinii cysts by microscopy, doubly confirmed by photo picturi ng, 42 of 206(20.39%) specimens presented positive results. TB culturing in Taipei Mu nicipal Hospital for Chronic Diseases for two months, 13 of 203(6.40%) specimens pres ented positive results for Mycobacterium tuberculosis. After cross-matching, 2 specime ns presented dual infection for PCP and TB.

This investigation revealed that among these patients with chronic cough suspected as T B infection, actually 19.42% (40/206) patients were single infected with PCP, much hig her than 5.42% (11/203) patients single infected with TB. Because PCP and TB are bot h diseases in lung and their clinical symptoms are so similar to be miss-diagnosed, we s uggest that in addition to TB culture, the Giemsa staining of sputum for

P. carinii is recommended when people see a doctor for chronic cough.

Study of correlation between Pneumocystis cari nii pneumonia and pulmonary tuberculosis in pa tients with chronic cough

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