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Cureus Aug 2022pneumonia (PCP) is one of the most common opportunistic infections worldwide that affects the lung. leads to pneumonia, caused by , formerly known as . In recent... (Review)
Review
pneumonia (PCP) is one of the most common opportunistic infections worldwide that affects the lung. leads to pneumonia, caused by , formerly known as . In recent decades, PCP has been a major health problem for human immunodeficiency virus (HIV) patients and is responsible for most of mortality and morbidity. However, the increasing number of immunosuppressive-related diseases has led to outbreaks in other patient populations, raising the concern for PCP as it becomes a major concern among those patients. These changes led to marked changes in the prevalence and mortality rates of PCP. Huge variations in those parameters among HIV and non-HIV patients have been seen also. Historically, the diagnosis was made by staining and direct visualization of the organism within the bronchoalveolar lavage (BAL) fluid. The diagnosis is now made by microscopic examination and a real-time polymerase chain reaction (PCR) of BAL. Serum (1,3)-β-D-glucan, which is a component of the cell wall that distinguishes it from other fungi, has become an important diagnostic tool. Early diagnosis and treatment play a vital role in the patient's survival and in the infection outcome; hence, empirical PCP therapy should be started immediately when the infection is suspected without waiting for the results of the diagnostic test. Steroids play an important role in the treatment of HIV patients, especially patients who present with hypoxia and respiratory failure. Prophylaxis is very effective and should be given to all patients at high risk of PCP. Antiretroviral therapy (ART) should be started as soon as possible in newly diagnosed HIV-infected patients with PCP, and the immune status of immunocompromised patients with PCP should be improved by temporarily withholding immunosuppressive drugs or reducing their doses.
PubMed: 36106266
DOI: 10.7759/cureus.27727 -
Computer Methods and Programs in... Mar 2022Pneumocystis carinii pneumonia, also known as pneumocystis carinii pneumonia (PCP), is an interstitial plasma cell pneumonia caused by pneumocystis spp. It is a...
OBJECTIVE
Pneumocystis carinii pneumonia, also known as pneumocystis carinii pneumonia (PCP), is an interstitial plasma cell pneumonia caused by pneumocystis spp. It is a conditional lung infectious disease. Because the early and correct diagnosis of PCP has a great influence on the prognosis of patients, the image processing of PCP's high-resolution CT (HRCT) is extremely important. Traditional image super-resolution reconstruction algorithms have difficulties in network training and artifacts in generated images. The super-resolution reconstruction algorithm of generative counter-networks can optimize these two problems well.
METHODS
In this paper, the texture enhanced super-resolution generative adversarial network (TESRGAN) is based on a generative confrontation network, which mainly includes a generative network and a discriminant network. In order to improve the quality of image reconstruction, TESRGAN improved the structure of the Super-Resolution Generative Adversarial Network (SRGAN) generation network, removed all BN layers in SRGAN, and replaced the ReLU function with the LeakyReLU function as the nonlinear activation function of the network to avoid the disappearance of the gradient.
EXPERIMENTAL RESULTS
The TESRGAN algorithm in this paper is compared with the image reconstruction results of Bicubic, SRGAN, Enhanced Deep Super-Resolution network (EDSR), and ESRGAN. Compared with algorithms such as SRGAN and EDSR, our algorithm has clearer texture details and more accurate brightness information without extending the running time. Our reconstruction algorithm can improve the accuracy of image low-frequency information.
CONCLUSION
The texture details of the reconstruction result are clearer and the brightness information is more accurate, which is more in line with the requirements of visual sensory evaluation.
Topics: Algorithms; Artifacts; Humans; Image Processing, Computer-Assisted; Pneumonia, Pneumocystis; Tomography, X-Ray Computed
PubMed: 34998168
DOI: 10.1016/j.cmpb.2021.106578 -
Current Rheumatology Reports Feb 2020The management of patients with idiopathic inflammatory myositis (IIM) can be complex and challenging due to the myriad of complications they can experience. The... (Review)
Review
PURPOSE OF REVIEW
The management of patients with idiopathic inflammatory myositis (IIM) can be complex and challenging due to the myriad of complications they can experience. The continued use of corticosteroids, in addition to the rise of combination immunosuppressive therapy, has contributed to the ongoing concern for infection. Perhaps the most feared infection in IIM patients is Pneumocystis jirovecii pneumonia (PJP) given its infrequent occurrence yet high mortality. The field has been, and continues to be, without evidence-based guidelines to help clinicians determine which patients with IIM to prescribe prophylaxis. Herein, we review this literature to provide the clinician with an up-to-date view of infections in IIM.
RECENT FINDINGS
In the past 5 years, a number of studies have been reported highlighting various infectious complications, which help us better understand their frequency and associated risk factors. In addition, data has been published on the potential harms of PJP prophylaxis, to better inform the risk/benefit of our decision-making. Infection remains a major contributor to morbidity and mortality in IIM. A better understanding of which patient subgroups are at risk for particular infections will inform optimal management strategies.
Topics: Antibiotic Prophylaxis; Glucocorticoids; Humans; Immunosuppressive Agents; Incidence; Infection Control; Infections; Myositis; Pneumocystis carinii; Pneumonia, Pneumocystis; Vaccines
PubMed: 32020305
DOI: 10.1007/s11926-020-0883-0 -
Journal de Mycologie Medicale Mar 2022To provide original data on Pneumocystis primary infection in non-immunosuppressed infants from Peru.
OBJECTIVES
To provide original data on Pneumocystis primary infection in non-immunosuppressed infants from Peru.
METHODS
A cross sectional study was performed. Infants less than seven months old, without any underlying medical conditions attending the "well baby" outpatient clinic at one hospital in Lima, Peru were prospectively enrolled during a 15-month period from November 2016 to February 2018. All had a nasopharyngeal aspirate (NPA) for detection of P. jirovecii DNA using a PCR assay, regardless of respiratory symptoms. P. jirovecii DNA detection was considered to represent pulmonary colonization contemporaneous with Pneumocystis primary infection. Associations between infants' clinical and demographic characteristics and results of P. jirovecii DNA detection were analyzed.
RESULTS
P. jirovecii DNA was detected in 45 of 146 infants (30.8%) and detection was not associated with concurrent respiratory symptoms in 40 of 45 infants. Infants with P. jirovecii had a lower mean age when compared to infants not colonized (p <0.05). The highest frequency of P. jirovecii was observed in 2-3-month-old infants (p < 0.01) and in the cooler winter and spring seasons (p <0.01). Multivariable analysis showed that infants living in a home with ≤ 1 bedroom were more likely to be colonized; Odds Ratio =3.03 (95%CI 1.31-7.00; p = 0.01).
CONCLUSION
Pneumocystis primary infection in this single site in Lima, Peru, was most frequently observed in 2-3-month-old infants, in winter and spring seasons, and with higher detection rates being associated with household conditions favoring close inter-individual contacts and potential transmission of P. jirovecii.
Topics: Cross-Sectional Studies; Humans; Infant; Peru; Pneumocystis; Pneumocystis carinii; Pneumonia, Pneumocystis
PubMed: 34598108
DOI: 10.1016/j.mycmed.2021.101202 -
Medical Mycology Sep 2023Pneumocystis jirovecii is a transmissible fungus responsible for severe pneumonia (Pneumocystis pneumonia [PCP]) in immunocompromised patients. Missense mutations due to... (Review)
Review
Pneumocystis jirovecii is a transmissible fungus responsible for severe pneumonia (Pneumocystis pneumonia [PCP]) in immunocompromised patients. Missense mutations due to atovaquone selective pressure have been identified on cytochrome b (CYB) gene of P. jirovecii. It was recently shown that atovaquone prophylaxis can lead to the selection of specific P. jirovecii CYB mutants potentially resistant to atovaquone among organ transplant recipients. In this context, our objectives were to provide data on P. jirovecii CYB mutants and the putative selective pressure exerted by atovaquone on P. jirovecii organisms in France. A total of 123 patients (124 P. jirovecii specimens) from four metropolitan hospitals and two overseas hospitals were retrospectively enrolled. Fourteen patients had prior exposure to atovaquone, whereas 109 patients did not at the time of P. jirovecii detection. A 638 base-pair fragment of the CYB gene of P. jirovecii was amplified and sequenced. A total of 10 single nucleotide polymorphisms (SNPs) were identified. Both missense mutations C431T (Ala144Val) and C823T (Leu275Phe), located at the Qo active site of the enzyme, were significantly associated with prior atovaquone exposure, these mutations being conversely incidental in the absence of prior atovaquone exposure (P < 0.001). Considering that the aforementioned hospitals may be representative of the national territory, these findings suggest that the overall presence of P. jirovecii CYB mutants remains low in France.
Topics: Animals; Pneumocystis carinii; Atovaquone; Cytochromes b; Retrospective Studies; Mutation
PubMed: 37656874
DOI: 10.1093/mmy/myad095 -
Zhongguo Fei Ai Za Zhi = Chinese... Apr 2022In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency... (Review)
Review
In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency virus (HIV) patients, such as those with malignancies, post-transplantation and autoimmune diseases. Although the risk factors and management of PJP have been extensively studied in the hematologic tumor and post-transplant populations, the research on real tumor cases is insufficient. Lung cancer has been the most common tumor with the highest number of incidence and death worldwide, and the prognosis of lung cancer patients infected with PJP is poor in clinical practice. By reviewing the previous studies, this paper summarized the epidemiology and clinical manifestations of PJP in lung cancer patients, the risk factors and possible mechanisms of PJP infection in lung cancer patients, diagnosis and prevention, and other research progresses to provide reference for clinical application. .
Topics: Humans; Incidence; Lung Neoplasms; Pneumocystis carinii; Pneumonia, Pneumocystis; Risk Factors
PubMed: 35340199
DOI: 10.3779/j.issn.1009-3419.2022.101.14 -
Diagnostic Microbiology and Infectious... Sep 2019Due to poor diagnostics and increased co-infections, HIV-associated Legionella infections are underreported. We aimed to retrospectively determine the frequency of...
Due to poor diagnostics and increased co-infections, HIV-associated Legionella infections are underreported. We aimed to retrospectively determine the frequency of Legionella infections in bronchoalveolar lavage (BAL) from HIV-associated pneumonia patients hospitalized in Medellin, Colombia, between February 2007 and April 2014. Although culture was negative, 17 BAL (36%) were positive for Legionella by quantitative polymerase chain reaction, most of which were in the Mycobacterium tuberculosis or Pneumocystis jirovecii co-infected patients, and included L. anisa (n = 6), L. bozemanae (n = 4), L. pneumophila (n = 3), and L. micdadei (n = 2). All L. bozemanae and L. micdadei associated with Pneumocystis, while all L. pneumophila associated with M. tuberculosis. Legionella probable cases had more complications and higher mortality rates (P = 0.02) and were rarely administered empirical anti-Legionella therapy while in hospital. Clinicians should be aware of the possible presence of Legionella in HIV and M. tuberculosis or P. jirovecii co-infected patients.
Topics: AIDS-Related Opportunistic Infections; Adult; Bronchoalveolar Lavage Fluid; Coinfection; Colombia; Female; Humans; Legionella; Legionellosis; Male; Middle Aged; Mycobacterium tuberculosis; Pneumocystis carinii; Pneumonia; Polymerase Chain Reaction; Retrospective Studies; Risk
PubMed: 31072645
DOI: 10.1016/j.diagmicrobio.2019.03.005 -
World Neurosurgery Feb 2022A 67-year-old male with chronic lymphocytic leukemia was admitted with headaches and ring-enhancing lesions on magnetic resonance imaging of the brain. His current...
A 67-year-old male with chronic lymphocytic leukemia was admitted with headaches and ring-enhancing lesions on magnetic resonance imaging of the brain. His current regimen included rituximab and ibrutinib with trimethoprim-sulfamethoxazole for secondary Pneumocystis jirovecii pneumonia prevention. All other elements of his history were noncontributory. The diagnosis of an invasive fungal infection was made via light microscopy of a stereotactic brain biopsy specimen.
Topics: Abscess; Aged; Brain; Humans; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 34883274
DOI: 10.1016/j.wneu.2021.12.002 -
Medical Mycology Nov 2020Pneumocystis jirovecii and microsporidia species are recognized as opportunistic infectious pathogens in AIDS patients. Coinfection of both in one patient has been...
Pneumocystis jirovecii and microsporidia species are recognized as opportunistic infectious pathogens in AIDS patients. Coinfection of both in one patient has been rarely reported. The aim of the present study was to investigate the coinfection of P. jirovecii and microsporidia in different tissues from AIDS deceased patients. Post mortem histological finding of P. jirovecii and microsporidia was demonstrated by means of the Grocott's methenamine silver and Brown Brenn staining, respectively. Molecular technique was used for identification and characterization of both fungi. Out of the 514 autopsied cases P. jirovecii and microsporidia species were identified in 53 (10.3%) and 62 (12.1%) cases respectively. A total of five cases (0.97%) coinfected with Pneumocystis and microsporidia were recovered from all analyzed autopsies. Coinfection of Pneumocystis and microsporidia is very challenging and raises interesting issues about host-parasite relationship. The early diagnosis of both pathogens must be crucial to establish correct and early treatments, improve the patient's evolution, reducing the risk of death.
Topics: AIDS-Related Opportunistic Infections; Adult; Autopsy; Coinfection; Female; Humans; Male; Microsporidia; Middle Aged; Pneumocystis carinii; Young Adult
PubMed: 32497173
DOI: 10.1093/mmy/myaa048 -
Current Opinion in Infectious Diseases Apr 2024This review highlights the epidemiology of Pneumocystis jirovecii pneumonia in solid organ transplant recipients, advancements in the diagnostic landscape, and updates... (Review)
Review
PURPOSE OF REVIEW
This review highlights the epidemiology of Pneumocystis jirovecii pneumonia in solid organ transplant recipients, advancements in the diagnostic landscape, and updates in treatment and prevention.
RECENT FINDINGS
The increasing use of immune-depleting agents in the context of solid organ transplantation has given rise to P. jirovecii pneumonia in this population. The use of prophylaxis has dramatically reduced risk of infection; however, late-onset infections occur after cessation of prophylaxis and in the setting of lymphopenia, advancing patient age, acute allograft rejection, and cytomegalovirus infection. Diagnosis requires respiratory specimens, with PCR detection of Pneumocystis replacing traditional staining methods. Quantitative PCR may be a useful adjunct to differentiate between infection and colonization. Metagenomic next-generation sequencing is gaining attention as a noninvasive diagnostic tool. Trimethoprim-sulfamethoxazole remains the drug of choice for treatment and prevention of Pneumocystis pneumonia. Novel antifungal agents are under investigation.
SUMMARY
P. jirovecii is a fungal opportunistic pathogen that remains a cause of significant morbidity and mortality in solid organ transplant recipients. Early detection and timely treatment remain the pillars of management.
Topics: Humans; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Organ Transplantation; Transplantation, Homologous; Transplant Recipients
PubMed: 38230604
DOI: 10.1097/QCO.0000000000001002