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BMC Infectious Diseases Nov 2023Cancer case during pregnancy is rare, but it is the second leading cause of maternal mortality. (Review)
Review
BACKGROUND
Cancer case during pregnancy is rare, but it is the second leading cause of maternal mortality.
CASE PRESENTATION
A-32-year old pregnant woman with a gestational age of 37 weeks was admitted to the hospital due to repeated coughing for 5 months. She received Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) treatment for severe hypoxemia after delivery. She was diagnosed with non-small cell lung cancer (NSCLC) with bone metastasis and pneumocystis pneumonia (PCP). She subsequently received anti-tumor therapy and anti-infective therapy. After treatment, her condition improved and she was weaned from ECMO. Two weeks after weaning ECMO, her condition worsened again. Her family chose palliative treatment, and she ultimately died.
CONCLUSIONS
NSCLC is rare during pregnancy. At present, there is still a lack of standardized methods to manage these cases. For theses cases, the clinician should be wary of opportunistic infections, such as pneumocystis jirovecii (P. jirovecii) and Elizabethkingia spp. Specialized medical teams with abundant experience and multidisciplinary discussions from the perspectives of the patient's clinical characteristics as well as preferences are crucial for developing individualized and the best approach.
Topics: Humans; Pregnancy; Female; Infant, Newborn; Pneumonia, Pneumocystis; Carcinoma, Non-Small-Cell Lung; Pregnant Women; Lung Neoplasms; Pneumocystis carinii
PubMed: 37964211
DOI: 10.1186/s12879-023-08790-z -
Frontiers in Immunology 2018pneumonia (PCP) remains a severe complication with high mortality in immunocompromised patients. It has been well accepted that CD4 T cells play a major role in...
INTRODUCTION
pneumonia (PCP) remains a severe complication with high mortality in immunocompromised patients. It has been well accepted that CD4 T cells play a major role in controlling infection. Th9 cells were the main source of IL-9 with multifaced roles depending on specific diseases. It is unclear whether IL-9/Th9 contributes to the immune response against PCP. The current study aims to explore the role of IL-9 and the effect of IL-9 on Th17 cells in murine model of PCP.
MATERIALS AND METHODS
Mice were intratracheally injected with 1 × 10 organisms to establish the murine model of infection. burden was detected by TaqMan real-time PCR. Using IL-9-deficient (IL-9) mice, flow cytometry, real-time PCR and enzyme-linked immunosorbent assay (ELISA) were conducted to investigate the immune function related to Th17 response in defense against infection.
RESULTS
Reduced burden was observed in lungs in IL-9 mice compared with WT mice at 3-week postinfection. IL-9mice exhibited stronger Th17 immune responses than WT PCP mice through flow cytometer and real-time PCR. ELISA revealed higher levels of IL-17 and IL-23 in bronchoalveolar lavage fluid from IL-9 mice than WT mice. And IL-9 deficiency promoted Th17 differentiation from CD4 naive T cells. IL-17A neutralization increased burden in IL-9 mice.
CONCLUSION
Although similar basic clearance of organisms was achieved in both WT and IL-9 PCP mice, IL-9 deficiency could lower organism burden and promote pulmonary Th17 cells response in the early stage of infection.
Topics: Animals; Apoptosis; Biomarkers; Bronchoalveolar Lavage Fluid; Cell Differentiation; Disease Models, Animal; Disease Susceptibility; Immunophenotyping; Interleukin-17; Interleukin-9; Male; Mice; Mice, Knockout; Neutrophils; Pneumocystis; Pneumonia, Pneumocystis; Th17 Cells
PubMed: 29887863
DOI: 10.3389/fimmu.2018.01118 -
Emerging Infectious Diseases 1996
Review
Topics: Animals; Humans; Molecular Epidemiology; Pneumocystis; Pneumonia, Pneumocystis
PubMed: 8903219
DOI: 10.3201/eid0202.960214 -
MBio Feb 2018Fungi of the genus are obligate parasites that colonize mammals' lungs and are host species specific. and infect, respectively, humans and rats. They can turn into...
Fungi of the genus are obligate parasites that colonize mammals' lungs and are host species specific. and infect, respectively, humans and rats. They can turn into opportunistic pathogens in immunosuppressed hosts, causing severe pneumonia. Their cell cycle is poorly known, mainly because of the absence of an established method of culture It is thought to include both asexual and sexual phases. Comparative genomic analysis suggested that their mode of sexual reproduction is primary homothallism involving a single mating type () locus encompassing plus and minus genes (, , and ; Almeida et al., mBio 6:e02250-14, 2015). Thus, each strain would be capable of sexual reproduction alone (self-fertility). However, this is a working hypothesis derived from computational analyses that is, in addition, based on the genome sequences of single isolates. Here, we tested this hypothesis in the wet laboratory. The function of the and genes was ascertained by restoration of sporulation in the corresponding mutant of fission yeast. Using PCR, we found the same single locus in all isolates and showed that all three genes are often concomitantly expressed during pneumonia. Extensive homology searches did not identify other types of transcription factors in the genomes or -acting motifs flanking the locus that could have been involved in switching or silencing. Our observations suggest that sexuality through primary homothallism is obligate within host lungs to complete the cell cycle, i.e., produce asci necessary for airborne transmission to new hosts. Fungi of the genus colonize the lungs of mammals. In immunosuppressed human hosts, may cause severe pneumonia that can be fatal. This disease is one of the most frequent life-threatening invasive fungal infections in humans. The analysis of the genome sequences of these uncultivable pathogens suggested that their sexual reproduction involves a single partner (self-fertilization). Here, we report laboratory experiments that support this hypothesis. The function of the three genes responsible for sexual differentiation was ascertained by the restoration of sexual reproduction in the corresponding mutant of another fungus. As predicted by self-fertilization, all isolates harbored the same three genes that were often concomitantly expressed within human lungs during infection. Our observations suggest that the sexuality of these pathogens relies on the self-fertility of each isolate and is obligate within host lungs to complete the cell cycle and allow dissemination of the fungus to new hosts.
Topics: Animals; DNA, Fungal; Disease Models, Animal; Genes, Mating Type, Fungal; Humans; Lung; Pneumocystis; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Rats; Recombination, Genetic
PubMed: 29463658
DOI: 10.1128/mBio.02201-17 -
Zhonghua Xue Ye Xue Za Zhi = Zhonghua... Feb 2023To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. A retrospective analysis was carried out in 46...
To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients ((2)=11.039, =0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all >0.05) . The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.
Topics: Male; Female; Humans; Adult; Middle Aged; Aged; Pneumonia, Pneumocystis; Retrospective Studies; Pneumocystis carinii; Hematologic Diseases; Tomography, X-Ray Computed; Fibrosis
PubMed: 36948865
DOI: 10.3760/cma.j.issn.0253-2727.2023.02.006 -
Clinical Microbiology Reviews Jan 1998Information about a number of Pneumocystis carinii lipids obtained by the analyses of organisms isolated and purified from infected lungs of... (Review)
Review
Information about a number of Pneumocystis carinii lipids obtained by the analyses of organisms isolated and purified from infected lungs of corticosteroid-immunosuppressed rats has been reported in recent years. Of the common opportunistic protists associated with AIDS (Cryptosporidium, Toxoplasma, and the microsporidia), more is currently known about the lipids of P. carinii than the others. Lipids that are synthesized by the organism but not by humans are attractive targets for drug development. Thus, the elucidation of delta 7C-24-alykylated sterol and cis-9,10-epoxystearic acid biosyntheses in P. carinii is currently being examined in detail, since these have been identified as P. carinii-specific lipids. The development of low-toxicity drugs that prevent sterol C-24 alkylation and the specific inhibition of the lipoxygenase that forms cis-9,10-epoxystearic acid might prove fruitful. Although humans can synthesize coenzyme Q10, the anti-P. carinii activity and low toxicity of ubiquinone analogs such as atovaquone suggest that the electron transport chain in the pathogen may differ importantly from that in the host. Although resistance to atovaquone has been observed, development of other naphthoquinone drugs would provide a broader armamentarium of drugs to treat patients with P. carinii pneumonia. Studies of bronchoalveolar lavage fluid and of infected lungs have demonstrated that the infection causes a number of chemical abnormalities. Bronchoalveolar lavage fluid obtained after the removal of lung cellular material and the organisms has been shown to contain larger amounts of surfactant proteins and smaller amounts of phospholipids than do comparable samples from P. carinii-free lungs. Increased phospholipase activity, inhibition of surfactant secretion by type II cells, and uptake and catabolism of lipids by the pathogen may explain this phenomenon related to P. carinii pneumonia. Although not yet thoroughly examined, initial studies on the uptake and metabolism of lipids by P. carinii suggest that the organism relies heavily on exogenous lipid nutrients.
Topics: Animals; Humans; Lipids; Lung; Pneumocystis; Pneumonia, Pneumocystis
PubMed: 9457427
DOI: 10.1128/CMR.11.1.27 -
PloS One 2013As a promising tool, PCR in bronchoalveolar lavage fluid (BALF) has not been accepted as a diagnostic criterion for PJP. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
As a promising tool, PCR in bronchoalveolar lavage fluid (BALF) has not been accepted as a diagnostic criterion for PJP.
OBJECTIVE
We undertook a systematic review of published studies to evaluate the diagnostic accuracy of PCR assays in BALF for PJP.
METHODS
Eligible studies from PubMed, Embase and Web of Science reporting PCR assays in BALF for diagnosing PJP were identified. A bivariate meta-analysis of the method's sensitivity, specificity, and positive and negative likelihood ratios with a 95% confidence interval (CI) were analyzed. The post-test probability was performed to evaluate clinical usefulness. A summary receiver operating characteristics (SROC) curve was used to evaluate overall performance. Subgroup analyses were carried out to analysis the potential heterogeneity.
RESULTS
Sixteen studies published between 1994 and 2012 were included. The summary sensitivity and specificity values (95% CI) of PCR in BALF for diagnosis of PJP were 98.3% (91.3%-99.7%) and 91.0% (82.7%-95.5%), respectively. The positive and negative likelihood ratios were 10.894 (5.569-21.309) and 0.018 (0.003-0.099), respectively. In a setting of 20% prevalence of PJP, the probability of PJP would be over 3-fold if the BALF-PCR test was positive, and the probability of PJP would be less than 0.5% if it was negative. The area under the SROC curve was 0.98 (0.97-0.99).
CONCLUSIONS
The method of PCR in BALF shows high sensitivity and good specificity for the diagnosis of PJP. However, clinical practice for the diagnosis of PJP should consider the consistent respiratory symptoms, radiographic changes and laboratory findings of the suspected patients.
Topics: Analysis of Variance; Bronchoalveolar Lavage Fluid; Clinical Trials as Topic; Humans; Pneumocystis carinii; Pneumonia, Pneumocystis; Polymerase Chain Reaction
PubMed: 24023814
DOI: 10.1371/journal.pone.0073099 -
Frontiers in Cellular and Infection... 2023(PJ) is an opportunistic pathogenic fungus, and PJ pneumonia (PJP) is a commonly problem in HIV-positive patients. While PJP is not caused by HIV, it generally advances...
BACKGROUND
(PJ) is an opportunistic pathogenic fungus, and PJ pneumonia (PJP) is a commonly problem in HIV-positive patients. While PJP is not caused by HIV, it generally advances rapidly and can quickly lead to severe respiratory failure. To improve pediatricians' understanding of the condition and aid early accurate diagnoses and therapy, we examined the clinical characteristics of five instances of non-HIV related PJP (NH-PJP) in children and the efficacy of metagenomic next-generation sequencing (mNGS) in its diagnosis.
METHODS
From January 2020 to June 2022, five children with NH-PJP were admitted to the PICU of the First Affiliated Hospital of Zhengzhou University. We retrospectively summarize the clinical presentation, previous histories, routine laboratory findings, treatment, outcome of regression, and results of mNGS in these five children.
RESULTS
Five male children between the ages of 11 months and 14 years had an acute onset on NH-PJP, three of the children had chest tightness after activity, shortness of breath and paroxysmal dry cough, - and two had high fever and dry cough. All five of the children had several flocculent high-density pictures in both lungs at the beginning of the disease, and lung auscultation revealed coarse breath sounds in both lungs, one of which was accompanied by a modest quantity of dry rales. PJ nuclear sequences were found in one patient and four patients' blood and alveolar lavage fluid. All five children were treated with Trimethoprim-sulfamethoxazole (TMP-SMX) in combination with Caspofungin and corresponding symptomatic treatment. Four patients were cured and one patient died.
CONCLUSION
Children commonly encounter an initial exposure to NH-PJP, which manifests as a high fever, dry cough, chest discomfort, dyspnea that worsens over time, fast disease progression, and a high death rate. The clinical presentation of children with PJ infection should be taken into consideration along with the results for diagnose. mNGS has higher sensitivity and a shorter detection period compared to identification of PJP.
Topics: Humans; Male; Child; Infant; Pneumonia, Pneumocystis; Retrospective Studies; Cough; Pneumocystis carinii; High-Throughput Nucleotide Sequencing
PubMed: 37009508
DOI: 10.3389/fcimb.2023.1132472 -
PLoS Pathogens Nov 2014
Review
Topics: Animals; Genome, Fungal; Humans; Pneumocystis carinii; Pneumonia, Pneumocystis
PubMed: 25375856
DOI: 10.1371/journal.ppat.1004425 -
Communications Biology Mar 2021Pneumocystis jirovecii, the fungal agent of human Pneumocystis pneumonia, is closely related to macaque Pneumocystis. Little is known about other Pneumocystis species in... (Comparative Study)
Comparative Study
Pneumocystis jirovecii, the fungal agent of human Pneumocystis pneumonia, is closely related to macaque Pneumocystis. Little is known about other Pneumocystis species in distantly related mammals, none of which are capable of establishing infection in humans. The molecular basis of host specificity in Pneumocystis remains unknown as experiments are limited due to an inability to culture any species in vitro. To explore Pneumocystis evolutionary adaptations, we have sequenced the genomes of species infecting macaques, rabbits, dogs and rats and compared them to available genomes of species infecting humans, mice and rats. Complete whole genome sequence data enables analysis and robust phylogeny, identification of important genetic features of the host adaptation, and estimation of speciation timing relative to the rise of their mammalian hosts. Our data reveals insights into the evolution of P. jirovecii, the sole member of the genus able to infect humans.
Topics: Animals; Evolution, Molecular; Fungal Proteins; Gene Expression Regulation, Fungal; Genome, Fungal; Host-Pathogen Interactions; Humans; Phylogeny; Pneumocystis carinii; Pneumonia, Pneumocystis; Species Specificity
PubMed: 33686174
DOI: 10.1038/s42003-021-01799-7