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An Overview of Parasite Diversity
Published in Eric S. Loker, Bruce V. Hofkin, Parasitology, 2023
Eric S. Loker, Bruce V. Hofkin
The Ascomycota (Figure 2.16B) is a vast group of fungi that includes several important plant parasites. These include the causative agents of Dutch elm disease (Ophiostoma ulmi), chestnut blight (Cryphonectria parasitica) (Figure 2.17A), and the recently problematic ash dieback (Chalara fraxinea). Chestnut blight devastated the American chestnut tree (Castanea dentata) across the North American continent in the early 1900s. Pneumocystis jirovecii (Pneumocystidiomycetes) is a frequent cause of pneumonia in humans (Figure 2.17B). This organism used to be called P. carinii, the latter a name now reserved for a species found in animals. Fungal infections such as pneumonia caused by P. jirovecii are often opportunistic because they do not cause disease in healthy hosts but can become problematic in unhealthy individuals. This parasite can cause fatal infections in immunocompromised individuals. The parasite is often found in those who have a concurrent infection with HIV or are taking immunosuppressive drugs following organ transplants. Another ascomycete that has achieved unwanted prominence is Pseudogymnoascus destructans (Dothideomycetes), the fungus responsible for white-nose syndrome currently decimating some species of North American bats (see Box 8.1).
Infectious disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Pneumocystis jirovecii (formally known as Pneumocystis carinii) is a fungus which causes pneumonia (pneumocystis pneumonia or PCP): dry cough, dyspnoea and fever but with few signs on examination of the chest. Patients may be hypoxic, particularly after exercise. Diagnosis: can be made following staining of a bronchoalveolar lavage. Treatment: co-trimoxazole, clindamycin/primaquine or pentamidine. Steroids are given in severe illnesses when patients are hypoxic.
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 68 year old female with known HIV infection presents to the emergency department with insidious onset exertional dyspnoea. Her CD4 count is 120 cells/mm3 (500–1400 cells/mm3) and her chest radiograph demonstrates bilateral perihilar ground glass opacification. Pneumocystis jiroveci is suspected and the clinical team refer her for a CT chest prior to bronchoscopy.
ANCA associated vasculitis (AAV): a review for internists
Published in Postgraduate Medicine, 2023
Kinanah Yaseen, Brian F. Mandell
Severe and opportunistic infections causing primarily pneumonia are considered the leading cause of death in the first year after diagnosis of AAV. The most common causative pathogens are bacteria, such as Streptococcus pneumonia and Haemophilus influenza followed by viruses and fungi such as Pneumocystis jirovecii. Identified risk factors for infection are older age, female gender, pulmonary involvement, diabetes, impaired renal function, dialysis dependence, hypogammaglobulinemia, lymphopenia, and immunosuppressive therapy [89]. Providing vaccination against streptococcus pneumonia, influenza, and coronavirus in high-risk populations is critical. Routine screening for tuberculosis and hepatitis B virus is mandatory prior to therapy initiation. Prophylaxis against Pneumocystis jirovecii pneumonia is warranted.
Reduction of Pneumocystis jirovecii pneumonia and bloodstream infections by trimethoprim–sulfamethoxazole prophylaxis in patients with rheumatic diseases
Published in Scandinavian Journal of Rheumatology, 2021
N Honda, Y Tagashira, S Kawai, T Kobayashi, M Yamamoto, K Shimada, N Yokogawa
Pneumocystis jirovecii pneumonia (PJP) is potentially life-threatening in immunocompromised patients but usually has more severe manifestations and a higher mortality rate in patients without human immunodeficiency virus (non-HIV patients) than in HIV patients (1). The most important risk factor for PJP in non-HIV patients is the use of high-dose glucocorticoids (2). A retrospective study published in 2018 demonstrated that trimethoprim–sulfamethoxazole (TMP/SMX) prophylaxis was very effective in preventing PJP in patients with rheumatic diseases exposed to prolonged, high-dose glucocorticoid treatment (2). The American Thoracic Society provides a low-quality evidence-based recommendation for TMP/SMX prophylaxis whenever the prednisone dose exceeds 20 mg/day for more than 1 month in non-HIV immunocompromised patients (3). A new algorithm has been proposed for the management of high, intermediate, and low-risk patients with rheumatic diseases receiving prednisone ≥ 20 mg/day for ≥ 1 month (4), and Verhaert et al proposed indications for PJP prophylaxis in patients with connective tissue diseases (5). However, the evidence for TMP/SMX prophylaxis in patients with rheumatic diseases is still scarce, and there is no consensus on its routine use in such patients (6).
Safety profile of baricitinib in Japanese patients with active rheumatoid arthritis with over 1.6 years median time in treatment: An integrated analysis of Phases 2 and 3 trials
Published in Modern Rheumatology, 2020
Masayoshi Harigai, Tsutomu Takeuchi, Josef S. Smolen, Kevin L. Winthrop, Atsushi Nishikawa, Terence P. Rooney, Chadi G. Saifan, Maher Issa, Yoshitaka Isaka, Naotsugu Akashi, Taeko Ishii, Yoshiya Tanaka
The infection EAIR was 41.8, and the vast majority of infections (97%) were mild or moderate. The IR of herpes zoster (reported as a cluster) was 6.5 (95%CI: 4.9, 8.4), with most cases (93% [51/55]) being mild to moderate. About 16% (9/55) had multidermatomal distribution (≥3 contiguous or ≥2 non-contiguous dermatomes), and none had visceral involvement. After discontinuation of baricitinib and use of antiviral therapy, most of the herpes zoster (cluster) cases (40/55) recovered or resolved during the respective studies. The other 15 patients had not recovered by the end of follow-up time. There were three cases of post herpetic neuralgia reported. Three cases of Pneumocystis jirovecii pneumonia were reported in three patients (EAIR 0.3). These were all SAEs. All three patients had risk factors; three received concomitant MTX, and two had baseline lymphopenia. There were no cases of sepsis, no cases of new onset TB or reactivation of latent TB.