Describe the clinical and paraclinical features of PJ pneumonia in HIV/AIDS patients. Determination of PJ genotype and its correlation with clinical and paraclinical features of PJ pneumonia in HIV/AIDS patients.
patients 29 with thrombocytopenia is not actually proportional to the number of patients presenting with infection, so it is difficult to use this indicator to predict the infection pathology. Thus, the increase and decrease of blood indicators reflect the status and degree of manifestation of pneumonia in patients, comparing with the results of this study with domestic and foreign studies showing the similarity certain of the hematological test indicators Biochemical tests of patients showed that the indicators Na +, Ca+, Cl showed no increase, some patients showed signs of reduction Other indicators such as urea, creatinine, albumin, %PT, fibrinogen did not show any abnormalities in HIV patients with PJ pneumonia in this study. However, we found an increase in liver enzyme activity index of most patients, which indicates that PJ's pulmonary infection is related to the patient's liver cell damage. In this study we recorded more than 80% of patients presenting with liver injury, but the question is whether lesions of liver lesions are really pneumonia caused by PJ etiology or coinfections such as tuberculosis, bacteria, viruses, and other fungi are either caused by medicines such as antiviral drugs, antibiotics, antituberculosis drugs or due to HIV disease Immunological indices Creactive protein (CRP) is produced by the liver and released into the bloodstream when an infection occurs, CPR has the ability to specifically bind to polysaccharide of bacteria, fungi and parasites, thus the concentration of CRP usually rises when the body has severe infections. In this study only four patients had normal CRP levels, the remaining cases showed an increase in CRP, even many cases had a very high increase. This is entirely consistent with the patient's infection status, however in the study all 31 patients were infected CD4 cells are produced from lymphocytederived stem cells (B and T lymphocytes), CD4 cells are the most important subgroup of T lymphocytes with the main function of identifying foreign antigens and regulating reconstitutes the body's immune system. HIV after entering the body will directly attack CD4 cells, thereby destroying this cell and reducing the amount of CD4 in the blood significantly. In this study, we found that most patients had very low CD4 Tcell losses, especially in those without or interrupting antiretroviral therapy, so these patients had opportunistic infections is completely understandable 30 Lung injury PJ usually resides in the alveoli and spreads to the alveoli, causing an increase in alveolar capillary permeability, causing the alveoli to flood with secretions, in severe cases, there may be interstitial edema, fibrosis. Therefore, PJ cases of pneumonia were recorded with lung injury and X ray is one of the solutions to help assess the extent of lung injury of the patient. In this study the majority of patients had images of lung lesions and predominantly localized dissemination, a small number of patients with scattered lesions or on one side of the lung. On Xray film, it is shown that most patients have blurred vision, opaque glass and lattice in the lungs, Lung injury signs of opaque glass are quite typical and high percentage in PJ pneumonia patients Several patients have pleural effusion and pneumothorax, no cases of pneumothorax and lung abscess, few have solid lung lobes Of the 31 cases we diagnosed with PJ positive, only less than 40% of cases were diagnosed with bronchial lesions, suggesting that PJ infection can cause varying degrees of injury. Depending on many factors such as PJ's genotype, the number of PJ multiplies and especially the patient's location. There are patients with atopic lesions and the number of PJ is not high, the possibility of bronchial injury is not high, and conversely, there are patients with atopic or injured plus the number of cells, the more PJ the risk of injury is very high 4.2 Molecular features of PJ and the correlation with clinical, paraclinical PJ pneumonia in HIV/AIDS patients 4.2.1. Molecular features of PJ With the development of molecular biology techniques, including gene sequencing techniques, many variants the genotype of PJ has been found in PJ outbreaks Therefore, understanding the molecular epidemiological features as well as the genetic connection of pathogenic PJ strains in humans through the application of molecular biology techniques is currently a new and promising direction in research. Research PJ as well as their pathogenic features. So far, many methods of identifying PJ variants have been developed, in which methods using a single locus often not elucidate the genetic information of PJ. Therefore, the multilocus sequence typing method is considered as the golden method in determining the genetic diversity of PJ 31 Results of sequence analysis of 31 samples showed that the genes of ITS1, mt26S, 26S appeared many different variants, while the genes of CYB, DHFR, DHPS and βTUB showed no change in nucleotide sequence. There was only one strain with a mutation in the SOD gene. Published data from previous studies show that the variation of ITS1 gene is based on eight mutation points, including nucleotide positions 2, 810, 11, 17, 22, 4647, 5462, 7172 and 111113. In this study we also did not detect coinfection with many PJ strains in one specimen. The specimens contain opportunistic PJs in HIV/AIDS in Vietnam have genetic differences to the PJ strains distributed in many geographical regions around the world. The discovery of new genotypes on ITS1, mt26S, 26S, SOD locus in pathogenic PJ specimens in this study is very interesting because these genotypes have never been published in previous studies. This is probably the difference in the genetic features of PJ distributed in Vietnam, but it can also be seen that a proportion of genotypes in these locus are similar to the PJ strains distributed in Portugal, Switzerland, Spain and France. Make comparisons and find that they have little genetic relationship with the PJ strains in other geographical areas. This raises the question of whether the PJ strains distributed in Vietnam are ancestral PJ species in this region or were they imported from neighboring regions long time ago. 4.2.2. The correlation with clinical, paraclinical The correlation between PJ's genotype and patient's fever features By analyzing the genotypic features of the PJ strains with fever features, we found that patients with the PJ strain of genotype 26S 1 or ITS A genotype all had high fever expression Although we used statistical methods to calculate the OR, 95% CI and P indices, due to the small sample size (31 strains) that were distributed in many criteria, we could not calculate the indices. However, the disparity distribution of the proportion of patients with fever corresponding to the rate of strains carrying genotype 26S 1 and ITS A genotype also showed that this could be a marker for diagnosis and prognosis number of patients through PJ's genotypic analysis The correlation between PJ infection, coinfection with lung injury Comparing fever data with molecular features of pathogenic PJ strains, analytical data from the results showed that of 31 cases of PJ 32 infection, 27 cases (accounting for 87.1%) had lung lesions. Thus, most of the infections with PJ etiology cause pneumonia all show signs of lung injury. The data show that PJ infection actually causes lung injury, the location of lesions is mainly diffuse, most of the lesions are blurred nodules, opaque glasses, less pleural effusion and lung solidification. These are significant data and are effective prognostic factors that give clinicians more information to evaluate and timely treatment solutions to help reduce the risk of harm to health and the lives of patients, especially those infected with HIV/AIDS are often immunocompromised The correlation between PJ genotype and CD4 load Regarding the the correlation between the number of CD4 cells and the genotype of PJ, the data showing that the sharp decline in CD4 cells (less than 100 cells/ml) is also largely related to the ITS A genotypes and the genotype 26S 1. The data in this study shows that CD4 decline occurs very early, possibly in the first 6 months of the disease, but the time a patient is found to be infected with HIV is counted as a new case, so the timing may not be very accurate because the patient may have been infected with the virus for a long time but not yet detected. Therefore, it is possible to estimate the duration of a patient's viral infection through the degree of CD4 cell decline, but this calculation is also affected by a number of factors such as patient baseline, amount of virus infection. In addition, the data also showed that the higher the viral load, the greater the degree of CD4 cell decline CONCLUSION Clinical and paraclinical features of PJ pneumonia in HIV/ AIDS patients 1.1 Clinical features: Patients with HIV/AIDS accquired PJ pneumonia have clinical features mainly shortness of breath 51.6%, fever 87.1% and cough (71%) Fever temperature: Average: 38.9 ± 0.9oC; the highest temperature: 41.0oC; lowest temperature: 37.5oC Time fever end after admission: ≤ 7 days (22.2%), 8 21 days (51.8%), > 21 days (25.9%) Respiratory condition: cyanosis (42%), Respiratory distress grade I (48.4%), Respiratory distress grade II (38.7%) Lung condition: Rale (45.2%); rale type: fine (9.7%), coarse (16.1%), 33 fine + coarse + rhonchus (19.3%). Paraclinical features 93.5% of patients had CD4 cell count