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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 -
Microbes and Infection Jul 2000Infections by Helicobacter pylori are responsible for duodenal and gastric ulcers and are a significant risk factor for the development of gastric adenocarcinoma. H....
Infections by Helicobacter pylori are responsible for duodenal and gastric ulcers and are a significant risk factor for the development of gastric adenocarcinoma. H. pylori was discovered in 1983, but many institutes in Canada, Europe, and the United States are already involved in programs to understand and treat the infections, as reflected by the growing number of internet sites devoted to this bacterium. Most AIDS patients and about 20% of children with acute lymphoblastic leukemia develop Pneumocystis carinii pneumoniae. Information on clinical symptoms and treatment, as well as the P. carinii genome sequencing project, are described at several web sites. Students and researchers wishing to understand the correlation between telomere length and AIDS may turn to web sites of the University of Colorado and Washington University School of Medicine for the latest on telomeres and telomerase, and their function in aging and cancer.
Topics: Helicobacter Infections; Helicobacter pylori; Humans; Internet; Pneumocystis; Pneumonia, Pneumocystis; Telomerase; Telomere
PubMed: 10962282
DOI: 10.1016/s1286-4579(00)00400-7 -
PloS One 2018Pneumocystis jirovecii pneumonia (PCP) is often fatal in human immunodeficiency (HIV)-negative patients and typically presents with respiratory insufficiency. Predicting...
BACKGROUND
Pneumocystis jirovecii pneumonia (PCP) is often fatal in human immunodeficiency (HIV)-negative patients and typically presents with respiratory insufficiency. Predicting treatment failure is challenging. This study aimed to identify prognostic factors and examine PCP polymerase chain reaction (PCR)-negative conversion in non-HIV PCP patients with respiratory failure.
METHOD
We retrospectively enrolled 81 non-HIV patients diagnosed with and treated for PCP with respiratory failure in the intensive care unit at a tertiary hospital over a 3-year period. PCP was diagnosed via nested PCR-mediated detection of Pneumocystis jirovecii in induced sputum samples, endotracheal aspirates, and bronchoalveolar lavage fluids. PCP PCR was performed weekly to check for negative conversion.
RESULTS
The overall survival rate was 35.8%. Seventy-four patients (91.3%) required mechanical ventilation, and 6 (7.4%) required high-flow nasal oxygen treatment. The PCP PCR-negative conversion rate was 70.5% (survivors, 97%; non-survivors, 63.5%); the median time to conversion was 10 (7.0-14.0) days. On univariate analysis, the APACHE II score (p < 0.001), renal failure requiring renal replacement therapy (p = 0.04), PCP PCR-negative conversion (p = 0.003), and the PaO2/FiO2 ratio (first 24 hours) (p < 0.001) significantly correlated with mortality. On multivariate analysis, PCP PCR-negative conversion (hazard ratio, 0.433; 95% confidence interval, 0.203-0.928; p = 0.031) and the PaO2/FiO2 ratio (first 24 hours) (hazard ratio, 0.988; 95% confidence interval, 0.983-0.993; p < 0.001) independently predicted prognosis.
CONCLUSIONS
Determination of PCP PCR-negative conversion and PaO2/FiO2 ratios may help physicians predict treatment failure and mortality in non-HIV PCP patients with respiratory failure.
Topics: Aged; Female; Gene Conversion; HIV; HIV Seronegativity; Humans; Immunocompromised Host; Intensive Care Units; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Prognosis; Respiratory Distress Syndrome; Retrospective Studies; Survival Analysis
PubMed: 30359436
DOI: 10.1371/journal.pone.0206231 -
BMJ (Clinical Research Ed.) Aug 1988Diagnosis of pneumocystis pneumonia is based on identifying Pneumocystis carinii cytochemically in material from the lung. The silver methenamine staining methods most...
Diagnosis of pneumocystis pneumonia is based on identifying Pneumocystis carinii cytochemically in material from the lung. The silver methenamine staining methods most commonly used are technically difficult and lack specificity. The diagnostic value of immunocytological identification of the parasite was evaluated by using mouse monoclonal antibody 3F6, specific for human pneumocystis, to identify P carinii in bronchoalveolar lavage fluid and sputum by immunofluorescence and was compared with that of other variables. Bronchoalveolar lavage was performed on 25 patients positive for HIV antibody with clinically suspected pneumocystis pneumonia and 40 patients negative for HIV antibody who presented with interstitial disorders of the lung. Lavage fluid showed pneumocystis only in the patients positive for antibody, the parasite being detected in 19 by immunofluorescence and in 17 by a modified silver methenamine staining method. Chest x ray films obtained at the time of bronchoscopy showed interstitial or alveolar shadowing in 17 of the 19 patients, but clinical symptoms and the presence of antibodies to pneumocystis did not seem to be predictive. Sputum samples were collected during 43 episodes of clinically suspected pneumocystis pneumonia in patients positive for HIV antibody. Pneumocystis was detected consistently more commonly by immunofluorescence than the silver strain in sputum collected routinely and induced by inhalation of saline. In 17 patients bronchoalveolar lavage followed sputum collection, and the sensitivity of detection of pneumocystis in immunofluorescence in sputum compared with lavage fluid was 57% (8/14). Immunofluorescence was suitable for specimens fixed in ethanol and seemed highly specific and more sensitive than the standard cytochemical methods for identifying pneumocystis.
Topics: Acquired Immunodeficiency Syndrome; Animals; Antibodies, Monoclonal; Antibodies, Protozoan; Bronchoalveolar Lavage Fluid; Fluorescent Antibody Technique; Humans; Opportunistic Infections; Pneumocystis; Pneumonia, Pneumocystis; Sputum
PubMed: 3044514
DOI: 10.1136/bmj.297.6645.381 -
Transplant International : Official... 2024pneumonia (PcP) remains life-threatening in kidney transplant recipients (KTR). Our study investigated risk factors one-year before PcP. We conducted a monocentric,...
pneumonia (PcP) remains life-threatening in kidney transplant recipients (KTR). Our study investigated risk factors one-year before PcP. We conducted a monocentric, case-control study including all KTR at the Dijon University Hospital (France) with a diagnosis of PcP between 2005 and 2022 (cases), and matched control KTR with no history of PcP (3 controls/case). Among all 1,135 KTR, 57 cases (5%) and 169 matched-controls were included. PcP was associated with 18% mortality. Compared to controls, cases were older, with a higher immunological risk, and CMV infection was more frequent in the year preceding the occurrence of PcP (23% vs. 4%; < 0.001). As early as 1 year before PcP, lymphocyte counts were lower and serum creatinine levels were higher in cases, but immunosuppressive regimens were not significantly different. Multivariable analysis identified lymphocyte count, serum creatinine level, being treated by immunosuppressive therapy other than anti-rejection drugs, and CMV infection in the year preceding the time PcP as independently associated with the occurrence of PcP. PcP was associated with an increased risk of subsequent chronic rejection (27% vs. 3%; = 0.001) and return to dialysis (20% vs. 3%; = 0.002). The occurrence of CMV infection and a low lymphocyte count could redefine the indications for continuation or reinitiation of anti- prophylaxis.
Topics: Humans; Pneumonia, Pneumocystis; Case-Control Studies; Kidney Transplantation; Pneumocystis carinii; Creatinine; Cytomegalovirus Infections; Risk Factors; Lymphopenia; Thrombocytopenia; Transplant Recipients; Retrospective Studies
PubMed: 38328616
DOI: 10.3389/ti.2024.12192 -
Kidney International Aug 2013Pneumocystis jirovecii is a unicellular organism that in individuals with impaired immunity may cause pneumonia that can progress from minor illness to severe...
Pneumocystis jirovecii is a unicellular organism that in individuals with impaired immunity may cause pneumonia that can progress from minor illness to severe inflammatory pneumonia (PCP) with respiratory failure and death. Despite antimicrobial prophylaxis, which has reduced the incidence of PCP, clusters of late infections have been reported among kidney transplant recipients worldwide. A nosocomial PCP cluster was first recognized in 2010 at a Sydney hospital, but PCP clusters have since occurred in almost half of the renal transplant units on the eastern Australian seaboard, refocussing attention on optimal prophylaxis regimens and the likelihood of patient-to-patient transmission. A consensus meeting was conducted to derive the lessons from this experience for responding to PCP outbreaks. These included: (1) acting quickly--clusters of PCP in kidney transplant recipients with patient-to-patient transmission required transplant programs to act quickly to institute prophylactic and treatment measures; (2) instituting universal prophylaxis for all patients seen in the affected unit; (3) reducing patient-to-patient transmission via airborne droplets in the outpatient waiting areas; (4) examining the P. jirovecii genotypes. The meeting also considered recommendations for the duration of prophylaxis following de novo transplant and, for the individuals in whom long term prophylaxis is required, separating units with and without clusters of PCP.
Topics: Antibiotic Prophylaxis; Australia; Consensus; Cross Infection; Disease Outbreaks; Humans; Immunosuppressive Agents; Infection Control; Kidney Transplantation; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Public Health; Treatment Outcome
PubMed: 23739237
DOI: 10.1038/ki.2013.212 -
Japanese Journal of Infectious Diseases Jul 2019Subsequent to the increasing use of immunosuppressant therapy, Pneumocystis jirovecii pneumonia (PcP) has emerged as a life-threatening condition in human...
Subsequent to the increasing use of immunosuppressant therapy, Pneumocystis jirovecii pneumonia (PcP) has emerged as a life-threatening condition in human immunodeficiency virus (HIV)-negative patients. We investigated changes in epidemiological and clinical characteristics among PcP cases with and without HIV infections. Data of 424 patients diagnosed with PcP in a 2,700-bed Korean tertiary care hospital between February 2003 and April 2017 were retrospectively analyzed. The study included patients with compatible clinical findings in whom PcP was confirmed via direct immunofluorescence assay. The annual average number of cases increased from 12.2 (initial 5-year period) to 42.2 (recent 5-year period). In HIV-negative patients, hematologic malignancy (34.8%) and solid organ transplantation (32.9%) were the most frequent major underlying conditions, and immunosuppressive therapies including corticosteroids (342/362, 94.5%) and chemotherapy (122/362, 33.7%) were significantly associated with PcP infection (p < 0.001 for both). The incidence of PcP has continued to increase among non-HIV-infected immunocompromised patients in recent years.
Topics: AIDS-Related Opportunistic Infections; Adult; Aged; Female; Humans; Immunocompromised Host; Incidence; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Republic of Korea; Retrospective Studies; Risk; Tertiary Care Centers
PubMed: 30918147
DOI: 10.7883/yoken.JJID.2018.400 -
Leukemia & Lymphoma Nov 2020A Polymerase Chain Reaction-based diagnosis of Pneumonia (PCP) and the need for anti- prophylaxis in Hodgkin lymphoma patients receiving chemotherapy requires further...
A Polymerase Chain Reaction-based diagnosis of Pneumonia (PCP) and the need for anti- prophylaxis in Hodgkin lymphoma patients receiving chemotherapy requires further investigation. This retrospective, single-center, study evaluated 506 consecutive adult patients diagnosed with Hodgkin lymphoma receiving chemotherapy between January 2006 and August 2018. The cumulative incidence of PCP 1 year after start of chemotherapy was 6.2% (95% CI 3.8-8.5%). Mortality 30 days from PCP diagnosis was 8% ( = 2) with one death attributable to PCP. Bleomycin-containing combination chemotherapy regimen was not significantly associated with a higher risk for PCP when compared to other regimens (HR = 1.59, 95% CI 0.55-4.62 = 0.40). Anti- prophylaxis was not significantly associated with a decreased incidence of PCP (HR = 0.51, 95% CI 0.15-1.71, = 0.28). As the overall incidence is above the commonly accepted 3.5% threshold, clinicians should consider the potential value of prophylaxis. The utility of universal vs. targeted anti- prophylaxis requires prospective, randomized investigation.
Topics: Adult; Hodgkin Disease; Humans; Incidence; Pneumocystis carinii; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Prospective Studies; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 32623928
DOI: 10.1080/10428194.2020.1786561 -
Antimicrobial Agents and Chemotherapy Dec 2017The dose of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of pneumonia (PCP) in patients without human immunodeficiency virus (HIV) infection has not been...
A Four-Center Retrospective Study of the Efficacy and Toxicity of Low-Dose Trimethoprim-Sulfamethoxazole for the Treatment of Pneumocystis Pneumonia in Patients without HIV Infection.
The dose of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of pneumonia (PCP) in patients without human immunodeficiency virus (HIV) infection has not been verified. The aim of this study was to investigate the efficacy and toxicity of a low-dose TMP-SMX regimen in such patients. A retrospective study was conducted in four hospitals. We reviewed the medical records of patients with PCP but not HIV (non-HIV-PCP) who were treated with TMP-SMX between 2003 and 2016. The patients were divided into conventional-dose (TMP, 15 to 20 mg/kg/day) and low-dose (TMP, <15 mg/kg/day) groups after patients who received high-dose (TMP, >20 mg/kg/day) treatment were excluded. Grouping was done according to a correction dose, which was based on renal function. Eighty-two patients had non-HIV-PCP. The numbers of patients who received high-, conventional-, and low-dose treatments were 5, 36, and 41, respectively. Kaplan-Meier analysis for death associated with PCP showed no statistically significant difference in survival rates between the conventional- and low-dose groups. Ninety-day cause-specific mortality rates were 25.0% and 19.5% in the conventional-dose and low-dose groups ( = 0.76), respectively. Adverse events that were graded as ≥3 according to the Common Terminology Criteria for Adverse Events (version 4.0) (National Cancer Institute, 2010) were 41.7% and 17.1% in the conventional-dose and low-dose groups ( = 0.02), respectively. Moreover, vomiting ( = 0.03) and a decrease in platelet count ( = 0.03) occurred more frequently in the conventional-dose group. Treatment of non-HIV-PCP with low-dose or conventional-dose TMP-SMX produces comparable survival rates; however, the low-dose regimen is better tolerated and associated with fewer adverse effects.
Topics: Aged; Female; Humans; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 28893787
DOI: 10.1128/AAC.01173-17 -
BMC Pulmonary Medicine Apr 2016Pulmonary infections caused by Pneumocystis jirovecii in immunocompromised host can be associated with cysts, pneumatoceles and air leaks that can progress to... (Review)
Review
Extra corporeal membrane oxygenation to facilitate lung protective ventilation and prevent ventilator-induced lung injury in severe Pneumocystis pneumonia with pneumomediastinum: a case report and short literature review.
BACKGROUND
Pulmonary infections caused by Pneumocystis jirovecii in immunocompromised host can be associated with cysts, pneumatoceles and air leaks that can progress to pneumomediastinum and pneumothoraxes. In such cases, it can be challenging to maintain adequate gas exchange by conventional mechanical ventilation and at the same time prevent further ventilator-induced lung injury. We report a young HIV positive male with poorly compliant lungs and pneumomediastinum secondary to severe Pneumocystis infection, rescued with veno-venous extra corporeal membrane oxygenation (V-V ECMO).
CASE PRESENTATION
A 26 year old male with no significant past medical history was admitted with fever, cough and shortness of breath. He initially required non-invasive ventilation for respiratory failure. However, his respiratory function progressively deteriorated due to increasing pulmonary infiltrates and development of pneumomediastinum, eventually requiring endotracheal intubation and invasive ventilation. Despite attempts at optimizing gas exchange by ventilatory maneuvers, patients' pulmonary parameters worsened necessitating rescue ECMO therapy. The introduction of V-V ECMO facilitated the use of ultra-protective lung ventilation and prevented progression of pneumomediastinum, maintaining optimal gas exchange. It allowed time for the antibiotics to show effect and pulmonary parenchyma to heal. Further diagnostic workup revealed Pneumocystis jirovecii as the causative organism for pneumonia and serology confirmed Human Immunodeficiency Virus infection. Patient was successfully treated with appropriate antimicrobials and de-cannulated after six days of ECMO support.
CONCLUSION
ECMO was an effective salvage therapy in HIV positive patient with an otherwise fatal respiratory failure due to Pneumocystis pneumonia and air leak syndrome.
Topics: Adult; Extracorporeal Membrane Oxygenation; Humans; Lung; Lung Compliance; Male; Mediastinal Emphysema; Pneumonia, Pneumocystis; Respiration, Artificial; Severity of Illness Index; Tomography, X-Ray Computed; Ventilator-Induced Lung Injury
PubMed: 27080997
DOI: 10.1186/s12890-016-0214-4