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Pneumocystis carinii
Published in Peter D. Walzer, Robert M. Genta, Parasitic Infections in the Compromised Host, 2020
Peter D. Walzer, C. Kurtis Kim, Melanie T. Cushion
Pneumocystis carinii pneumonia should be considered in any compromised host who develops fever, respiratory symptoms, or infiltrates on chest X-ray. These clinical features can be mimicked by a long list of other infectious agents including gram-positive and gram-negative bacteria, legionella, mycobacteria, fungi, viruses, parasites, mycoplasmas, and chlamydia. A similar clinical picture can be caused by noninfectious etiologies including tumor, hemorrhage, edema, fibrosis, oxygen, radiation, and drugs. The frequence of occurrence of P. carinii in AIDS and its subtle and varied presentation have raised medical interest in the clinical manifestations of this organism. Patients with HIV infection frequently develop fever and a variety of other prodromal symptoms for weeks to months before developing pneumocystosis as the first manifestation of AIDS. Whether these clinical symptoms are all due to P. carinii is as yet unclear.
Adenosine deaminase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
The majority of patients reported with ADA deficiency have been infants with SCID and recurrent infections [19, 20]. Pneumonia may be caused by Pneumocystis carinii or by viruses. Candidiasis may involve the skin, the mucosa of the mouth, esophagus, or vagina, and stool cultures may reveal this organism. Patients surviving infancy may have pulmonary insufficiency, a consequence of repeated infection. Among late-onset presentations were pulmonary insufficiency and recurrent warts in adult sisters [21].
The Lymphatic/Immune System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Infection with human immunodeficiency virus (HIV) presents special problems. HIV is a retrovirus that preferentially attacks the T-helper lymphocytes, entering the host cell by attaching at the CD4' site. By reproducing within the T-lymphocytes, HIV kills the host cell and destroys the host's immune response. HIV infection may be asymptomatic, or it may progress to minor or severe immunodeficiency. The severe form is acquired immune deficiency syndrome (AIDS), from which fatality may result because of opportunistic infections. Among the more prominent of the HIV opportunistic infections are Pneumocystis carinii pneumonia, Cytomegalovirus pneumonia, candidiasis, toxoplasmosis, and Herpesvirus infections.
The quest for an HIV-1 vaccine: will mRNA deliver us from evil?
Published in Expert Review of Vaccines, 2023
Forty-two years have gone by since the first report of five unusual cases of Pneumocystis carinii pneumonia in previously healthy young men in Los Angeles [1], which heralded the official appearance of AIDS on the world stage, but the quest for an HIV-1 vaccine is still on. The obstacles have been enormous. HIV-1 remains unrivaled in its extraordinary armamentarium of immune-evasive tactics, spanning from antigenic variation to glycan-mediated shielding to conformational camouflage. Most importantly, the bar to achieve protection from HIV/AIDS is extremely high because, in the case of HIV-1, protection equals ‘sterilizing’ immunity. The reason is that, as a retrovirus, HIV-1 integrates its genome into the host DNA where it can survive indefinitely, outside the reach of current therapeutic strategies. For most other infectious agents, the major goal of a vaccine is prevention of the acute illness that occurs during primary infection. For HIV-1 this objective is of no relevance to protection because the real disease is caused by a progressive corruption of the adaptive immune system that occurs over the course of several years of chronic infection. Once the virus gets its foot in the door, the clock starts. And the disease will almost invariably progress unless antiretroviral treatment is initiated and continued indefinitely. Thus, the sole way to immunize against HIV-1 disease is to lock the virus out of the body from square one: ‘sterilizing’ immunity.
Impact of pre-transplantation minimal residual disease (MRD) on the outcome of Allogeneic hematopoietic stem cell transplantation for acute leukemia
Published in Hematology, 2021
Xing Shen, Jing Pan, Chenchen Qi, Yuan Feng, Hanxin Wu, Sixuan Qian, Hua Lu, Lijuan Chen, Jianyong Li, Kourong Miao, Hairong Qiu, Han Zhu
All patients received central venous catheters and were isolated in a laminar airflow room. Empirical antibiotics and anti-fungal agents were administered to the patients when they experienced fever. The cytomegalovirus (CMV) and Epstein–Barr virus (EBV) were measured weekly during the immunosuppressive period and the patients were administered with gancyclovir when CMV was positive. Trimethoprim/sulfamethoxazole was given for the prevention of pneumocystis carinii infection. Irradiated blood components were infused while needed to maintain the hemoglobin above 70 g/L and platelet counts over 20 × 109/L. The subcutaneous G-CSF (5 μg kg−1·day−1) was administered to all recipients from the day 5 after transplantation until neutrophil recovery. All patients were transfused with 10 g of gamma-immunoglobulin each week from transplantation day to 3 months after transplantation.
Bronchoalveolar lavage: role in the evaluation of pulmonary interstitial disease
Published in Expert Review of Respiratory Medicine, 2020
Stanca-Patricia Hogea, Emanuela Tudorache, Camelia Pescaru, Monica Marc, Cristian Oancea
Furthermore, the analyzes of the BAL fluid has high diagnostic value for Pneumocystisinfection. Pneumocystis carinii pneumonia (PCP) remains an opportunistic infection that causes morbidity and mortality in all immunosuppressed patients especially in HIV-infected patients [73]. Performing bronchoscopy with BAL should be considered for definitive diagnosis of Pneumocystis pneumonia, if an adequate induced sputum cannot be obtained. Also, polymerase chain reaction (PCR) may be used to diagnose PCP [74]. PCR testing of BAL fluid is increasing identification of pneumocystis infections and viruses that were previously missed through conventional testing. Lipschik GY. et al. showed in a study that the sensitivity of conventional staining methods (direct and indirect fluorescence antibody and toluidine-blue-O tests), in non-HIV immunocompromised patients had low sensitivity, ranging from 38% to 53% in sputum samples, compared with nested PCR (p < 0.05). They found a sensitivity of 84% and a specificity of 93% for nested PCR in BAL for the detection of Pneumocystis carinii. The positive and negative predictive values were 70% and 97%, respectively [75]. In a meta-analysis, the pooled sensitivity of the BALF-PCR for the diagnosis of PCP was 98.3% (95% CI, 91.3%–99.7%) and the pooled specificity was 91.0% (95% CI, 82.7%–95.5%), which predicts PCR in BALF is a suitable method for diagnosis of this infection [73]. Thus the therapy can be adapted based on results [74,76,77].