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Thorax Aug 1985
Review
Topics: Animals; Disease Models, Animal; Disease Susceptibility; Humans; Pneumocystis; Pneumonia, Pneumocystis
PubMed: 3898464
DOI: 10.1136/thx.40.8.561 -
BMC Infectious Diseases Mar 2011The number of patients with non-HIV Pneumocystis pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We investigated the clinical characteristics...
BACKGROUND
The number of patients with non-HIV Pneumocystis pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We investigated the clinical characteristics of non-HIV PCP and its association with microbiological genotypes.
METHODS
Between January 2005 and March 2010, all patients in 2 university hospitals who had been diagnosed with PCP by PCR were enrolled in this study. Retrospective chart review of patients, microbiological genotypes, and association with 30-day mortality were examined.
RESULTS
Of the 82 adult patients investigated, 50 patients (61%) had inflammatory diseases, 17 (21%) had solid malignancies, 12 (15%) had hematological malignancies, and 6 (7%) had received transplantations. All patients received immunosuppressive agents or antitumor chemotherapeutic drugs. Plasma (1→3) β-D-glucan levels were elevated in 80% of patients, and were significantly reduced after treatment in both survivors and non-survivors. However, β-D-glucan increased in 18% of survivors and was normal in only 33% after treatment. Concomitant invasive pulmonary aspergillosis was detected in 5 patients. Fifty-six respiratory samples were stored for genotyping. A dihydropteroate synthase mutation associated with trimethoprim-sulfamethoxazole resistance was found in only 1 of the 53 patients. The most prevalent genotype of mitochondrial large-subunit rRNA was genotype 1, followed by genotype 4. The most prevalent genotype of internal transcribed spacers of the nuclear rRNA operon was Eb, followed by Eg and Bi. Thirty-day mortality was 24%, in which logistic regression analysis revealed association with serum albumin and mechanical ventilation, but no association with genotypes.
CONCLUSIONS
In non-HIV PCP, poorer general and respiratory conditions at diagnosis were independent predictors of mortality. β-D-glucan may not be useful for monitoring the response to treatment, and genotypes were not associated with mortality.
Topics: Adult; Aged; Aged, 80 and over; DNA, Bacterial; DNA, Mitochondrial; Female; Genotype; HIV Infections; Humans; Japan; Male; Middle Aged; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Prognosis; Retrospective Studies; Young Adult; beta-Glucans
PubMed: 21439061
DOI: 10.1186/1471-2334-11-76 -
Experimental Lung Research 2016Pneumocystis pneumonia is a major cause of morbidity and mortality in patients infected with HIV/AIDS. In this study, we evaluated the intestinal microbial communities...
BACKGROUND
Pneumocystis pneumonia is a major cause of morbidity and mortality in patients infected with HIV/AIDS. In this study, we evaluated the intestinal microbial communities associated with the development of experimental Pneumocystis pneumonia, as there is growing evidence that the intestinal microbiota is critical for host defense against fungal pathogens.
METHODS
C57BL/6 mice were infected with live Pneumocystis murina (P. murina) via intratracheal inoculation and sacrificed 7 and 14 days postinfection for microbiota analysis. In addition, we evaluated the intestinal microbiota from CD4+ T cell depleted mice infected with P. murina.
RESULTS
We found that the diversity of the intestinal microbial community was significantly altered by respiratory infection with P. murina. Specifically, mice infected with P. murina had altered microbial populations, as judged by changes in diversity metrics and relative taxa abundances. We also found that CD4+ T cell depleted mice infected with P. murina exhibited significantly altered intestinal microbiota that was distinct from immunocompetent mice infected with P. murina, suggesting that loss of CD4+ T cells may also affects the intestinal microbiota in the setting of Pneumocystis pneumonia. Finally, we employed a predictive metagenomics approach to evaluate various microbial features. We found that Pneumocystis pneumonia significantly alters the intestinal microbiota's inferred functional potential for carbohydrate, energy, and xenobiotic metabolism, as well as signal transduction pathways.
CONCLUSIONS
Our study provides insight into specific-microbial clades and inferred microbial functional pathways associated with Pneumocystis pneumonia. Our data also suggest a role for the gut-lung axis in host defense in the lung.
Topics: Animals; Carbohydrate Metabolism; Energy Metabolism; Gastrointestinal Microbiome; Host-Pathogen Interactions; Mice; Mice, Inbred C57BL; Pneumonia, Pneumocystis; Signal Transduction; Xenobiotics
PubMed: 27925857
DOI: 10.1080/01902148.2016.1258442 -
Revista Chilena de Infectologia :... Aug 2014Although P. jiroveci pneumonia affects immunocompromised (IC) patients of any etiology, clinical features and prognostic outcomes are different depending if they are... (Comparative Study)
Comparative Study
BACKGROUND
Although P. jiroveci pneumonia affects immunocompromised (IC) patients of any etiology, clinical features and prognostic outcomes are different depending if they are patients with HIV infection or other causes of IC.
OBJECTIVES
To compare clinical and laboratory features as well as outcomes of P. jiroveci pneumonia in HIV versus non-HIV patients.
METHODS
Retrospective review of clinical records of HIV and non-HIV patients with P. jiroveci pneumonia managed at the Hospital Clínico Universidad Católica in Santiago, Chile, between 2005 and 2007.
RESULTS
We included 28 HIV and 45 non-HIV patients with confirmed P. jiroveci pneumonia. The non-HIV population was older (65 vs 36,2 years, p < 0,01), had shorter duration of symptoms (7 [1-21] vs 14 [2-45] days, p < 0,01), required more invasive techniques (60 vs 21%, p < 0,01) and RT-PCR to confirm the diagnosis (93 vs 68%, p < 0,01), were more frequently treated at intensive care units (58 vs. 25%, p < 0,01) requiring artificial ventilation (56 vs 11%, p < 0,01), and had a higher attributable mortality (33% vs 0%, p < 0,01).
CONCLUSIONS
Our study confirmed that P. jiroveci pneumonia in non-HIV IC patients is more severe, more difficult to diagnose and has higher mortality that in HIV patients. Therefore, it is mandatory to optimize diagnostic and therapeutic strategies for this patients group.
Topics: Adult; Aged; Female; HIV Infections; Humans; Immunocompromised Host; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Prognosis; Retrospective Studies
PubMed: 25327195
DOI: 10.4067/S0716-10182014000400007 -
Archives of Pathology & Laboratory... Sep 2004To review and update the literature on current trends with regard to Pneumocystis carinii (jiroveci ) diagnosis, treatment modalities, and its role in human disease... (Review)
Review
OBJECTIVE
To review and update the literature on current trends with regard to Pneumocystis carinii (jiroveci ) diagnosis, treatment modalities, and its role in human disease processes.
DATA SOURCES
Bibliographic databases (PubMed and Ovid) were searched for material and data between 1980 and September 2003 relevant to the review. Indexing terms used were "Pneumocystis carinii pneumonia," and "Pneumocystis jiroveci," with the English language as a constraint. Other sources were the PhD thesis of one of the authors (J.F.W., London University, 1993) and the library at the Arabian Gulf University in the Kingdom of Bahrain.
STUDY SELECTION
Acquired immunodeficiency syndrome and organ transplant cases with Pneumocystis carinii pneumonia.
DATA EXTRACTION
Independent extraction by 2 observers.
DATA SYNTHESIS
We reviewed the major characteristics of P carinii (jiroveci ) with special emphasis on the more recently acquired data including the presence of a round pore in the cyst wall, which appears to be used for the release of sporozoites, supporting the hypothesis of sexual reproduction in P carinii (jiroveci ).
CONCLUSIONS
Opportunistic infection with P carinii (jiroveci ) remains a significant cause of morbidity and mortality in human immunodeficiency virus and non-human immunodeficiency virus-associated immunosuppressed patients. Diagnosis may be achieved in the majority of cases by routine cytochemical stains and specialized techniques such as immunocytochemistry and polymerase chain reaction. The incidence of P carinii pneumonia can significantly be reduced with effective use of prophylaxis and early detection of cases at high risk. Immunization for P carinii pneumonia is in the early stages and presents a challenging area for research.
Topics: Animals; Humans; Pneumocystis carinii; Pneumonia, Pneumocystis
PubMed: 15335253
DOI: 10.5858/2004-128-1023-PCI -
Critical Care (London, England) Nov 2019
Topics: Adult; Aged; Extracorporeal Membrane Oxygenation; Female; HIV Infections; Humans; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis
PubMed: 31727133
DOI: 10.1186/s13054-019-2661-9 -
PLoS Pathogens 2012
Review
Topics: Animals; Humans; Pneumocystis; Pneumonia, Pneumocystis; Rats
PubMed: 23209406
DOI: 10.1371/journal.ppat.1003025 -
PloS One 2014Pneumocystis pneumonia (PCP) is an emerging infectious disease in immunocompromised hosts. However, the clinical characteristics of these patients are poorly understood...
BACKGROUND
Pneumocystis pneumonia (PCP) is an emerging infectious disease in immunocompromised hosts. However, the clinical characteristics of these patients are poorly understood in mainland China.
METHODS
We performed a retrospective study of PCP from 2008 to 2012. Information was collected regarding clinical manifestations, hospitalization, and outcome. A prognostic analysis was performed using a Cox regression model.
RESULTS
151 cases of PCP were included; 46 non-HIV and 105 HIV cases. All-cause mortality (15.2% vs. 12.4%, p = 0.64) and the results of time-to-event analysis (log-rank test, p = 0.62) were similar between non-HIV and HIV infected cases, respectively. From 2008 to 2012, time from admission to initial treatment in non-HIV infected PCP patients showed declining trend [median (range) 20 (9-44) vs. 12 (4-24) vs. 9 (2-23) vs. 7 (2-22) vs. 7 (1-14) days]. A similar trend was observed for all-cause mortality (33.3% vs. 20.0% vs.14.3% vs. 14.3% vs. 6.7%). Patients with four or more of the following clinical manifestations (cough, dyspnea, fever, chest pain, and weight loss) [adjusted HR (AHR) 29.06, 95% CI 2.13-396.36, P = 0.01] and admission to intensive care unit (ICU) [AHR 22.55, 95% CI 1.36-375.06, P = 0.03] were independently associated with all-cause mortality in non-HIV infected PCP patients. Variables associated with mortality in HIV infected PCP patients were admission to ICU (AHR 72.26, 95% CI 11.76-443.87, P<0.001) and albumin ≤ 30 g/L (AHR 9.93 95% CI 1.69-58.30, P = 0.01).
CONCLUSIONS
Upon admission comprehensive clinical assessment including assessment of four or more clinical manifestations (cough, dyspnea, fever, chest pain, and weight loss) in non-HIV infected PCP patients and albumin ≤ 30 g/L in HIV infected patients might improve prognosis.
Topics: AIDS-Related Opportunistic Infections; Adult; China; Female; HIV Infections; Hospitalization; Humans; Immunocompromised Host; Male; Middle Aged; Pneumonia, Pneumocystis; Prognosis; Regression Analysis; Retrospective Studies; Treatment Outcome
PubMed: 25029342
DOI: 10.1371/journal.pone.0101943 -
Thorax 1994
Review
Topics: AIDS-Related Opportunistic Infections; Acquired Immunodeficiency Syndrome; Adult; Humans; Lung; Lung Diseases, Interstitial; Male; Pneumonia, Pneumocystis
PubMed: 7974327
DOI: 10.1136/thx.49.suppl.s46 -
Bioengineered Dec 2021pneumonia (PJP) is an opportunistic fungal infection after renal transplantation, which is always severe, difficult to diagnose, combined with multiple complications...
pneumonia (PJP) is an opportunistic fungal infection after renal transplantation, which is always severe, difficult to diagnose, combined with multiple complications and have poor prognosis. We retrospectively analyzed clinical data, including risk factors, diagnosis, treatment and complications of seven clinical cases suffered with severe PJP after renal transplantation in our department in 2019. All the seven recipients were routinely prescribed with PJP prophylaxis after renal transplantation, and six of them suffered acute graft rejection before the infection. sequence was identified in blood or broncho-alveolar lavage fluid (BALF) by the metagenomic next-generation sequencing (mNGS) in all patients. All the patients were improved with the therapy trimethoprim-sulfamethoxazole (TMP-SMX) combined with caspofungin for the PJP treatment, but suffered with complications including renal insufficiency, leukopenia, thrombocytopenia, gastrointestinal bleeding, mediastinalemphysema, pulmonary hemorrhage, and hemophagocytic syndrome and other severe infections. Taken together, mNGS is a powerful tool that could be used to diagnose PJP in renal transplantation recipients. And PJP prophylaxis should be prescribed during and after treatment for acute rejection. TMP-SMX is the first-line and effective drug for PJP treatment, but the complications are always life-threatening and lead to poor prognosis. We should pay attention to these life-threatening complications.
Topics: Adult; Aged; Bronchoalveolar Lavage Fluid; Female; Humans; Intensive Care Units; Kidney Transplantation; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33896387
DOI: 10.1080/21655979.2021.1911203