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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.
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
On pathological examination, the lung in Pneumocystis pneumonia is solid, pale brown, and dry (Figure 20.7). Microscopically, the alveoli are filled with masses of cysts, thus preventing gas exchange. The cysts are 3–4 μm in diameter, and contain small nuclei (Figure 20.8). There is often a mild interstitial lymphoplasmacytic infiltrate (interstitial pneumonitis). Aided by chemotherapy, macrophages phagocytose the fungi to clear the alveoli. However, if the infection persists or returns, there is progressive intraalveolar organization and interstitial fibrosis. The diagnosis of Pneumocystis pneumonia is made by identifying the organisms in sputum or bronchial lavage specimens, or by lung biopsy. Standard treatment is with co-trimoxazole, which enables the lung to return to normal. However, in those with continuing immunosuppression, prophylactic therapy needs to be maintained. If and when Pneumocystis pneumonia returns, it tends to cause progressive lung damage, with fibrosis and even cavitation.
Pneumocystis jirovecii
Published in Rossana de Aguiar Cordeiro, Pocket Guide to Mycological Diagnosis, 2019
Rosely Maria Zancopé-Oliveira, Fernando Almeida-Silva, Rodrigo de Almeida Paes, Mauro de Medeiros Muniz
Pneumocystis pneumonia (PJP) in humans is caused by the fungus Pneumocystis jirovecii, which affects mainly immunocompromised patients. PJP, formerly known as pneumonia by Pneumocystis carinii (PCP), was an early indicator of the human immunodeficiency virus (HIV) epidemic, and in the 1980s occurred in 70%–80% of AIDS patients (CDC 1982; Masur et al., 1981). However, the incidence of PJP in AIDS has decreased as a result of early HIV diagnosis, better antiretroviral therapy, and the use of prophylaxis measures. PJP manifestations are mainly associated with the respiratory tract and symptoms are generally nonspecific. Diagnosis is hampered by the inability to culture the organism and based on microscopic examination of respiratory samples, x-ray patterns, or clinical presentation. New assays can assist in the diagnosis and even aid with the emergence of resistant infections (White et al., 2017).
Pneumocystis jirovecii: a review with a focus on prevention and treatment
Published in Expert Opinion on Pharmacotherapy, 2021
R. Benson Weyant, Dima Kabbani, Karen Doucette, Cecilia Lau, Carlos Cervera
Pneumocystis would not be recognized as a human pathogen until 1942 when Van der Meer and Brug would describe 3 cases of it. In 1952 Otto Jirovec reported pneumocystis as the causative organism of plasma cell pneumonitis in neonates [3]. He described the clinical symptoms we now associate with pneumocystis pneumonia such as cyanosis, low-grade fever, and respiratory distress. Prior to the 1980s PJP was best known as a pediatric disease, found mainly in malnourished infants and cancer patients. Even before the HIV/AIDs epidemic, research was being led by Walter Hughes at the St. Jude Children’s Research Hospital in pediatric acute lymphoblastic leukemia (ALL) populations, where it was estimated that as many as 1 in 4 children would develop PJP in their lifetime. These studies investigated the epidemiology, treatment, and prophylaxis of PJP, and were no doubt invaluable when the disease started spreading in adults [4,5].
The efficacy and safety of reduced-dose sulfamethoxazole-trimethoprim for chemoprophylaxis of Pneumocystis pneumonia in patients with rheumatic diseases
Published in Modern Rheumatology, 2021
Tomoya Harada, Ryohei Kato, Yuriko Sueda, Yoshihiro Funaki, Miki Takata, Ryota Okazaki, Yasuyuki Hasegawa, Akira Yamasaki
Pneumocystis pneumonia (PCP) is a potentially life-threatening opportunistic infection caused by Pneumocystis jirovecii in compromised patients such as individuals with human immunodeficiency virus (HIV) infection and patients under immunosuppressive therapy [1–3]. An infectious disease is an important prognostic factor in rheumatic disease. Pneumocystis pneumonia occurs in HIV-positive patients, and it is one of the most common opportunistic infections in the absence of prophylaxis [4]. Its incidence is 5–15% in patients with solid organ transplantation [5] and 2%–4% in patients with rheumatic diseases [6,7]. The mortality rate of PCP associated with rheumatic disease is higher than the rate associated with HIV-positive patients [7–10]; therefore, preventing PCP in patients with rheumatic disease is important.
Clinical features and prognosis of nocardiosis in patients with connective tissue diseases
Published in Modern Rheumatology, 2021
Mizuki Yagishita, Hiroto Tsuboi, Daiki Tabuchi, Toshiki Sugita, Taihei Nishiyama, Shota Okamoto, Toshihiko Terasaki, Masaru Shimizu, Fumika Honda, Ayako Ohyama, Izumi Kurata, Saori Abe, Hiroyuki Takahashi, Atsumu Osada, Shinya Hagiwara, Yuya Kondo, Isao Matsumoto, Takayuki Sumida
Second, only a small proportion of patients were given TMP/SMX for prophylaxis of pneumocystis pneumonia in our study. It is not clear whether this also provides efficient prophylaxis against nocardiosis. Some studies support the hypothesis that prophylactic TMP-SMX is effective for preventing nocardiosis in hematopoietic stem cell transplant recipients [16,17]. In contrast, other studies concluded that TMP-SMX was not protective against nocardiosis in organ transplant recipients [15,18]. In our study, only two patients (14.3%) had been given TMP-SMX for prophylaxis of pneumocystis pneumonia and, moreover, a strain of Nocardia identified in one of these two patients had resistance to TMP-SMX, indicating a lack of prophylactic effect. These results suggest that TMP-SMX may have a certain, but still unclear, degree of effect for preventing nocardiosis in patients with CTDs.