HIV and pneumonia than to treat. Consequences of pneumonia in HIV-infected people: prognosis and treatment of severe stage of the disease

Pneumocytic pneumonia is a disease that occurs in people with immune problems. It is ubiquitous and can affect people of any age and any gender. Pneumonia can be expressed in different ways, depending on the immune status infected. After the lesion, whooping cough, gray sputum, pain in the chest, fever.

Pneumocystis pneumonia- This is a disease that manifests itself after a couple of weeks, as a result of interaction with a carrier of bacteria. In HIV-infected people, the latent process is much shorter.

Pneumocysts, penetrating through the bronchial tree into the alveoli, begin to develop and provoke inflammatory processes. As a result, the number of healthy cells decreases and an alveolar-capillary block occurs.

If the immune system is weak, the pathogen develops rapidly and provokes pulmonary insufficiency. Due to the disruption of the membrane, pathogens enter the bloodstream and combine with a secondary infection.

Pneumocystis pneumonia - complications and consequences

As a result of the neglect of pneumocystis pneumonia, a lung abscess, escudative pleurisy, and unexpected pneumothorax occur. Pneumocystosis has several definitive options:

• cure
• Death from 1 to 100% depending on the manifested immunodeficiency. Death can occur if respiratory failure when gas exchange occurs. In the absence of treatment, the lethal outcome in children reaches 20-60%, and in adults - 90-100%.

Important. When interacting with those affected by the virus, HIV-infected patients often relapse.

Who is at risk?

The main risk groups among babies and adults:

1. HIV-infected
2. Patients with cancer
3. Patients with blood and connective tissue problems
4. With immunosuppressive therapy, radiation
5. Organ Transplant Patients
6. smokers
7. Elderly people who have diabetes
8. People interacting with harmful and dangerous components.

Pneumocystis pneumonia often affects children in early age with weakened immunity due to prematurity, with malformations, in the case of cytomegalovirus infection.

Features of pneumocystis pneumonia in HIV-infected

Pneumocystis pneumonia is a disease that often manifests itself as a result of the presence of HIV infection in patients.

With pneumocystis pneumonia, the following stages of the disease are observed:

• The initial stage is the absence of inflammatory changes in the alveoli, the manifestation of trophosiodes, cysts.
• Intermediate stage - violations of the alveolar epithelium, significant amount macrophages inside the alveoli, as well as cysts.
• The final stage is marked by the activation of alveolitis, a change in the epithelium. The presence of cysts is noticeable both inside macrophages and in the lumen of the alveoli.

Features of the disease in children

1. The period of occurrence is often children at 5-6 months of age who are at risk (patients with rickets, premature babies, with IUI pathology, central nervous system, oncology).
2. Gradual manifestation of the disease - loss of appetite, low weight gain, subfebrile temperature, whooping cough-like cough, shortness of breath (more than 70 breaths per minute), pale skin (slightly cyanotic). At this point, consequences may occur - pulmonary edema, which is fatal.
3. When viewed on an X-ray, focal shadows of a "cloudy" lung are noticeable.

Causes

The causative agent of this pneumonia is a unicellular microorganism - pneumocystis, which belongs to fungi. It resides permanently in the lung tissue of every person and is safe. It can provoke pneumonia only if there is immunodeficiency states. 70% of those with pneumonia are HIV-infected people. In addition, pneumocystis pneumonia can manifest itself in people prone to the development of pathology:

• Children who were born prematurely, who survived asphyxia, who have developmental anomalies.
• People of any age who exercise radiation therapy, or are treated with glucocorticosteroids, cytostatics, or other medications that destroy the immune system.
• Sick rheumatoid arthritis, lupus erythematosus, tuberculosis, cirrhosis of the liver and other chronic diseases.

Attention! Pneumocystis pneumonia spreads through the air by drip and from mother to baby during pregnancy.

Inflammation does not form stable immunity, as a result of which relapses can occur when interacting with the pathogen in HIV-infected patients, pneumonia recurs in 25%.

Symptoms of pneumocystosis

With pneumocystis pneumonia, the incubation period is 7 to 10 days. It can be in the form of acute chronic bronchitis, acute respiratory infections, laryngitis, or pneumocystis interstitial pneumonia. Pneumonia has 3 stages:

• Edema (7-10 days)
• Atelectatic (no more than 4 weeks)
• Emphysematous (more than 3 weeks)

During the edematous stage, the symptoms of fever and intoxication are not pronounced. The temperature may remain normal or subfebrile. Patients complain of weakness, fatigue, loss of appetite, decreased activity. There is a cough with a small amount of viscous sputum. While listening to the lungs, hard breathing is felt, while there are no wheezing.
During the atelectatic stage, shortness of breath occurs, a bluish tint of the skin appears, sometimes pulmonary - heart failure is observed. The cough is severe and incessant, with transparent sputum which is hard to come off. When listening to the lungs, small and medium rales are felt.

During the emphysematous stage, the condition improves - shortness of breath passes, and the cough gradually disappears.

In addition, pneumocytic pneumonia is characterized by pain in the chest area. On examination, the doctor determines an increased heartbeat, wheezing in the lungs and a blue nasolabial triangle.

Diagnostics

Diagnosis of pneumocystis pneumonia is carried out on the basis of such measures:

• Anamzez. The doctor finds out about the interaction with an infected person, determines the presence of pathology, clarifies the symptoms.
• Physical examination allows you to determine the presence of shortness of breath, respiratory failure, tachycardia.
• Instrumental methods involve the use of x-rays of the lungs. It is he who will determine the violations that have occurred in the lung zone.
• Laboratory analyzes are primarily general analysis blood, lung biopsy, blood serology for detection of antibodies to pneumocystis.

Treatment

The peculiarity of pneumocystis pneumonia is that the causative agent of the disease is not susceptible to most antibiotics. Often, drugs to which he has sensitivity provoke various negative moments, especially in babies and HIV-infected people.

In the case of present respiratory failure, the following treatment regimens are distinguished:

• At mild form prescribe sulfamethoxazole, trimethoprim, biseptol
• In the moderate form - clindamycin, dapsone, atovaquone
• With a running form - primaquin, pentamidine, trimetrexate.

Medicines must be combined with each other, as they are very toxic and can provoke rashes, fever, neuropathy, hepatitis, and gastrointestinal pathologies.

In addition to these drugs, therapy involves the use of expectorant drugs, mucolytics, anti-inflammatory drugs. In the treatment of HIV-infected patients, in addition to the main drugs, corticosteroids are prescribed to reduce inflammation in the lungs and make breathing easier. Respiratory activity must be constantly monitored. In some embodiments, it is necessary to connect the patient to the ventilator.

The duration of treatment is two weeks, for HIV - infected - three weeks. Often, an improvement in well-being with a properly selected treatment regimen is observed after 4-7 days.

Pneumocystis pneumonia (PCP, pneumocystis) is a species that can be life-threatening in people with weakened immune systems. The causative agent of PCP is Pneumocystis jiroveci, a little-studied genus of ascomycete fungi. People living with HIV (human immunodeficiency virus) infection with a CD4 count below 200 are at risk of developing pneumocystis pneumonia.

Symptoms may include fever, shortness of breath, tightness or pain in the chest, fatigue, night sweats and dry cough. Fortunately, there are drugs that can effectively prevent and treat this disease.

PCP is relatively rare today; however, the disease remains common among people who do not know they have HIV, people who do not receive ongoing HIV care, and people with severely weakened immune systems as a result of taking immunosuppressive drugs.

Causes and Risk Factors of Pneumocystis Pneumonia

PCP is a type of pneumonia caused by a fungus Pneumocystis jiroveci. This fungus does not make people with a healthy immune system sick, but it can cause a lung infection in a person with a weakened immune system.

Pneumocystis pneumonia is one of many infections that people living with HIV can develop, also called opportunistic infections. This only happens if your immune system is weakened enough that your body becomes vulnerable to infections that would not otherwise affect you. PCP is the most common opportunistic infection among people living with HIV.

As part of your treatment, you may also be given oxygen to breathe through a mask.

Treatment for Pneumocystis pneumonia usually lasts 21 days.. How the body responds to treatment depends on the medications used, whether you have had previous episodes of PCP, the severity of the disease, the condition of your immune system and when therapy started.

Your doctor should closely monitor your treatment. General side effects of taking TMP/SMX include rash, fever, nausea, vomiting, loss of appetite, low level leukocytes and low platelets. The doctor may recommend additional medicines to eliminate these side effects.

Many people who are infected with the human immunodeficiency virus (HIV-positive) are allergic or hypersensitive to these drugs. In these cases, alternative medications may be prescribed.

There is also evidence that, in some cases where people have hypersensitivity to co-trimoxazole, starting with a small amount of trimethoprim/sulfamethoxazole and increasing it up to full tolerance of the full dose may help the person overcome adverse reactions or to help “desensitize” the person with hypersensitivity to the drug.

Taking co-trimoxazole pregnant women may increase the risk of birth defects in children. Additives folic acid can reduce this risk. Since a woman with PCP also faces more high risk preterm labor and miscarriage, pregnant women who develop PCP after 20 weeks of gestation should be monitored for early cuts uterus.

If, after four to eight days of antibiotic therapy, the pneumonia has shown no signs of improvement or worsens, a doctor may recommend another treatment. Other drugs used in PCP, such as Dapsone plus Trimethoprim, Primaquine plus Clindamycin or Atovaquone, are alternative medicines for people intolerant to trimethoprim/sulfamethoxazole.

After the inflammation in the lungs has gone, your doctor may prescribe an additional drug to prevent the infection from coming back (called preventive therapy). This prophylactic medicine should be taken until the CD4 cell count exceeds 200 for at least three consecutive months. Talk to your doctor before starting or stopping any prescribed medications.

The best way to prevent PCP is to keep your immune system in good shape and keep your CD4 count slightly above 200. Taking antiretroviral drugs can help keep your CD4 count above 200.

If you smoke, another great way to help you reduce your risk of getting PCP is to stop smoking. Studies have shown that HIV-infected people are much more likely to develop PCP than non-smokers with the human immunodeficiency virus.

Preventive drugs should be taken by HIV-infected adults and adolescents, including pregnant women and people taking antiretroviral drugs, who have a CD4 count below 200 or have a history of the disease.

The medicine used to treat PCP can also be used to prevent it. The most effective prophylactic drug is Trimethoprim/Sulfamethoxazole More about the Author.

Pneumocystis pneumonia in HIV-infected people is an indicator disease of this immunodeficiency, since this pathology occurs mainly only in this category of patients. Healthy people do not suffer from this disease. Without HIV infection, it occurs only in premature babies due to immaturity of the immune system and in patients with cancer or taking immunosuppressive drugs.

This disease has no seasonality. Since only the state of immunity affects its occurrence. And the prevalence and number of these microorganisms in nature, depending on the season, does not play a special role.

For the same reason, epidemics of this disease do not occur. All cases of its occurrence are sporadic. But in groups, the likelihood of infection in individuals at risk increases, since the possibility of contact with carriers of pneumocysts in such situations is higher.

The mechanism of development of pneumocystosis

This disease is transmitted by airborne droplets. This is how pneumocysts get into the bronchi and alveoli. There they attach to their walls, causing damage and interstitial edema.

At this stage, the mucus fills the gaps of the alveoli and small bronchi, which leads to the appearance of respiratory failure.

As a result, the lungs are filled with alveolar foam (waste surfactant) containing a large number of toxic substances.

Lack of surfactant and swelling of the alveoli leads to disruption of gas exchange and exclusion of large areas of the lungs from breathing. Due to this, the phenomena of respiratory failure increase, which can be very pronounced and lead to death.

How the disease manifests itself

The course of pneumocystis pneumonia is most often erased. Symptoms are not expressed, slowly increase, therefore correct diagnosis often placed on late stages illness.

The incubation period after infection, on average, lasts 10 days. But it can take up to 12-14 weeks.

The first manifestations of the disease are weakness, fatigue, drowsiness, and appetite disorders. The temperature most often remains within the normal range, but there may be subfebrile condition - an increase to 37.5-38 degrees.

There is usually no pronounced intoxication syndrome with this form of the disease. But if another type of infection is attached, which is often the case with HIV-infected people, intoxication can manifest itself in the form high temperature and bad health.

Within 3-5 weeks, symptoms from the lungs appear:

• dyspnea;
• cough (first dry, then wet);
• soreness in the chest.

Dyspnea

Shortness of breath is the very first symptom. At first, it occurs only with tangible physical exertion, but over time it does not go away at rest. Shortness of breath can be the only manifestation of pneumocystosis for a long time.

Cough

2-3 weeks after the onset of shortness of breath, a dry cough joins it. It occurs mainly in the morning. But then it is celebrated at any time of the day. The nature of the cough gradually changes to wet. A clear, viscous sputum appears, which is coughed up with great difficulty.

Chest pain

As the process progresses, patients begin to complain of chest pain. They may be minor. And they can be so strong that patients begin to breathe shallowly to reduce pain. This leads to an even greater increase in respiratory failure.

In parallel with these symptoms, patients have weight loss, pallor of the skin with acrocyanosis (blue tip of the nose, fingers and toes), increased breathing and pulse.

Diagnostics

The diagnosis of this disease is difficult to make, since there is no bright clinical picture. Most of the symptoms are general, do not allow suspecting pneumonia on initial stages. Therefore, they should not be ignored and attributed to fatigue. It is better to immediately go to the hospital for examination.

The doctor will prescribe:

• general blood test and biochemical;
• analysis for the number of CD4-lymphocytes in the blood;
• immunological examination of blood for the presence of antibodies to pneumocystis;
• microscopy and bacteriological analysis sputum, bronchial lavage or biopsy;
• x-ray chest;
• CT and MRI.

Table 1. Possible results of immunoassay for antibodies to pneumocystis:

A doctor's diagnosis of pneumocystosis can be prompted by a decrease in the number of CD4-lymphocytes less than 200 per µl of blood, which corresponds to the stage of AIDS. Pneumonia in AIDS occurs in 90% of patients, so such a sharp decrease in CD4 lymphocytes is important. diagnostic sign this disease.

Treatment

Treatment of pneumocystis pneumonia in HIV-infected patients is necessarily carried out in a hospital setting. The therapeutic instruction in this case requires the appointment of antibacterial drugs, antiretroviral agents, mucolytics and expectorants, anti-inflammatory drugs, measures for the treatment and prevention of respiratory failure.

Antibacterial therapy

Treatment of pneumocystis pneumonia begins with the appointment of broad-spectrum antibiotics, since most often in HIV-infected patients not only pneumocystis, but also other infections are detected.

Doctors prefer the following drugs:

• Biseptol;
• Pentamidine;
• Trimethoprim, etc.

All of them are toxic, can inhibit the function of the liver, kidneys and hematopoietic system.

Antiretroviral therapy

AT different countries the approach to this issue varies - some doctors prescribe antiretroviral therapy simultaneously with antibiotics, others prefer to wait. In any case, to prevent further suppression of the immune system, it is necessary to take drugs that affect the cells of the human immunodeficiency virus (HIV) itself.

With pneumocystis pneumonia, DFMO (difluoromethylornithine) becomes the drug of choice, as it not only inhibits RNA viruses (including HIV), but also prevents further reproduction of pneumocysts. However, this drug has a significant disadvantage - its price.

Other antiretroviral agents are shown in the photo below.

Anti-inflammatory therapy

In this case, in order to reduce inflammation in the lungs, not anti-inflammatory drugs are prescribed, but hormonal ones. Non-steroidal glucocorticosteroids cope with the task more efficiently and faster.

But these drugs have pronounced side effects and can also depress the immune system, so they can not be used for a long time.

Improved drainage function

In order to improve drainage function mucolytic and bronchodilator drugs are prescribed. They thin the mucus, making it easier to pass. This is especially true in the case of pneumocystosis, since in this disease the sputum is very viscous and thick.

Prevention and treatment of respiratory failure

In order to restore the level of oxygenation of the body, patients with pneumocystis pneumonia are prescribed oxygen therapy - inhalation of O2 through a mask under slight pressure. Patients unconscious or with severe respiratory failure are temporarily transferred to mechanical ventilation using an oxygen mixture.

Prevention

Since pneumocystis pneumonia and AIDS (the last stage of HIV) are practically inseparable pathologies, with a pronounced decrease in CD4-lymphocytes, all HIV-infected patients are advised to prevent pneumocytosis. For this purpose, they are prescribed antibiotic therapy until the level of CD4-lymphocytes exceeds 200 per μl of blood. It is also recommended for those who have already had this disease in order to avoid relapse (secondary prevention).

Table 2. Prophylactic antibiotic therapy in HIV-infected people:

When the level of CD4-lymphocytes reaches above 200 per µl of blood and these indicators are maintained for three months, prophylactic antibiotics can be stopped. In addition, such patients need to adhere to a nutritious diet, observe the rules of personal hygiene, carry out wet cleaning of the premises daily and ventilate them often, and undergo regular examinations with a doctor. You can learn more about ways to prevent pneumocystosis in HIV patients from the video in this article.

Pneumocystis pneumonia in HIV-infected patients without treatment leads to death in 100% of cases. Only timely diagnosis and treatment can reduce this figure to a minimum. Therefore, with such serious illness it is important to find a competent doctor and see him regularly, fulfilling all prescriptions and recommendations. This will maximize the life of a person with HIV and preserve its quality.

Pneumonia in HIV (pneumocystosis) is a common complication of the human immunodeficiency virus, which is diagnosed in more than half of patients. The disease is characterized by damage to the lower organs respiratory system, and against the background of a decrease in immunity, it can cause an early death in the absence of timely and correct treatment. After infection, the period of onset of symptoms varies from 7 to 40 days.

Pathogenic microorganisms begin to multiply on the respiratory organs

Pneumocystis carinii is a unicellular fungus that causes pneumocystis pneumonia in HIV-infected people. The pathogenic microorganism is transmitted by airborne droplets from an infected person or animal. Also can long time dwell in the air.

Most often, infection occurs in childhood, but with normal immunity does not cause the development of the disease. With a decrease in the protective properties of the body, penetrating into the organs of the respiratory system, it causes a disease.

Inflammation of the lungs in case of damage by pneumocysts is characterized by the development of extensive edema and purulent abscesses in the tissues of the lower organs of the respiratory system.

Most often, the diagnosis appears after an x-ray of the lungs.

Should know! According to statistics, the carrier of pneumocystosis is more than 90% of those infected with HIV and about 80% of medical personnel.

Pathogenesis

With human immunodeficiency, a decrease in T-lymphocytes responsible for the immune response is dangerous to life and health.

Against the background of the reduction of T-helpers, pneumocysts penetrate into the organs of the respiratory system and actively multiply in the alveoli, which, as they spread, occupy the alveolar space and cover the entire lung tissue. This entails compaction and an increase in the size of the membranes, which leads to disruption of gas exchange and hypoxia. In addition, at the sites of attachment of pneumocytes, lung tissues are damaged, which leads to the accumulation of infiltrate and purulent exudate.

The described pathological processes lead to the development of respiratory failure.

Should know! In patients with pneumonia with HIV infection, there is a high probability that the pathogenic microorganism will spread through the blood or lymph from the lungs to other organs.

Features of the flow

Pneumocystis pneumonia in HIV develops gradually, due to the presence of a long incubation period, from one week to 40 days. During this time, infection and reproduction of pathogenic flora in the alveoli of the lungs occurs. During this period, the patient begins to worry about episodic fever, weakness, excessive sweating, loss of appetite. As a rule, during the latent period of the course, patients do not seek medical help, which aggravates the general condition and complicates future treatment.

A feature of pneumonia in immunodeficiency is the frequent recurrence of the disease or the transition to chronic form currents. Often, pneumocystosis can occur in a latent form and disguise itself as acute respiratory diseases, bronchitis or laryngitis, while distinctive feature are frothy discharge white color from mouth.

How the disease manifests itself

Symptoms and treatment in adults are interrelated, so it is important to accurately identify the former. At the initial stage of the development of the disease, the patient may be disturbed by a deterioration in appetite and a slight decrease in body weight. Periodic increases in body temperature to subfebrile levels are possible. As you progress pathological process symptoms of a violation of the respiratory system are increasing, which are accompanied by pallor of the skin, cyanosis of the lips.

The disease is difficult to tolerate, even for a person who is not infected with HIV, it is difficult to cope with this disease, so without strong drugs not enough

Dyspnea

Shortness of breath is the leading symptom of pneumonia, diagnosed in almost 100% of cases of pneumonia. On the early stages The development of pneumocystosis can disturb the patient only during intense physical exertion, but after 14 days it accompanies the patient even in a state of complete rest.

Shortness of breath has an expiratory form and is characterized by the occurrence of difficulties on exhalation, which is associated with the appearance of obstacles in the path of air passage. The muscles of the abdominal region are involved in the process when the chest remains motionless.

Cough

In almost all patients, the disease is accompanied by an unproductive or dry cough, which intensifies in the morning or at night. Sputum separation is possible in active smokers. The symptom is paroxysmal.

Cough will torment throughout the illness

Chest pain

Cough may be accompanied by irritation, pain and discomfort in the chest area, which indicates the development of complications from the organs of the respiratory system.

Fever

An immunodeficiency state is accompanied by a decrease in body temperature. When infected with pneumocystosis, there is an increase in body temperature to subfebrile levels. In the last stages of the disease, hyperthermia is possible with critical levels - 38-39 0 C.

pathogens

Pathogenic microorganisms become the causative agents of the disease:

Diagnosis of the disease begins with a survey of the patient for complaints, medical history. After that, the patient's lungs are listened to, during which it is possible to determine wheezing, as well as a change in breathing. Based on the data obtained, an initial diagnosis is made and the patient is sent for laboratory and instrumental studies.

An experienced doctor will immediately hear characteristic wheezing in the lungs and prescribe treatment

The first group of diagnostic measures includes:

• general clinical and biochemical analysis blood, during which a change in the number of leukocytes, erythrocytes, protein and erythrocyte sedimentation rate is detected, which indicate the presence of an inflammatory process in the body;
• microscopic examination of sputum (bronchial secretion) by ELISA or PCR, which can determine the DNA or antibodies of the pathogen;
• bacteriological examination of sputum or bronchial secretion allows you to determine the resistance of pathological microorganisms to antibiotics, which allows you to choose the most effective treatment.

In order to determine the degree and nature of the lesion of the bronchopulmonary system, a chest x-ray is prescribed. During the study, a modification of the lungs is diagnosed, the presence of blackouts that indicate inflammatory process, accumulation of infiltrate or purulent exudate.

Therapeutic tactics

Treatment of pneumonia in HIV-infected people begins immediately, without waiting for the results of studies - delay can cost the patient's life. For this purpose, drugs of complex action are prescribed with the active substance 5-[(3,4,5-trimethoxyphenyl)methyl]-2,4-pyrimidinediamine, Co-trimoxazole, as well as alpha-difluoromethylornithine ( this drug currently most commonly used), (Pentamidine) 4,4′ (Pentamethylenedioxy) dibenzamidine.

Further treatment is selected individually by the attending physician, based on general condition and the effectiveness of the initial therapy and is aimed at destroying the pathogen, maintaining the protective properties of the body and normalizing the functioning of the respiratory system.

Which doctor should I contact?

When the first signs of an inflammatory process appear in the lower organs of the respiratory system, you should contact a pulmonologist. During therapy, you will also need to consult an infectious disease specialist.

Treatment of HIV-infected people is carried out in a general hospital, as they do not pose an epidemiological threat to others.

Treatment

Treatment of pneumocystis pneumonia or pneumocystosis lasts 21 days, during which regular monitoring of the patient's condition, blood counts and the effectiveness of the chosen direction of treatment is carried out.

Antibacterial therapy

To suppress the activity of pneumococci that caused pneumonia are prescribed antibacterial drugs wide spectrum of action: Trimethoprim (Trimethoprim), Sulfamethoxazole (Sulfamethoxazole), Co-trimoxazole. The latter is prescribed for severe pneumonia by intramuscular injection. This group of medicines is also indicated for the prevention of the attachment of bacterial flora in viral or fungal pathology etiology.

Antiretroviral therapy

ART ( antiretroviral therapy) is aimed at suppressing the activity and rate of HIV reproduction, restoring the immune system, as well as improving the patient's quality of life. ARVT requires a clear schedule of intake, with dosage compliance. This group includes:

• nucleoside reverse transcriptase inhibitors (Zidovudine, Didanosine, Abacavir);
• non-nucleoside reverse transcriptase inhibitors (Saquinavir, Nevirapine, Tenofovir, Emtricitabine, Rilpivirine);
• protease inhibitors -furanyl ether, Ritonavir(Ritonavir), N-(3-[(1R)-1-[(2R)-6-Hydroxy-4-oxo-2-(2-phenylethyl)-2-propyl-3,4- dihydro-2H-pyran-5-yl]propyl]phenyl)-5-yl(trifluoromethyl)pyridine-2-sulfonamide (and as disodium salt));
• integrase inhibitors (Raltegravir, Elvitegravir);
• receptor inhibitors (Maraviroc);
• fusion inhibitors (enfuvirtide).

Anti-inflammatory therapy

With inflammation of the lungs, anti-inflammatory drugs of the group of glucocorticosteroid drugs (Dexamethasone, Prednisolone) are prescribed. From the group of anti-inflammatory nonsteroidal drugs to reduce body temperature and stop the inflammatory process, a course of Ibuprofen, Nurofen, Paracetamol is recommended.

Improved drainage function

To improve sputum discharge, a course of expectorants and sputum thinners is prescribed: Bromhexine, ACC, Carbocysteine. To stimulate the drainage function, medications with a bronchodilator effect (Eufillin) are also prescribed.

Prevention and treatment of respiratory failure

To prevent pneumonia and complications from HIV, healthy lifestyle life: give up alcohol, smoking, eat right, exercise physical activity as far as possible. For this purpose, retroviral therapy is also important, which is prescribed to patients with HIV.

With the rapid development of respiratory failure, a course of corticosteroids, oxygen therapy, vibration massage, as well as artificial ventilation lungs.

Forecast

At timely treatment pneumocystis pneumonia, the prognosis is favorable. In the absence of therapy and final stages disease, there is a high risk of pathology transition to a chronic form with frequent relapses or death from respiratory failure.

Complications

• pneumothorax - accumulation of air in the pleural cavity;
• acute respiratory failure;
• abscessing pneumonia - a purulent-destructive process;
• pleurisy - inflammation of the pleural sheets;
• bronchial obstruction syndrome.

Conclusion

Pneumonia in AIDS dangerous complication which can cost the patient's life. The probability of developing the disease is more than 50% in all HIV-positive, which is associated with weak immunity. When diagnosing pneumocystosis, it is prescribed combination therapy, aimed at the destruction of the pathogen, maintaining the protective properties of the body, stopping the inflammatory process and normalizing respiratory activity.

Any treatment must be prescribed by a doctor! Attention - do not self-medicate. This article is informational and aimed at specialists.

A disease that is harmless to most people, such as pneumocystis pneumonia, in HIV-infected people is a serious pathology that requires difficult treatment, and the forecasts of doctors are not always favorable. This is due to the fact that the HIV virus affects the human immune system, making his body defenseless against all diseases.

Of course, those infected with the HIV virus are aware of this feature of their disease and diligently monitor their health. But you can protect yourself only from infections that lie in wait for a person outside, and not from those that are already present inside. This applies to many pathogenesis, but is especially true for pneumocystis pneumonia, which annually causes the death of hundreds of HIV-infected people.

Description

Pneumocystosis is a specific inflammation of the lung tissue, which manifests itself similarly to ordinary pneumonia. The difference between the disease and pneumonia is that its causative agent is a yeast-like fungus called Pneumocystis jirovecii. This microorganism is opportunistic, it is often part of the microflora of the lungs and respiratory tract.

Pneumocystis becomes pathogenic with rapid reproduction, an increase in its presence in the body with concomitant suppression of other microorganisms. That is, pneumonia develops due to disturbances in the balance of the pulmonary microflora. The impetus for the growth of pneumocysts and, accordingly, the development of pathology, is the weakening of the body's immune forces, which is characteristic feature HIV infection.

According to medical classifications, pneumonia of this type refers to opportunistic infections. That is, to a group of diseases caused by opportunistic viruses or cellular organisms - bacteria, protozoa, fungi, which people with a normally functioning immune system do not suffer from. The disease code in the international classification list of ICD 10 is B59.0.

The disease itself proceeds with manifestations similar to ordinary pneumonia, with the only difference being that the usual remedial measures pathogenesis does not respond, on the contrary, the patient's condition is constantly deteriorating.

In general, the disease is characterized by the following:

Symptom	With absence HIV infection	In the presence of HIV infection
Temperature	At around 37-38 degrees, constant	At around 39-41 degrees, paroxysmal, with severe feverish conditions
Cough	Heavy, staccato, persistent, i.e. coughing with sore throat and chest	Protracted hysterical attacks, as if the person turns inside out
Sputum	Doesn't cough, but felt	Felt and coughed up in small amounts, often with blood
Breath	Superficial, aggravated by physical exertion	Superficial, with constant shortness of breath, manifested both in a state of activity and at rest

Many people mistakenly believe that this type of pneumonia only affects people with the HIV virus and those with AIDS. This is not true. In a person with a normally functioning immune system, this pathogenesis does not really occur, but with the slightest failure in immunity, the disease makes itself felt.

Pneumonia caused by opportunistic fungi often affects the elderly, newborns and children. younger age. This disease affects those who abuse diets, lead a specific lifestyle, or take potent drugs for a long time. But only with HIV infection and in AIDS patients it is characteristic severe course pathology that can lead to death.

Causes

The disease occurs only in the presence of a pathogen in the microflora of the lungs - Pneumocystis jirovecii. Whether it is present in the human body initially or it enters from the outside is the subject of controversy of scientists, the same as the belonging of this opportunistic microorganism to a certain class.

For quite a long time, pneumocysts were classified as protozoa, but in the middle of the last century, after a series of discoveries in microbiology, they began to be considered an intermediate step between protozoa and fungi. Toward the end of the last century, the microorganism was officially recognized as a fungus.

Nevertheless, the pneumocystis, although classified as a fungal flora, does not show sensitivity to most antifungal drugs. The microorganism is different appearance throughout its life cycle. The pneumocyst changes three main stages during its life span:

1. polymorphic trophozoites.
2. Precysts.
3. cysts.

Each cyst is protected by cellular multilayer shell, has the shape of a sphere and is equipped with 6-8 sporozoites. In fact, the causative agent of the disease at the cyst stage is outwardly similar to a jellyfish.

Polymorphic trophozoites, unlike cysts, are similar to amoebas, and precysts are a transitional stage and clear external characteristics deprived. Each of the stages of development of the fungus is pathogenic for human health, but only if pneumocysts accumulate a lot, which happens with immunodeficiency.

The inflammatory process itself in the lung tissues causes rapid reproduction and rapid growth of the fungus, and not its predominance in general composition microflora. With growth, change of stages and active reproduction, pneumocysts release toxins that affect the alveolar and other tissues. This not only ulcerates the internal surfaces of the respiratory organs and generally poisons the body, but also disrupts the natural processes of gas exchange.

The mechanics of the exhalation process suffer most from the vital activity of pneumocysts. During exhalation, the alveoli are supported from collapsing by a mixture of surfactants called surfactant. The same mixture ensures normal functioning immune cells in the respiratory organs.

In case of a shortage of surfactant, the alveoli fall, and a full exhalation does not occur, the body tries to make up for the lack of substances necessary for functioning, which, in turn, provokes further reproduction of the fungus, as it provides a nutrient medium for pneumocysts.

signs

Symptoms of pneumocystosis are generally similar to those of ordinary pneumonia, but there are also differences depending on the age of the patient, his state of health, and the causes that caused the manifestation of the disease.

In HIV it is characterized the following signs visible to the patient himself:

• fever, fever up to 40 degrees;
• hysterical "wet" cough;
• accumulations in the lungs and respiratory tract large volumes of sputum with high viscosity.

In addition, the disease is accompanied by:

1. Shortness of breath, both with and without exertion.
2. Heaviness and shallowness of breathing.
3. Rapid weight loss.
4. Profuse sweating without a clear localization, but with a specific smell.

chief hallmark pneumocystosis, which can accurately identify this disease even without a visit to the doctor, is the unproductive use of the usual medicines. For example, antipyretics will not give the desired effect, taking them will lower the body temperature by a maximum of a couple of degrees and for a short period of time.

The same applies to expectorants. The use of syrups or tablets will not cause sputum to come out. The same applies to other medicines commonly used to treat simple pneumonia.

The disease, manifested against the background of HIV infection or AIDS, has another feature. The lack of immune protection opens up almost unlimited spaces for pathogenic microorganisms, as a result of which pneumocysts are not limited to lung tissues.

Mushrooms penetrate the liver, spleen, heart and other organs. As a rule, this is the last stage of the development of the disease, in which therapy is no longer effective. In the absence of HIV infection or AIDS, such a spread of pneumocysts in the body does not occur.

Course of the disease

From a medical point of view, the disease begins at the moment when the level of CD4 cells in the blood falls to 200/1 per microliter. This level is considered critical for the normal functioning of the human immune system.

The composition of CD4 cells includes all functional immune cells, however, the level of physicians is determined by the number of the following of them:

• T-lymphocytes produced bone marrow universal protective cages.
• T-killers that destroy virus-affected cells in the body.
• B-lymphocytes, a subtype of lymphocytes, are responsible for the condition humoral immunity i.e. the production of antibodies.
• Monocytes, mononuclear leukocyte-type cells capable of transformation and responsible for the healing and repair of inflamed or otherwise damaged tissues in the body.
• NK cells, granular lymphocyte forms that fight tumors and other mutations in the cells of the body.

Accordingly, the pneumocyst is transformed from a harmless component of the microflora into a pathogenic and dangerous microorganism only after the immune functionality decreases in a complex way. In the absence of only one type of protective immune cell, pneumocysts are not activated.

The disease begins with inflammation in the interstitial tissues of the lungs. This process appears as:

1. Severe hyperemia.
2. Thickening, compaction of the alveolar septa with concomitant edema.
3. Reducing the width of the lumen in the alveoli.
4. An increase in the level of lactate dehydrogenase, followed by a violation in gas exchange processes.
5. Hypoxemia, that is, a decrease in the level of oxygen in tissues and organs.
6. Hypercapnia, that is, violations of the biochemical balance in the blood due to an increase in the level carbon dioxide.

It is the large swelling in the alveoli that causes difficulty in breathing in patients, and excess carbon dioxide leads to shortness of breath and dizziness. In the absence of therapy, a condition develops, which doctors call hypoxia. This is a long, chronic lack of oxygen in all organs and tissues of the body with a simultaneous excess of carbon dioxide in them. Developed hypoxia is one of the main causes of death in pneumonia caused by pneumocystis.

Revealing

Diagnosis of pathology is based on a complex medical events, the main ones being:

• x-ray;
• CT scan.

These studies complement each other. The results of CT alone are an incomplete picture that needs additional confirmation and clarification. The combination of the two methods provides doctors with an overall holistic picture of the state of diffuse or diffuse-mosaic zones and the degree of damage to the lung tissue.

In addition to these studies, the so-called "bronchial flush", that is, a sputum sample for laboratory research, is taken. If it is possible to identify pneumocysts in the biological material, the diagnosis is considered confirmed.

These three diagnostic procedures are based on the detection of SARS caused by the activity of pneumocysts. Although each method is effective, only their combination allows the diagnosis of pneumocystosis to be made.

When in doubt, doctors prescribe a micropreparation of the lung with contrast agents. With pneumocystosis, this method allows you to visually determine the presence of:

1. Accumulations of pneumocysts in the lumen of the alveoli.
2. Edema of the interalveolar septa.
3. Infiltration with lymphocytes and plasma cells.

However, in the presence of HIV infection this study rarely done because it is usually not necessary.

Rest medical procedures prescribed by doctors to identify the general condition of the human body. These tests include blood tests, urine tests, and other procedures. Their conduct is necessary in order to identify possible concomitant infections and to have an accurate idea of ​​the state of the organism as a whole, of all the processes occurring in it.

The standards for diagnosing pneumocystosis are unchanged and do not depend on such nuances as the age of the patient, his lifestyle, gender and medical records. That is, the presence of HIV infection or AIDS does not make any adjustments to the order of diagnostic procedures.

Treatment

Therapy of this disease in HIV-infected and those with AIDS is difficult because not all drugs can be used. Typical medical recommendations on drug therapy pneumocystosis in these diseases include the use of such drugs:

• "Co-Trimoxazole";
• "Isothionate";
• "Pentamidine";
• "Primaquine" in combination with "Clindamycin";
• "Atovacwon";
• "Dapson" in combination with "Trimethoprim".

Biseptol treatment, successfully used in the treatment of patients whose causes of pneumocystosis are not associated with the presence of HIV infection, while carrying the immunodeficiency virus or AIDS, is not considered effective. Nevertheless, this drug is often included in complex therapy.

Of course, the list of medicines necessary in each specific case, the order of their use, dosage and duration of administration is determined by the attending physician. There are no general recommendations for the treatment of pneumocystosis in the presence of the immunodeficiency virus in the body.

Difference in treatment this disease in patients with HIV infection or AIDS with the treatment of patients without such pathologies lies in the fact that in the second case, the actions of physicians are aimed at increasing immunity, and in the first, at destroying the pathogenic flora.

Prevention

Since there is no exact, unambiguous answer to the question of how a pneumocyst appears in the body, whether this fungus is initially present in the microflora or enters the lungs from the outside, there is no way to prevent this disease from two sides. That is, you need to minimize the risk of infection with this microorganism and prevent its activation inside your own body.

To reduce the risk of infection, you need to:

1. Use pharmaceutical protective masks.
2. As little as possible to be in places filled with people.
3. Avoid travel to public transport at rush hour.
4. Try not to visit public places in seasons of exacerbation of respiratory diseases.

Ways to prevent the disease are similar to the prevention of any infections transmitted by airborne droplets.

In order to reduce the risk of activation of pneumocysts already in the lungs and their transformation from a component of the local microflora into a pathogenic microorganism, it is necessary to take medications prescribed by a doctor. As a rule, to suppress the risk of activation of pneumocysts in HIV infection and AIDS, doctors recommend prophylactic weekly courses of taking Co-Trimoxazole together with Pentamidine inhalation procedures.

Enough great attention in the prevention of pathology is given to the lifestyle, nutrition and habits of a person. Of course, these nuances are important not only for preventing the development of pneumonia caused by pneumocystis in HIV-infected people, they are also important for people who do not suffer from the immunodeficiency virus. However, in the presence of this disease, these factors often become decisive.

No medicine can cope with the fungal flora activated in the lungs in the absence of immunity, if the sick person does not lead a healthy lifestyle, sleep and eat normally. What seems insignificant for otherwise healthy people is important for HIV carriers, since every little thing, such as stress or chronic sleep deprivation, can undermine their health.

Therefore, in addition to prophylactic medicines and protect the body from external infections, to reduce the risk of developing pneumocystosis, it is necessary:

• get enough sleep, that is, sleep at least 8-10 hours a day;
• avoid hypothermia and overheating of the body;
• exclude the possibility of being in drafts;
• avoid any stressful circumstances;
• walk on fresh air, in the park, and not on sidewalks along highways;
• provide yourself with feasible physical activity;
• Eat healthy, nutritious and varied food.

You can coordinate your own diet with the help of a nutritionist. However, there are many unskilled "specialists" in this profession, so you should visit a nutritionist only in medical institution. In addition, to draw up a diet, the doctor will need medical card data, this should not be forgotten.

Video: types and symptoms of pneumonia.

In the presence of HIV infection in the blood, it is impossible to take on your own, without the approval of the attending physician:

1. Vitamin complexes.
2. dietary supplements.
3. Folk remedies.
4. Means of API therapy.

This is due to the fact that even a seemingly harmless “ascorbic acid”, if present in excess in the body, can cause an imbalance in the internal microflora and serve as an impetus for the reproduction of pneumocysts. All biologically active products, such as honey and other bee products, have the same property. medicinal herbs and, of course, phytocomplexes sold in pharmacies.

Of course, the basis for the prevention of pneumocystosis for people with AIDS or infected with HIV is the intake of drugs, carried out according to the regimen recommended by the doctor. But, in addition to the use of drugs, with such diseases it is important not to forget about other preventive measures.