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目的:回顾性分析4例肾移植术后肺部蠊缨滴虫感染患者的临床表现及预后。方法:4例肾移植术后肺部感染患者经纤维支气管镜和支气管肺泡灌洗液检查确诊蠊缨滴虫感染,分析其临床特点,影像学特征和治疗、预后。结果:(1)4例肾移植术后肺部蠊缨滴虫感染均在术后2~3个月出现,其中2例合并其他病原体感染(细菌和巨细胞病毒)。(2)病程早期均表现为单纯发热,胸片和CT显示肺门轮廓模糊、密度增高、结构不清,部分支气管影增粗,紊乱;病程中可出现咳嗽、咯痰、胸闷、气短。(3)4例经甲硝唑治疗及撤减免疫抑制剂后4~7天3例体温降至正常,1例降至37·5℃;胸片和CT上的渗出性改变明显吸收消散;2例患者治疗后行重复支气管镜检查,肺泡灌洗液镜检可见大量死亡的蠊缨滴虫。结论:(1)肺部蠊缨滴虫感染早期表现隐匿,对于病原学诊断不明确和治疗反应不佳的术后肺部感染患者,需注意蠊缨滴虫感染的可能;(2)支气管肺泡灌洗液镜检是诊断蠊缨滴虫肺部感染的确切手段,撤减免疫抑制剂同时进行甲硝唑治疗可以迅速有效地缓解病情。
OBJECTIVE: To retrospectively analyze the clinical manifestations and prognosis of 4 patients with pulmonary candidal infection after renal transplantation. Methods: Four patients with pulmonary infection after renal transplantation were diagnosed with Trichomonas vaginalis infection by fiberoptic bronchoscopy and bronchoalveolar lavage fluid. The clinical features, imaging characteristics, treatment and prognosis were analyzed. Results: (1) Four cases of T.jejuni infection in the lung after renal transplantation occurred 2 to 3 months after operation. Two of them were infected with other pathogens (bacteria and cytomegalovirus). (2) The early course of the disease showed simple fever, chest X-ray and CT showed hilar contour blurred, increased density, unclear structure, part of the bronchial hyperfunction, disorder; course of the disease may occur cough, expectoration, chest tightness, shortness of breath. (3) In 4 cases after 4 days and 7 days after metronidazole treatment and withdrawal of immunosuppressive agents, the body temperature dropped to normal in 1 case and decreased to 37.5 ° C. The exudative changes of chest and CT were absorbed and dissipated ; 2 patients after treatment of repeat bronchoscopy, bronchoalveolar lavage fluid microscopic examination revealed a large number of dead cockroach Trichomonas. Conclusions: (1) In the early stage, pulmonary infection of Trichomonas vaginalis is obscure. Pay attention to the possibility of infection of T. cockroach in postoperative pulmonary infection patients with unclear etiological diagnosis and poor response to treatment. (2) Bronchial alveoli Lavage fluid microscopy is the diagnosis of T. cockroach lung infection the exact means of withdrawal of immunosuppressive agents metronidazole at the same time treatment can quickly and effectively alleviate the condition.