WorldWideScience

Sample records for aids-associated pneumocystis carinii

  1. Prognostic markers of short-term mortality in AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Helweg-Larsen, J; Bang, D

    2001-01-01

    BACKGROUND: Since 1990, corticosteroids have been recommended as adjunctive therapy for patients with AIDS-associated Pneumocystis carinii pneumonia (PCP) and respiratory failure. We hypothesized that the natural course of AIDS-associated PCP has changed in the era of adjunctive corticosteroid...

  2. Prognostic markers of short-term mortality in AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Helweg-Larsen, J; Bang, D

    2001-01-01

    BACKGROUND: Since 1990, corticosteroids have been recommended as adjunctive therapy for patients with AIDS-associated Pneumocystis carinii pneumonia (PCP) and respiratory failure. We hypothesized that the natural course of AIDS-associated PCP has changed in the era of adjunctive corticosteroid...... therapy. OBJECTIVE: To study variables obtained on hospital admission for possible prognostic value of short-term (3-month) outcome of PCP. DESIGN AND PATIENTS: Prospective observational study of 176 consecutive HIV-1-infected individuals with PCP between 1990 and 1999. METHOD: Cox proportional...... of outcome of PCP in patients treated in the era of adjunctive corticosteroid therapy....

  3. Effects of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of AIDS-associated P. carinii pneumonia

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Benfield, Thomas; Eugen-Olsen, J

    1999-01-01

    Sulpha drugs are widely used for the treatment and long-term prophylaxis of Pneumocystis carinii pneumonia (PCP) in HIV-1-infected individuals. Sulpha resistance in many microorganisms is caused by point mutations in dihydropteroate synthase (DHPS), an enzyme that is essential for folate biosynth......Sulpha drugs are widely used for the treatment and long-term prophylaxis of Pneumocystis carinii pneumonia (PCP) in HIV-1-infected individuals. Sulpha resistance in many microorganisms is caused by point mutations in dihydropteroate synthase (DHPS), an enzyme that is essential for folate...

  4. Effects of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of AIDS-associated P. carinii pneumonia

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Benfield, Thomas; Eugen-Olsen, Jesper

    1999-01-01

    BACKGROUND: Sulpha drugs are widely used for the treatment and long-term prophylaxis of Pneumocystis carinii pneumonia (PCP) in HIV-1-infected individuals. Sulpha resistance in many microorganisms is caused by point mutations in dihydropteroate synthase (DHPS), an enzyme that is essential...

  5. Prognostic value of interleukin-8 in AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Vestbo, Jørgen; Junge, Jette

    1995-01-01

    Interleukin-8 (IL-8) is a potent neutrophil chemoattractant and activator. Pneumocystis carinii pneumonia is associated with an accumulation of neutrophils in bronchoalveolar lavage (BAL) fluid. Thus, we hypothesized that IL-8 is involved in the pathogenesis of P. carinii pneumonia. BAL fluid...... and serum were prospectively collected in 76 consecutive HIV-infected patients with a primary episode of P. carinii pneumonia, as well as in 10 healthy control subjects. Patients were found to have elevated levels of IL-8 in BAL fluid compared with control subjects (p ... the course of P. carinii pneumonia. Comparing survivors with nonsurvivors, the median IL-8 level in BAL fluid was 127 (0 to 3,900) versus 584 (127 to 6,100) pg/ml (p

  6. Prognostic value of interleukin-8 in AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Vestbo, Jørgen; Junge, Jette

    1995-01-01

    and serum were prospectively collected in 76 consecutive HIV-infected patients with a primary episode of P. carinii pneumonia, as well as in 10 healthy control subjects. Patients were found to have elevated levels of IL-8 in BAL fluid compared with control subjects (p patients died during...... the course of P. carinii pneumonia. Comparing survivors with nonsurvivors, the median IL-8 level in BAL fluid was 127 (0 to 3,900) versus 584 (127 to 6,100) pg/ml (p patients with levels of IL-8 in BAL fluid greater than 90 pg/ml (i.e., greater than control subjects) had significantly......Interleukin-8 (IL-8) is a potent neutrophil chemoattractant and activator. Pneumocystis carinii pneumonia is associated with an accumulation of neutrophils in bronchoalveolar lavage (BAL) fluid. Thus, we hypothesized that IL-8 is involved in the pathogenesis of P. carinii pneumonia. BAL fluid...

  7. Clusters of Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Tsolaki, A G; Miller, Raymonde

    1998-01-01

    Genotyping at the internal transcribed spacer (ITS) regions of the nuclear rRNA operon was performed on isolates of P. carinii sp. f. hominis from three clusters of P. carinii pneumonia among eight patients with haematological malignancies and six with HIV infection. Nine different ITS sequence...... types of P. carinii sp. f. hominis were identified in the samples from the patients with haematological malignancies, suggesting that this cluster of cases of P. carinii pneumonia was unlikely to have resulted from nosocomial transmission. A common ITS sequence type was observed in two of the patients...

  8. Alveolar damage in AIDS-related Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Prentø, P; Junge, Jette

    1997-01-01

    OBJECTIVE: Pneumocystis carinii pneumonia is the most common and serious of the pulmonary complications of AIDS. Despite this, many basic aspects in the pathogenesis of HIV-associated P carinii pneumonia are unknown. We therefore undertook a light and electron microscopic study of transbronchial...... biopsy specimens to compare pathologic features of P carinii pneumonia and other HIV-related lung diseases. DESIGN AND PATIENTS: Thirty-seven consecutive HIV-infected patients undergoing a diagnostic bronchoscopy. RESULTS: P carinii pneumonia was characterized by an increase in inflammation, edema...... with P carinii pneumonia, whereas none without P carinii pneumonia had this finding (p pneumonia. The changes may form...

  9. Transmission of Pneumocystis carinii from patients to hospital staff

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Elvin, K; Rothman, L P;

    1997-01-01

    BACKGROUND: An extrahuman reservoir of human pathogenic Pneumocystis carinii remains unknown. Host to host transmission has been described in animal studies and in cluster cases among immunodeficient patients. P carinii DNA has recently been detected in air filters from inpatient and outpatient r...

  10. Pneumocystis carinii from pigs and humans are antigenically distinct

    DEFF Research Database (Denmark)

    Christensen, C B; Settnes, Osvald Peter; Bille-Hansen, Vivi;

    1996-01-01

    The antigens of Pneumocystis carinii cysts isolated from pigs and humans were compared by the Western immunoblotting technique. Convalescent pig serum reacted with two antigens (approximately 78 kDa and 32.5 kDa) of porcine P. carinii cysts, whereas convalescent serum from humans did not react wi...

  11. Isolation and expression of the Pneumocystis carinii dihydrofolate reductase gene

    DEFF Research Database (Denmark)

    Edman, J C; Edman, U; Cao, Mi-Mi;

    1989-01-01

    Pneumocystis carinii dihydrofolate reductase (DHFR; 5,6,7,8-tetrahydrofolate: NADP+ oxidoreductase, EC 1.5.1.3) cDNA sequences have been isolated by their ability to confer trimethoprim resistance to Escherichia coli. Consistent with the recent conclusion that P. carinii is a member of the Fungi...

  12. Pneumonia por "Pneumocystis carinii": forma tumoral

    Directory of Open Access Journals (Sweden)

    BARRA LUIZ ALBERTO COSTA

    2000-01-01

    Full Text Available A pneumocistose é uma infecção oportunística freqüente em imunodeprimidos, principalmente naqueles com a síndrome da imunodeficiência adquirida (AIDS. Relata-se o caso de um paciente com quadro insidioso de febre, tosse e emagrecimento. Na radiografia de tórax observou-se imagem tumoral em seio costofrênico direito. Iniciou-se uso de prova terapêutica para tuberculose com rifampicina, isoniazida e pirazinamida (esquema I, sem resolução. Posteriormente, foi realizada biópsia pulmonar "a céu aberto" e o estudo histopatológico revelou pneumonia por Pneumocystis carinii. Houve melhora clínica e radiológica após o início do tratamento específico.

  13. Evidence for a Melanin Cell Wall Component in Pneumocystis carinii

    OpenAIRE

    Icenhour, Crystal R.; Kottom, Theodore J.; Limper, Andrew H

    2003-01-01

    Fluorescein isothiocyanate-labeled monoclonal antibodies specific for fungal melanin were used in this study to visualize melanin-like components of the Pneumocystis carinii cell wall. A colorimetric enzyme assay confirmed these findings. This is the first report of melanin-like pigments in Pneumocystis.

  14. Risk Factors for Breakthrough Pneumocystis carinii Pneumonia on Aerosol Pentamidine Prophylaxis

    Directory of Open Access Journals (Sweden)

    RA McIvor

    1995-01-01

    Full Text Available OBJECTIVE: To identify baseline characteristics of human immunodeficiency virus (HIV-infected individuals on aerosol pentamidine for Pneumocystis carinii prophylaxis that are predictive of subsequent breakthrough Pneumocystis carinii pneumonia (PCP.

  15. Identification of Pneumocystis carinii chromosomes and mapping of five genes

    DEFF Research Database (Denmark)

    Lundgren, B; Cotton, R; Lundgren, J D;

    1990-01-01

    Pulsed field gel electrophoresis was used to identify the chromosome-size DNA of Pneumocystis carinii, a major pathogen of immunocompromised patients. Thirteen chromosomes of rodent Pneumocystis carinii, ranging in size from 300 to 700 kilobases (kb), were identified. The minimum genome size for P....... carinii, estimated on the basis of the sizes of chromosomes, is 7,000 kb. Genetic heterogeneity among different P. carinii isolates was documented by demonstration of chromosomal size variability. By hybridization studies, the genes for topoisomerase I, dihydrofolate reductase, rRNA, actin......, and thymidylate synthase were mapped to single chromosomes of approximately 650, 590, 550, 460, and 350 kb, respectively. Hybridization studies further confirmed the genetic heterogeneity of P. carinii....

  16. Radiographic and HRCT findings of pneumocystis carinii pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Jin Sam; Kim, Kun Il; Kim, Chang Won; Park, Soon Kew; Cho, Goon Jae [Pusan National Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-08-01

    To analyze the radiographic and HRCT findings of Pneumocystic carinii pneumonia. We reviewed the medical records and retrospectively analysed the chest radiographs(n=31) and HRCT scans(n=17) of 31 patients with Pneumocystis carinii pneumonia who had been followed up at our institute between, 1993 and March 1998. Pneumocystis carinii pneumonia was confirmed by cytologic evaluation of sputum stained with methenamine silver(n=25) or on the basis of clinical history(n=6). The study group included 17 men and 14 women aged 28-78(average, 53.6) years. Twenty-eight patients had underlying conditions such as hematologic diseases(n=13), AIDS(n=8), malignancy(n=2), DM(n=2) and malnutrition(n=1), and three were free from underlying diseases. Twenty patients had pure Pneumocystis carinii pneumonia and 11 had combined lung diseases, namely pulmonary tuberculosis(n=4), pulmonary metastasis(n=2), bacterial pneumonia(n=2), atypical mycobacterial infection(n=1), pulmonary edema(n=1), and Kaposi' s sarcoma(n=1). Chest radiographic findings of 20 cases of pure Pneumocystis carinii pneumonia included consolidation(n=12), linear-reticular opacity(n=8), ill defined haziness(n=7), and nodules(n=6), with bilaterality in is cases and zonal predominance in ten [central(n=5), lower(n=5)]. Ancillary findings included pleural effusion(n=10), cysts(n=5), lymphadenopathy(n=4) and pneumothorax(n=1). In two patients, findings were entirely normal. HRCT findings in ten cases of pure Pneumocystis carinii pneumonia included ground-glass opacity(n=6), consolidation(n=6), linear-reticular opacity(n=8), and nodules(n=5), with bilaterallity in seven cases and zonal predominance in five [central(n=5), lower(n=2)]. Ancillary findings among these cases included pleural effusion(n=4), lymphadenopathy(n=2), cysts(n=1), and pneumothorax(n=1). HRCT findings in seven cases of Pneumocystis carinii pneumonia combined with other lung diseases included nodules(n=6), ground-glass opacity(n=5), linear

  17. Alveolar damage in AIDS-related Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Prentø, P; Junge, Jette

    1997-01-01

    OBJECTIVE: Pneumocystis carinii pneumonia is the most common and serious of the pulmonary complications of AIDS. Despite this, many basic aspects in the pathogenesis of HIV-associated P carinii pneumonia are unknown. We therefore undertook a light and electron microscopic study of transbronchial...... biopsy specimens to compare pathologic features of P carinii pneumonia and other HIV-related lung diseases. DESIGN AND PATIENTS: Thirty-seven consecutive HIV-infected patients undergoing a diagnostic bronchoscopy. RESULTS: P carinii pneumonia was characterized by an increase in inflammation, edema...

  18. Iron chelator daphnetin against Pneumocystis carinii in vitro

    Institute of Scientific and Technical Information of China (English)

    叶彬; 郑玉强; 武卫华; 张静

    2004-01-01

    Background Although there are several drugs and drug combinations for the treatment of Pneumocystis carinii (P. carinii) pneumonia, all drugs have the toxicity as well as low efficacy. Iron chelators have been proposed as a source of new drugs for combating these infections. We hypothesized that iron chelators would suppress the growth of P. carinii by deprivation of the nutritional iron required for growth. In this study, a short-term axenic culture system of P. carinii was established. Daphnetin (7,8-dihydroxycoumarin), a known iron chelator, was demonstrated to exhibit in vitro activity against P. carinii in this system. Methods P. carinii organisms were obtained from the lungs of immunosuppressed rats. The culture system consisted of Iscove Dulbecco Eagle's Minimum Essential Medium (IMDM), supplemented with S-adenosyl-L-methionine, N-acetylglucosamine, putrescine, L-cysteine, L-glutamine, 2-mercaptoethanol, and fetal bovine serum, and was maintained at 37℃, in 5% CO2, 95% O2, at the optimal pH of 8.0. The culture system was used to assess the effect of daphnetin on the proliferation of P. carinii organisms. The ultrastructures of the treated organisms were observed by transmission electron microscopy.Conclusions Daphnetin can suppress the growth of P. carinii in vitro. The efficacy of daphnetin in suppressing the the growth of P. carinii in vitro is related to its ability to chelate iron.

  19. Effect of surfactant replacement on Pneumocystis carinii pneumonia in rats

    NARCIS (Netherlands)

    E.P. Eijking (Eric); G.J. van Daal; R. Tenbrinck (Robert); A. Luijendijk (Ad); J.F. Sluiters (Hans); E. Hannappel (E.); B.F. Lachmann (Burkhard)

    1991-01-01

    textabstractThe effect of intratracheal surfactant instillation on pulmonary function in rats with Pneumocystis carinii pneumonia (PCP) was investigated. In those animals which developed PCP with severe respiratory failure after administration of cortisone acetate s. c. over 8-12 weeks, pulmonary fu

  20. Isolation and expression of the Pneumocystis carinii thymidylate synthase gene

    DEFF Research Database (Denmark)

    Edman, U; Edman, J C; Lundgren, B;

    1989-01-01

    The thymidylate synthase (TS) gene from Pneumocystis carinii has been isolated from complementary and genomic DNA libraries and expressed in Escherichia coli. The coding sequence of TS is 891 nucleotides, encoding a 297-amino acid protein of Mr 34,269. The deduced amino acid sequence is similar...

  1. Albendazole inhibits Pneumocystis carinii proliferation in inoculated immunosuppressed mice.

    OpenAIRE

    Bartlett, M S; Edlind, T D; Lee, C. H.; Dean, R; Queener, S F; Shaw, M M; Smith, J W.

    1994-01-01

    Albendazole, a benzimidazole derivative widely used for treating helminth infections, was successfully used to treat and prevent development of Pneumocystis carinii pneumonia in transtracheally inoculated immunosuppressed mice. For treatment, 3 weeks postinoculation, albendazole at 300 and 600 mg/kg of body weight per day was administered in food for 3 weeks. For prophylaxis, albendazole was begun on the same day as inoculation at 300 mg/kg/day for 7 days, and then the dose was reduced to 150...

  2. Prevention of infection caused by Pneumocystis carinii in transplant recipients.

    Science.gov (United States)

    Fishman, J A

    2001-10-15

    Pneumocystis carinii remains an important pathogen in patients who undergo solid-organ and hematopoietic transplantation. Infection results from reactivation of latent infection and via de novo acquisition of infection from environmental sources. The risk of infection depends on the intensity and duration of immunosuppression and underlying immune deficits. The risk is greatest after lung transplants, in individuals with invasive cytomegalovirus disease, during intensive immunosuppression for allograft rejection, and during periods of neutropenia. Prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) prevents many opportunistic infections, including infection with P. carinii, Toxoplasma gondii, and community-acquired respiratory, gastrointestinal, and urinary tract pathogens. Intolerance of TMP-SMZ is common; desensitization is useful less often in transplant patients than in patients with AIDS. Alternative agents provide a narrower spectrum of protection than does TMP-SMZ and less adequate protection against Pneumocystis species. Clinically, the diagnosis of breakthrough Pneumocystis pneumonia often requires invasive procedures. Strategies for the prevention of Pneumocystis infection must be individualized on the basis of a stratification of risk for each patient.

  3. Experimental corticosteroid induction of Pneumocystis carinii pneumonia in piglets

    DEFF Research Database (Denmark)

    Nielsen, Jens; Bille-Hansen, Vivi; Settnes, O.P.

    1999-01-01

    Animal models of Pneumocystis carinii (Pc) pneumonia (PCP) play a central role in research on the Pc microorganism itself and the disease, especially the pathogenesis and the host defence. The classic rat model with corticosteroid-induced reactivation of a latent infection has been most widely used...... of the frontal lung lobes and/or atelectatic looking diaphragmatic lobes. Histopathologically, there was a focal interstitial pneumonia. Alveolar walls and interstitia had mononuclear cell infiltrations and the alveolar lumina were occluded by foamy acidophilic honeycomb material with a varying number of Pc...

  4. Altered distribution of Pneumocystis carinii pneumonia during radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, H.H.; Park, S.H. [Department of Diagnostic Radiology, Kangnam St. Mary`s Hospital, College of Medicine, Seoul (Korea, Republic of); Kim, S.C. [Department of Internal Medicine, Kangnam St. Mary`s Hospital, College of Medicine, Catholic University of Korea, Seoul (Korea, Republic of); Kim, Y.S. [Department of Therapeutic Radiology, Kangnam St. Mary`s Hospital, College of Medicine, Catholic University of Korea, Seoul (Korea, Republic of)

    1999-10-01

    The radiographic findings of Pneumocystis carinii pneumonia (PCP) are various. The typical findings are diffuse, bilateral, symmetric, finely granular, or reticular infiltrates. In patients taking aerosol pentamidine, atypical findings may be the first manifestation. One interesting radiologic finding of PCP is that the pneumonia may spare the irradiated lung. We report PCP developed in a patient undergoing irradiation for lung cancer. High-resolution CT revealed diffuse, bilateral, and symmetric ground-glass opacities with septal thickening in both lungs; however, the radiation port was spared and appeared as the ``photographic negative of post-radiation pneumonia.`` The distribution of the pneumonic infiltrates was altered by radiotherapy. (orig.) With 1 fig., 6 refs.

  5. Complexity of the MSG gene family of Pneumocystis carinii

    Directory of Open Access Journals (Sweden)

    Stringer James R

    2009-08-01

    Full Text Available Abstract Background The relationship between the parasitic fungus Pneumocystis carinii and its host, the laboratory rat, presumably involves features that allow the fungus to circumvent attacks by the immune system. It is hypothesized that the major surface glycoprotein (MSG gene family endows Pneumocystis with the capacity to vary its surface. This gene family is comprised of approximately 80 genes, which each are approximately 3 kb long. Expression of the MSG gene family is regulated by a cis-dependent mechanism that involves a unique telomeric site in the genome called the expression site. Only the MSG gene adjacent to the expression site is represented by messenger RNA. Several P. carinii MSG genes have been sequenced, which showed that genes in the family can encode distinct isoforms of MSG. The vast majority of family members have not been characterized at the sequence level. Results The first 300 basepairs of MSG genes were subjected to analysis herein. Analysis of 581 MSG sequence reads from P. carinii genomic DNA yielded 281 different sequences. However, many of the sequence reads differed from others at only one site, a degree of variation consistent with that expected to be caused by error. Accounting for error reduced the number of truly distinct sequences observed to 158, roughly twice the number expected if the gene family contains 80 members. The size of the gene family was verified by PCR. The excess of distinct sequences appeared to be due to allelic variation. Discounting alleles, there were 73 different MSG genes observed. The 73 genes differed by 19% on average. Variable regions were rich in nucleotide differences that changed the encoded protein. The genes shared three regions in which at least 16 consecutive basepairs were invariant. There were numerous cases where two different genes were identical within a region that was variable among family members as a whole, suggesting recombination among family members. Conclusion A

  6. Sterols of Saccharomyces cerevisiae erg6 Knockout Mutant Expressing the Pneumocystis carinii S-Adenosylmethionine:Sterol C-24 Methyltransferase.

    Science.gov (United States)

    Kaneshiro, Edna S; Johnston, Laura Q; Nkinin, Stephenson W; Romero, Becky I; Giner, José-Luis

    2015-01-01

    The AIDS-associated lung pathogen Pneumocystis is classified as a fungus although Pneumocystis has several distinct features such as the absence of ergosterol, the major sterol of most fungi. The Pneumocystis carinii S-adenosylmethionine:sterol C24-methyltransferase (SAM:SMT) enzyme, coded by the erg6 gene, transfers either one or two methyl groups to the C-24 position of the sterol side chain producing both C28 and C29 24-alkylsterols in approximately the same proportions, whereas most fungal SAM:SMT transfer only one methyl group to the side chain. The sterol compositions of wild-type Sacchromyces cerevisiae, the erg6 knockout mutant (Δerg6), and Δerg6 expressing the P. carinii or the S. cerevisiae erg6 gene were analyzed by a variety of chromatographic and spectroscopic procedures to examine functional complementation in the yeast expression system. Detailed sterol analyses were obtained using high performance liquid chromatography and proton nuclear magnetic resonance spectroscopy ((1)H-NMR). The P. carinii SAM:SMT in the Δerg6 restored its ability to produce the C28 sterol ergosterol as the major sterol, and also resulted in low levels of C29 sterols. This indicates that while the P. carinii SAM:SMT in the yeast Δerg6 cells was able to transfer a second methyl group to the side chain, the action of Δ(24(28)) -sterol reductase (coded by the erg4 gene) in the yeast cells prevented the formation and accumulation of as many C29 sterols as that found in P. carinii.

  7. Identification of porcine Pneumocystis carinii as a genetically distinct organism by DNA amplification

    DEFF Research Database (Denmark)

    Wakefield, A. E.; Keely, S. P.; Stringer, J. R.

    1997-01-01

    DNA was amplified from lung samples from three piglets infected with Pneumocystis carinii, using oligonucleotide primers designed to the P. carinii mitochondrial large subunit ribosomal RNA gene. The nucleotide sequence of the amplification product was determined and indicated lack of sequence va...

  8. Development of a Rapid Real-Time PCR Assay for Quantitation of Pneumocystis carinii f. sp. Carinii

    DEFF Research Database (Denmark)

    Larsen, Hans Henrik; Kovacs, Joseph A; Stock, Frida

    2002-01-01

    A method for reliable quantification of Pneumocystis carinii in research models of P. carinii pneumonia (PCP) that is more convenient and reproducible than microscopic enumeration of organisms would greatly facilitate investigations of this organism. We developed a rapid quantitative touchdown (QTD...... 6 log values for standards containing > or =5 copies/tube. Application of the assay to a series of 10-fold dilutions of P. carinii organisms isolated from rat lung demonstrated that it was reproducibly quantitative over 5 log values (r = 0.99). The assay was applied to a recently reported in vitro...... axenic cultivation system for P. carinii and confirmed our microscopy findings that no organism multiplication had occurred during culture. For all cultures analyzed, QTD PCR assays showed a decrease in P. carinii DNA that exceeded the expected decrease due to dilution of the inoculum upon transfer...

  9. Amount of Pneumocystis carinii and degree of acute lung inflammation in HIV-associated P carinii pneumonia

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Nielsen, T L; Junge, Jette

    1993-01-01

    Correlations between semiquantitative amounts of Pneumocystis carinii (PC), the degree of inflammation, and the severity of pneumonia were analyzed in 58 patients with PC pneumonia (PCP). Material from both transbronchial biopsies (TBBs; n = 39) and bronchoalveolar lavage fluid (BALF; n = 57...

  10. Population Structure of Rat-Derived Pneumocystis carinii in Danish Wild Rats

    DEFF Research Database (Denmark)

    Palmer, Robert J.; Settnes, Osvald P.; Lodal, Jens

    2000-01-01

    samples. We report a lack of variation in the ITS1 and ITS2 regions that is consistent with an evolutionary bottleneck in the P. carinii f. sp. carinii population. This study shows that human- and rat-derived P. carinii organisms are very different, not population. This study shows that human- and rat......The rat model of Pneumocystis carinii pneumonia is frequently used to study human P. carinii infection, but there are many differences between the rat and human infections. We studied naturally acquired P. carinii in wild rats to examine the relevance of the rat model for human infection. P......-derived organisms are very different, not only in genetic composition but also in population structure and natural history....

  11. Cultured rat and purified human Pneumocystis carinii stimulate intra- but not extracellular free radical production in human neutrophils

    DEFF Research Database (Denmark)

    Jensen, T; Aliouat, E M; Lundgren, B

    1998-01-01

    The production of free radicals in human neutrophils was studied in both Pneumocystis carinii derived from cultures of L2 rat lung epithelial-like cells and Pneumocystis carinii purified from human lung. Using the cytochrome C technique, which selectively measured extracellular superoxide....... It was established that 1) P. carinii stimulated intra- but not extracellular free radical production in human neutrophils, 2) opsonized cultured rat-derived P. carinii stimulated human neutrophils to a strong intracellular response of superoxide production, and 3) opsonized P. carinii, purified from human lung also...

  12. Pneumocystis carinii in bronchoalveolar lavage and induced sputum: detection with a nested polymerase chain reaction

    DEFF Research Database (Denmark)

    Skøt, J; Lerche, A G; Kolmos, H J;

    1995-01-01

    To evaluate polymerase chain reaction (PCR) for detection of Pneumocystis carinii, 117 bronchoalveolar lavage (BAL) specimens, from HIV-infected patients undergoing a diagnostic bronchoscopy, were processed and a nested PCR, followed by Southern blot and hybridization with a P32-labelled probe......, but sensitivity dropped markedly with this system. A further 33 patients had both induced sputum and bronchoalveolar lavage performed and the induced sputum was analysed using PCR and routine microbiological methods. The PCR sensitivity on induced sputum was equal to that of routine methods. At present...... the evaluated PCR cannot replace routine microbiological methods for detection of Pneumocystis carinii, on either BAL fluid or induced sputum....

  13. Purification and characterization of a major human Pneumocystis carinii surface antigen

    DEFF Research Database (Denmark)

    Lundgren, B; Lipschik, G Y; Kovacs, J A

    1991-01-01

    with zymolyase followed by molecular sieve and ion exchange chromatography. The native proteins had an apparent mol wt of 290,000 or greater, based on molecular sieve studies as well as cross-linking studies. Both proteins were glycoproteins; treatment with endoglycosidase H resulted in a 9% decrease in mol wt......Previous studies of Pneumocystis carinii have identified the major surface antigen of rat and human isolates as proteins of 116,000 and 95,000 mol wt, respectively, that are antigenically not identical. In this study both rat and human P. carinii proteins were purified by solubilization....... The carbohydrate composition of the rat P. carinii glycoprotein was distinct from the human isolate; glucose, mannose, galactose, and glucosamine occurred in approximately equimolar ratios in the human P. carinii protein, whereas glucose and mannose were the predominant sugars of the rat P. carinii protein...

  14. Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non-Pneumocystis carinii pneumonia in AIDS patients

    Energy Technology Data Exchange (ETDEWEB)

    Hidalgo, A.; Mauleon, S.; Andreu, J.; Caceres, J. [Department of Radiology, Hospital General Universitari Vall d' Hebron, Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Paseo Vall d' Hebron 119-129, 08035 Barcelona (Spain); Falco, V.; Crespo, M.; Ribera, E.; Pahissa, A. [Department of Medicine, Service of Infectious Diseases, Hospital General Universitari Vall d' Hebron, Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Paseo Vall d' Hebron 119-129, 08035 Barcelona (Spain)

    2003-05-01

    The aim of this study was to assess the value of high-resolution CT in distinguishing between Pneumocystis carinii and non-Pneumocystis carinii pneumonia (PCP) in patients HIV-positive and high risk to have PCP. We performed a prospective study in 30 patients with <200 CD4 lymphocytes, clinical symptoms of pulmonary disease and chest X-ray non-conclusive for pulmonary infection. Evaluated CT findings included ground-glass opacities, reticulation, tree-in-bud appearance, consolidation, cystic lesions, bronchiectasis and lymphadenopathies. The diagnosis of ''examination suggestive of PCP'' was applied to cases showing a diffuse or predominant ground-glass pattern in the upper fields, associated or not with reticulations and small cystic lesions. The sensitivity, specificity, positive predictive value and negative predictive value of high-resolution computed tomography (HRCT) for the diagnosis of PCP was 100, 83.3, 90.5 and 100%, respectively. Pneumocystis carinii pneumonia was not demonstrated in any of the cases classified as ''examination not suggestive of PCP''. Significant small airway disease was not observed in any of the PCP cases. We conclude that HRCT is a reliable method for differentiating PCP from other infectious processes in HIV-positive patients and a good method to rule our PCP. Its inclusion in the diagnostic algorithm of lung infections is justified in these patients. (orig.)

  15. Pneumocystis carinii in bronchoalveolar lavage and induced sputum: detection with a nested polymerase chain reaction

    DEFF Research Database (Denmark)

    Skøt, J; Lerche, A G; Kolmos, H J;

    1995-01-01

    To evaluate polymerase chain reaction (PCR) for detection of Pneumocystis carinii, 117 bronchoalveolar lavage (BAL) specimens, from HIV-infected patients undergoing a diagnostic bronchoscopy, were processed and a nested PCR, followed by Southern blot and hybridization with a P32-labelled probe...

  16. Adjunctive corticosteroid therapy for Pneumocystis carinii pneumonia in AIDS: a randomized European multicenter open label study

    DEFF Research Database (Denmark)

    Nielsen, T L; Eeftinck Schattenkerk, J K; Jensen, B N

    1992-01-01

    Fifty-nine human immunodeficiency virus type-1-infected patients with a microscopically proven first episode of moderate to severe Pneumocystis carinii pneumonia (PCP) were enrolled into a randomized European multicenter study. The effect of adjunctive corticosteroid (CS) therapy was assessed on (a...

  17. Sterols of Pneumocystis carinii hominis organisms isolated from human lungs

    DEFF Research Database (Denmark)

    Kaneshiro, E S; Amit, Z; Chandra, Jan Suresh

    1999-01-01

    in conjunction with analyses of chemically synthesized authentic standards. The sterol composition of isolated P. carinii hominis organisms has yet to be reported. If P. carinii from animal models is to be used for identifying potential drug targets and for developing chemotherapeutic approaches to clear human...... infections, it is important to determine whether the 24-alkylsterols of organisms found in rats are also present in organisms in humans. In the present study, sterol analyses of P. carinii hominis organisms isolated from cryopreserved human P. carinii-infected lungs and from bronchoalveolar lavage fluid were...

  18. AIDS-Related Extrapulmonary Pneumocystis carinii Infection Presenting as a Solitary Rectal Ulcer

    Directory of Open Access Journals (Sweden)

    Eric M Yoshida

    1996-01-01

    Full Text Available Extrapulmonary infection with Pneumocystis carinii, although uncommon, is increasingly recognized. Use of aerosolized pentamidine versus a systemic medication is thought to be a contributing factor due to the low concentrations of drug that are incapable of suppressing systemic infection. Infection with P carinii has been reported in every organ system including the gastrointestinal system. A 28-year-old acquired immunodeficiency syndrome patient receiving prophylaxis with aerosolized pentamidine who presented with a solitary rectal ulcer is reported. Initial biopsy was characteristic of extrapulmonary P carinii infection, with numerous organisms present. Occasional cytomegalovirus inclusion bodies were noted which may have been a copathogen but which were not treated. Treatment with intravenous pentamidine resulted in documented eradication of P carinii and complete resolution of the ulcer. Although lower gastrointestinal pneumocystosis has been described without ulceration, this is the first description of rectal ulceration presenting as the initial manifestation of extrapulmonary pneumocystosis.

  19. Identification of porcine Pneumocystis carinii as a genetically distinct organism by DNA amplification

    DEFF Research Database (Denmark)

    Wakefield, A E; Keely, S P; Stringer, J R

    1997-01-01

    DNA was amplified from lung samples from three piglets infected with Pneumocystis carinii, using oligonucleotide primers designed to the P. carinii mitochondrial large subunit ribosomal RNA gene. The nucleotide sequence of the amplification product was determined and indicated lack of sequence va...

  20. Relationship between the burden of pneumocystis carinii, the inflammatory reaction and lung injury in pneumocystis carinii pneumonia

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Obiective To study the relationship between the burden of Pneumocystis carinii (P.cadninii) and the inflammatory reaction and biochemical markers in bronchoalveotar lavage fluids (BAL.F)in a rat model of p. carirnii pneumonia (PCP). Methods Clean grade 50 male Sprague-Dawley rats were immunosuppressed by a subcutaneous injection of 25mg cortisone acetate twice a week for 8-12 weeks; the PCP model was successfully induced in 14 rats. The inflammatory reaction and biochemical markers of the activity of lactate dehydrogenass (LDH), alknline phosphatase(ALP) end type Ⅳ collagenase(matrix metalloproteinases, MMP-2,MMP-9) as well as the values of total protein (TP) and albumin (ALB) in BALF between the mild burden group of P. caninii (involved alveoli<25% per 100 alveoli,Group A) and the moderate to severe burden group (involved alveoli≥25% per 100 alveoli, Group B)were measured. The other six clean grade SD rata served es normal control group (Group C). Results The total white cell count in BALF=was higher in Group B [(6.8±1.7)×106/L] than in Group A [(3.8±1.2)×106/L] (P<0.01);however, there were no differences in white cell differentiation.Assays of biochemical markers showed that ALB in BALF in Group B (0.893±0.469 g/L) was increased in companison with Group A (0.262±0.169 g/L); it was only 0.026±0.021 g/L in Group C. The contents of TP and activities of LDH were higher in Group B (TP 1.756±0.706 g/L, LDH 2580±550 U/L) than inGroup A (TP 0.784±0.553 g/L, LDH 1410±620 U/L); the values of TP and LDH were 0.063±0.020 g/L and 370±250 U/L respectively in Group C.The activity of Type IV collagenase, including MMP-2 and MMP-9, was higher in Group B than in Group A ( P<0.01) (MMP-2: 1102±169 grey value vs 459±274 grey valce; MMP-9: 1218±257 grey value vs 449±225 grey value).There was no activity of Type IV cellagenase in BALF of Group C. No statistically significant difference was obselved in ALP between the groups B and A. Conclusions These results

  1. Multiple genes encode the major surface glycoprotein of Pneumocystis carinii

    DEFF Research Database (Denmark)

    Kovacs, J A; Powell, F; Edman, J C;

    1993-01-01

    this antigen is a good candidate for development as a vaccine to prevent or control P. carinii infection. We have cloned and sequenced seven related but unique genes encoding the major surface glycoprotein of rat P. carinii. Partial amino acid sequencing confirmed the identity of these genes. Based on Southern...... hydrophobic region at the carboxyl terminus. The presence of multiple related msg genes encoding the major surface glycoprotein of P. carinii suggests that antigenic variation is a possible mechanism for evading host defenses. Further characterization of this family of genes should allow the development...

  2. Indication for fiberoptic bronchoscopy in HIV-infected patients suspected for Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Orholm, M; Lundgren, Jens Dilling; Nielsen, T L;

    1990-01-01

    During a six-month period, 40 consecutive fiberoptic bronchoscopic procedures including bronchoalveolar lavage, bronchial brushing and forceps biopsy were performed in local anaesthesia on 34 HIV-infected males presenting symptoms compatible with Pneumocystis carinii pneumonia. In 23 examinations...... did not differ with regard to history, clinical examination, immunology, serology or chest radiograph. We conclude that fiberoptic bronchoscopy should be performed on wide indications in HIV-infected patients with symptoms compatible with P. carinii pneumonia. The procedure is easily performed......, it is safe, and it is highly sensitive. The advantage of an early diagnosis compensates for a rather high frequency of negative examinations....

  3. Pneumocystis carinii pneumonia in a patient on etanercept for psoriatic arthritis.

    LENUS (Irish Health Repository)

    Lahiff, C

    2007-12-01

    Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells\\/mm(3). We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept.

  4. A simple method of separation of Pneumocystis carinii from rat lung.

    OpenAIRE

    Read, J. A.; Burns, S M

    1991-01-01

    Existing methods for purification of Pneumocystis carinii are unsatisfactory. Dialysis is a simple, non-stressful treatment which aided purification of organisms from rat cells. Yields were quantitated using a Petroff-Hausser chamber and nuclear staining. Following dialysis overnight, three times the yields of similar, undialysed preparations were obtained, with less than 0.2% contamination by lung cells. Overnight incubation at 4 degrees C also improved separation, but yields were only half ...

  5. Improved detection of Pneumocystis carinii by an immunofluorescence technique using monoclonal antibodies

    DEFF Research Database (Denmark)

    Orholm, M; Holten-Andersen, W; Lundgren, Jens Dilling

    1990-01-01

    To assess whether a recently developed indirect immunofluorescent stain using monoclonal antibodies was more sensitive in detecting Pneumocystis carinii than the combination of Giemsa and methenamine silver nitrate stains which has routinely been used in the laboratory, 88 lavage fluid specimens...... and 34 induced sputum specimens were examined. All specimens were stained by five techniques: immunofluorescence using a combination of three monoclonal antibodies (from the National Institutes of Health, USA), immunofluorescence using a single monoclonal antibody (from Dakopatts), Giemsa, methenamine...

  6. Cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate

    DEFF Research Database (Denmark)

    Balslev, U; Berild, D; Nielsen, T L

    1992-01-01

    A 27-year-old man, HIV-positive for 4 years, developed ventricular fibrillation and cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate. The dosage was 4 mg/kg/day for 18 days. Nephrotoxicity occurred and raised serum potassium. The plasma...... concentration of pentamidine was 580 nmol/l. Careful monitoring of renal and cardiac functions is recommended during intravenous therapy with pentamidine isethionate....

  7. Diagnostic use of PCR for detection of Pneumocystis carinii in oral wash samples

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Jensen, Jens Ulrik Stæhr; Benfield, T

    1998-01-01

    and was compared to a previously described PCR protocol (mitochondrial RNA) run in a research laboratory. Both PCR methods amplified a sequence of the mitochondrial rRNA gene of P. carinii. Paired bronchoalveolar lavage (BAL) and oral wash specimens from 76 consecutive human immunodeficiency virus type 1-infected...... persons undergoing a diagnostic bronchoscopy were included. The TD-PCR procedure was quicker than the mitochondrial PCR procedure (compared to microscopy, had sensitivity, specificity, and positive and negative predictive values of 89, 94, 93, and 91%, respectively, for oral wash......There is a need to develop noninvasive methods for the diagnosis of Pneumocystis carinii pneumonia in patients unable to undergo bronchoscopy or induction sputum. Oral wash specimens are easily obtained, and P. carinii nucleic acid can be amplified and demonstrated by PCR. In routine clinical use...

  8. Ploidy of cell-sorted trophic and cystic forms of Pneumocystis carinii.

    Science.gov (United States)

    Martinez, Anna; Aliouat, El Moukhtar; Standaert-Vitse, Annie; Werkmeister, Elisabeth; Pottier, Muriel; Pinçon, Claire; Dei-Cas, Eduardo; Aliouat-Denis, Cécile-Marie

    2011-01-01

    Once regarded as an AIDS-defining illness, Pneumocystis pneumonia (PcP) is nowadays prevailing in immunocompromised HIV-negative individuals such as patients receiving immunosuppressive therapies or affected by primary immunodeficiency. Moreover, Pneumocystis clinical spectrum is broadening to non-severely-immunocompromised subjects who could be colonized by the fungus while remaining asymptomatic for PcP, thus being able to transmit the infection by airborne route to susceptible hosts. Although the taxonomical position of the Pneumocystis genus has been clarified, several aspects of its life cycle remain elusive such as its mode of proliferation within the alveolus or its ploidy level. As no long-term culture model exists to grow Pneumocystis organisms in vitro, an option was to use a model of immunosuppressed rat infected with Pneumocystis carinii and sort life cycle stage fractions using a high-through-put cytometer. Subsequently, ploidy levels of the P. carinii trophic and cystic form fractions were measured by flow cytometry. In the cystic form, eight contents of DNA were measured thus strengthening the fact that each mature cyst contains eight haploid spores. Following release, each spore evolves into a trophic form. The majority of the trophic form fraction was haploid in our study. Some less abundant trophic forms displayed two contents of DNA indicating that they could undergo (i) mating/fusion leading to a diploid status or (ii) asexual mitotic division or (iii) both. Even less abundant trophic forms with four contents of DNA were suggestive of mitotic divisions occurring following mating in diploid trophic forms. Of interest, was the presence of trophic forms with three contents of DNA, an unusual finding that could be related to asymmetrical mitotic divisions occurring in other fungal species to create genetic diversity at lower energetic expenses than mating. Overall, ploidy data of P. carinii life cycle stages shed new light on the complexity of its

  9. Ploidy of cell-sorted trophic and cystic forms of Pneumocystis carinii.

    Directory of Open Access Journals (Sweden)

    Anna Martinez

    Full Text Available Once regarded as an AIDS-defining illness, Pneumocystis pneumonia (PcP is nowadays prevailing in immunocompromised HIV-negative individuals such as patients receiving immunosuppressive therapies or affected by primary immunodeficiency. Moreover, Pneumocystis clinical spectrum is broadening to non-severely-immunocompromised subjects who could be colonized by the fungus while remaining asymptomatic for PcP, thus being able to transmit the infection by airborne route to susceptible hosts. Although the taxonomical position of the Pneumocystis genus has been clarified, several aspects of its life cycle remain elusive such as its mode of proliferation within the alveolus or its ploidy level. As no long-term culture model exists to grow Pneumocystis organisms in vitro, an option was to use a model of immunosuppressed rat infected with Pneumocystis carinii and sort life cycle stage fractions using a high-through-put cytometer. Subsequently, ploidy levels of the P. carinii trophic and cystic form fractions were measured by flow cytometry. In the cystic form, eight contents of DNA were measured thus strengthening the fact that each mature cyst contains eight haploid spores. Following release, each spore evolves into a trophic form. The majority of the trophic form fraction was haploid in our study. Some less abundant trophic forms displayed two contents of DNA indicating that they could undergo (i mating/fusion leading to a diploid status or (ii asexual mitotic division or (iii both. Even less abundant trophic forms with four contents of DNA were suggestive of mitotic divisions occurring following mating in diploid trophic forms. Of interest, was the presence of trophic forms with three contents of DNA, an unusual finding that could be related to asymmetrical mitotic divisions occurring in other fungal species to create genetic diversity at lower energetic expenses than mating. Overall, ploidy data of P. carinii life cycle stages shed new light on the

  10. Glycosylation of the major human Pneumocystis carinii surface antigen

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Koch, C; Mathiesen, Lars Reinhardt;

    1993-01-01

    It has recently been shown that the major rat P. carinii surface antigen is important for initial host-organism attachment, possibly through binding to fibronectin, mannose-binding protein, or surfactant protein A. Since a carbohydrate/lectin interaction may be involved in adhesion, we undertook...

  11. Immunohistochemical study of the cellular immune response in human Pneumocystis carinii pneumonia Estudo imuno-histoquímico da resposta imune celular na pneumonia humana por Pneumocystis carinii

    Directory of Open Access Journals (Sweden)

    Leandro Mantovani de Castro

    2006-02-01

    Full Text Available OBJECTIVES: It has been experimentally demonstrated that host defense against Pneumocystis carinii depends on complex interactions within host immune response, mainly CD4 lymphocytes and alveolar macrophages. Since this is an important agent related to immunodeficiency, our purpose was to characterize the inflammatory immune response in lung from necropsy of AIDS patients. PROCEDURES: Twenty-five necropsies with diagnosis of Pneumocystis carinii pneumonia were selected for immunohistochemical investigation of CD4 and CD8 lymphocytes, macrophages (CD68+, NK cells (CD57+ and cells expressing TNF-alpha. The immunostained cells were quantified and statistically analyzed. RESULTS: All specimens presented a great number of cysts of Pneumocystis carinii in alveoli, as well as septal enlargement with inflammatory infiltrate constituted predominantly by lymphocytes and macrophages. CD4+ T cells were decreased in number, and CD8+ T cells, NK cells and macrophages predominated. Cells expressing TNF-alpha were frequently observed in septal inflammatory infiltrate. CONCLUSIONS: The immunosupression related to AIDS induces a reduction in the number of CD4+ T cells and influences high-level parasitism. The cell components that characterize the inflammatory infiltrate contribute to the severe lung injury of those patients.OBJETIVO: Trabalhos experimentais demonstram que as defesas do hospedeiro frente ao Pneumocystis carinii incluem interações complexas entre as células imunes, principalmente linfócitos TCD4+ e macrófagos alveolares. Sendo esse um agente importante associado às imunodeficiências, nosso objetivo foi caracterizar a resposta inflamatória em pulmão de necrópsias de pacientes com AIDS. MÉTODOS: Foram selecionadas 25 necrópsias com diagnóstico de pneumonia por Pneumocystis carinii para pesquisa imuno-histoquímica de linfócitos TCD4+, TCD8+, macrófagos CD68+, células NK CD57+ e células com expressão de TNF-alfa. As c

  12. Interaction Energy Analysis of Nonclassical Antifolates with Pneumocystis carinii Dihydrofolate Reductase

    Directory of Open Access Journals (Sweden)

    William M. Southerland

    2002-11-01

    Full Text Available Abstract: The x-ray structure of the Pneumocystis carinii dihydrofolate reductase (DHFR:trimethoprim:NADPH ternary complex obtained from the Protein Databank was used as a structural template to generate models for the following complexes: P. carinii DHFR:piritrexim:NADPH, P. carinii DHFR:epiroprim:NADPH, and P. carinii DHFR:trimetrexate:NADPH. Each of these complexes, including the original trimethoprim complex was then modeled in 60 angstrom cubes of explicit water and minimized to a rms gradient between 1.0 to 3.0 x 10-5 kcal/angstrom. Subsequently, each antifolate structure was subdivided into distinct substructural regions. The minimized complexes were used to calculate interaction energies for each intact antifolate and its corresponding substructural regions with the P. carinii DHFR binding site residues, the DHFR protein, the solvated complex ( which consists of P. carinii DHFR, NADPH, and solvent water, solvent water alone, and NADPH. Antifolate substructural regions which contained nitrogen and carbon atoms in an aromatic environment (i. e. the pteridyl, pyridopyrimidinyl, and diaminopyrimidinyl subregions contributed most to the stability of antifolate interactions, while interaction energies for the hydrocarbon aromatic rings, methoxy, and ethoxy groups were much less stable. Additionally, interaction energy analyses were calculated for carbon and nitrogen atoms of the pteridyl, pyridopyrimidinyl, and diaminopyrimidinyl subregions and for the carbon and oxygen atoms of methoxy and ethoxy subregions. The contributions of hydrogen atoms were included with those of the carbon, nitrogen and oxygen atoms to which they are attached. These analyses revealed that the carbon atoms of the pteridyl, pyridopyrimidinyl, and diaminopyrimidinyl subregions generally contributed most to the stability of those regions. Carbon atoms also contributed favorably to the stability of the methoxy group interactions. Those substructural regions which exhibit

  13. Pneumocystis carinii: its incidence in rodents and enhancement of the infection by corticosteroids

    Directory of Open Access Journals (Sweden)

    Helly A. Lage

    1973-01-01

    Full Text Available A survey was made on the incidence of Pneumocystis carinii in 361 rodents including sewer rats, albino rats, albino mice, guinea-pigs and rabbits. P. carinii was found in 4 of the 215 Rattus norvegicus examined (1,8%. These results accord with recent observations but disagree with investigations made by the researchers who first studied this parasite in the past when high indexes of infection were found. However, in 20 albino rats treated with corticosteroids (betamethazone we found 8 positive (40% and in 20 albino mice treated by the same way, 9 were positive for P. carinii (45%. These results confirm the opportunistic character of P. carinii in rodents already well demonstrated in man.Foi feita uma investigação sobre a ocorrência de P. carinii em 361 roedores, incluindo ratos de esgoto, ratos albinos, camundongos albinos, cobaios e coelhos. Só foram encontrados positivos 4 Rattus norvegicus em 215 examinados (1.8%. Estes resultados estão de acordo com observações feitas nos últimos anos, os quais constrastam com as verificações feitas nos primeiros anos, os quais contrastam com as verificações feitas nos primeiros anos de estudo do P. carinii, quando foram assinalados altos índices infecciosos. Entretanto, em 20 ratos albinos tratados com corticosteróides (betametasona foram encontrados 8 positivos (40%; e em 20 camundongos albinos, tratados do mesmo modo, foram encontrados 9 positivos (45%. Estes resultados confirmaram o caráter oportunístico do P. carinii no roedores, do mesmo modo como acontece no homem.

  14. Evidence of airborne excretion of Pneumocystis carinii during infection in immunocompetent rats. Lung involvement and antibody response.

    Directory of Open Access Journals (Sweden)

    Jean Menotti

    Full Text Available To better understand the role of immunocompetent hosts in the diffusion of Pneumocystis in the environment, airborne shedding of Pneumocystis carinii in the surrounding air of experimentally infected Sprague Dawley rats was quantified by means of a real-time PCR assay, in parallel with the kinetics of P. carinii loads in lungs and specific serum antibody titres. Pneumocystis-free Sprague Dawley rats were intratracheally inoculated at day 0 (d0 and then followed for 60 days. P. carinii DNA was detected in lungs until d29 in two separate experiments and thereafter remained undetectable. A transient air excretion of Pneumocystis DNA was observed between d14 and d22 in the first experiment and between d9 and d19 in the second experiment; it was related to the peak of infection in lungs. IgM and IgG anti-P. carinii antibody increase preceded clearance of P. carinii in the lungs and cessation of airborne excretion. In rats receiving a second challenge 3 months after the first inoculation, Pneumocystis was only detected at a low level in the lungs of 2 of 3 rats at d2 post challenge and was never detected in air samples. Anti-Pneumocystis antibody determinations showed a typical secondary IgG antibody response. This study provides the first direct evidence that immunocompetent hosts can excrete Pneumocystis following a primary acquired infection. Lung infection was apparently controlled by the immune response since fungal burdens decreased to become undetectable as specific antibodies reached high titres in serum. This immune response was apparently protective against reinfection 3 months later.

  15. Effect of folic and folinic acid on cytopenia occurring during co-trimoxazole treatment of Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Bygbjerg, Ib Christian; Lund, J T; Hørding, M

    1988-01-01

    12 AIDS/ARC patients with or suspected of Pneumocystis carinii pneumonia were treated with co-trimoxazole and received supplementary folic or folinic acid to avoid peripheral blood cytopenia. Most patients developed decreased numbers of neutrophils and hemoglobin while receiving co-trimoxazole. S......12 AIDS/ARC patients with or suspected of Pneumocystis carinii pneumonia were treated with co-trimoxazole and received supplementary folic or folinic acid to avoid peripheral blood cytopenia. Most patients developed decreased numbers of neutrophils and hemoglobin while receiving co...

  16. Rapid detection of dihydropteroate polymorphism in AIDS-related Pneumocystis carinii pneumonia by restriction fragment length polymorphism

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Eugen-Olsen, J; Lundgren, B

    2000-01-01

    Sulpha agents, which act by inhibiting the enzyme dihydropteroate synthase (DHPS), are used widely for the treatment and prophylaxis of Pneumocystis carinii pneumonia (PCP). Recently, we have shown that mutations in the dihydropteroate synthase (DHPS) gene of Pneumocystis carinii f.sp hominis...... are associated with failure of sulpha prophylaxis and increased mortality in HIV-1 positive patients with PCP, suggesting that DHPS mutations may cause sulpha resistance. To facilitate detection of DHPS mutations we developed a restriction fragment length polymorphism (RFLP) assay, detecting mutations at codon...

  17. Pentamidine for the treatment of Pneumocystis carinii pneumonia and other protozoal diseases.

    Science.gov (United States)

    Pearson, R D; Hewlett, E L

    1985-11-01

    Pentamidine isethionate, discovered to have antiprotozoal activity in 1938, has recently been approved in the United States for the treatment of Pneumocystis carinii pneumonia. Despite frequent adverse reactions, which are at times life-threatening, pentamidine remains an important alternative to trimethoprim-sulfamethoxazole for the treatment of P. carinii pneumonia in patients with a history of allergy to sulfonamides or who have severe reactions or a lack of response to treatment with trimethoprim-sulfamethoxazole. Although not approved for other indications, pentamidine has been shown to be effective when used prophylactically against Trypanosoma brucei gambiense, the cause of West African sleeping sickness, as well as for treatment of the early hemolymphatic stage of that disease, and for treatment of some forms of leishmaniasis.

  18. Intestinal cryptosporidiosis. association with Pneumocystis carinii, cytomegalovirus and Candida sp. Infections

    Directory of Open Access Journals (Sweden)

    K. I. R. Coelho

    1987-10-01

    Full Text Available This is a case report of intestinal cryptosporidiosis diagnosed in histological specimen collected from autopsy. The patient was a child of 5 months admitted to the hospital with severe acute diarrhea associated with Pneumocystis carinii pneumonia, cytomegalic sialadenitis, oral and dermal candidiasis. The presence of multiple opportunistic infections in this case indicated immunodeficiency state. Cryptosporidium sp is a possible etiology of acute diarrhea in both immunodeficient and immunocompetent patients and has to be searched for at autopsy when diagnosis was not possible "in vivo".

  19. Aerosolized pentamidine: Effect on diagnosis and presentation of Pneumocystis carinii pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Jules-Elysee, K.M.; Stover, D.E.; Zaman, M.B.; Bernard, E.M.; White, D.A. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))

    1990-05-15

    The objective of this study was to determine the effect of previous aerosolized pentamidine therapy on diagnosis and presentation of Pneumocystis carinii pneumonia. This was a retrospective study of fifty-two consecutive patients with P. carinii pneumonia and underlying infection with the human immunodeficiency virus (HIV) who had bronchoscopy. Twenty-one patients who were on aerosolized pentamidine therapy served as the study group. Thirty-one patients who had not received the drug served as the control group. The yield of bronchoalveolar lavage for P. carinii pneumonia was 62% for the study group and 100% for the control group (P less than 0.05). This lower yield was significant for the subset of patients having their first episode of P. carinii pneumonia. The yield of transbronchial biopsy was similar for both groups of patients (81% compared with 84%). The yield of bronchoscopy was not influenced by use of zidovudine. Review of lavage specimen slides suggested that there may be fewer organisms present in patients receiving aerosolized pentamidine. An atypical roentgenographic presentation of upper lobe predominant infiltrates was seen in 38% of the study patients and 7% of the control patients. In addition, pneumothoraces and cystic changes were also frequently seen in the study patients. Gallium scans, when done, were also atypical in the study group. Markers of the severity of disease, however, were similar in both groups. The yield of bronchoalveolar lavage for P. carinii pneumonia in HIV-infected patients is lower in patients receiving aerosolized pentamidine. Unusual roentgenographic presentations and atypical gallium scans are also found in this setting.

  20. Independent risk of mechanical ventilation for AIDS-related Pneumocystis carinii pneumonia associated with bronchoalveolar lavage neutrophilia

    DEFF Research Database (Denmark)

    Bang, D; Emborg, J; Elkjaer, J

    2001-01-01

    The use of mechanical ventilation (MV) for AIDS-related Pneumocystis carinii pneumonia (PCP) has varied over time. The introduction of adjunctive corticosteroid therapy has changed the pathophysiology of PCP. In the present study, we attempted to identify factors predictive of severe respiratory...

  1. Pneumocystis carinii: A Review of an Important Opportunistic Pathogen in AIDS

    Directory of Open Access Journals (Sweden)

    M John Gill

    1991-01-01

    Full Text Available Since the first report of human infection with Pneumocystis carinii in 1942, cases of pneumonia due to this opportunistic pathogen have become increasingly common. Animal studies and clinical observations show that a significant depletion or dysfunction of T helper lymphocytes predisposes to clinical disease. Individuals with damaged T helper cells secondary to malignancies (eg, Hodgkin’s lymphoma, drugs (eg, cyclosporine, steroids, or certain infections (eg, human immunodeficiency virus are at particular risk. Serological studies suggest that disease is most often secondary to the reactivation of an asymptomatic infection, usually acquired during childhood. Increasing shortness of breath, a nonproductive cough and hypoxia often preceded by several weeks of lethargy, fever and weight loss are the classical features of P carinii pneumonia in acquired immune deficiency syndrome. Bronchoalveolar lavage is usually the optimal diagnostic test. Immunofluorescent staining on liquified sputum induced by nebulized saline appears to be a promising and noninvasive test. Early empiric therapy with trimethoprim-sulphamethoxazole (trimethoprim 5 mg-sulphamethoxazole 25 mg/kg/day every 6 h or intravenous pentamidine (4 mg/kg/day for 21 days is usually effective, but infection is not eradicated, and clinical disease is likely to recur. Prophylaxis using aerosolized pentamidine reduces the risk of pulmonary disease but can predispose to extrapulmonary infection. Improved in vitro and in vivo models of human pneumocystis infection would significantly increase understanding of the molecular biology of the organism, the pathogenesis of disease, and the optimal therapeutic regimens.

  2. Adverse effects associated with intravenous pentamidine isethionate as treatment of Pneumocystis carinii pneumonia in AIDS patients

    DEFF Research Database (Denmark)

    Balslev, U; Nielsen, T L

    1992-01-01

    To evaluate the adverse effects of intravenous pentamidine isethionate, a retrospective study was carried out over a four-year period. Twenty-one acquired immunodeficiency syndrome (AIDS) patients received intravenous pentamidine as treatment of Pneumocystis carinii pneumonia (PCP). This was 13......% of the total number of patients with PCP in the department during that period. Four patients died during treatment and were not evaluated for side effects. Thirteen patients (13/17 = 76%) suffered from one or more minor side effects. The most common of these were gastrointestinal discomfort, pancreatitis......, nephro- and hepatotoxicity. Five patients (5/17 = 29%) experienced a major adverse effect. These were cardiac arrest (one patient), severe hypoglycaemia (one patient) and severe pancreatitis (three patients). In two patients, discontinuation of treatment was necessary due to adverse reactions. As long...

  3. The outcome of Pneumocystis carinii pneumonia in Danish patients with AIDS

    DEFF Research Database (Denmark)

    Pedersen, C; Lundgren, Jens Dilling; Nielsen, T

    1989-01-01

    A total of 100 consecutive patients with AIDS were evaluated for efficacy and safety of treatment and secondary prophylaxis directed against Pneumocystis carinii pneumonia (PCP). 89 episodes of PCP were recorded in 75 patients. 63 of the 75 patients (84%) with a first episode of PCP were discharged....... Of 72 patients with a first episode of PCP who were initially treated with trimethoprim-sulfamethoxazole. 76% completed therapy successfully. Side effects were common, but generally mild and tolerated during continued treatment. 7/11 patients (64%) with a first episode of PCP who required mechanical....../16 (69%) patients who were not receiving prophylaxis (p less than 0.00001). No patients discontinued prophylaxis because of side effects. It is concluded that for most patients with AIDS and PCP, treatment and secondary prophylaxis with TMP-SMZ is safe and effective....

  4. Pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral leishmaniasis in an adult HIV negative patient

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Toledo Jr.

    2001-06-01

    Full Text Available This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having HIV infection, based on risk factor analyses, but was subsequently shown to be HIV negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for Mycobacterium tuberculosis and Pneumocystis carinii, and stool tests were positive for Strongyloides stercoralis and Schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the HIV tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his HIV ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as HIV infection. The occurrence of opportunistic infections in severely ill patients without HIV must always be considered and alternate causes of immunosuppression sought.

  5. Abnormal lung gallium-67 uptake preceding pulmonary physiologic impairment in an asymptomatic patient with Pneumocystis carinii pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Reiss, T.F.; Golden, J. (Univ. of California, San Francisco (USA))

    1990-05-01

    Pneumocystis carinii pneumonia was suggested by a diffuse, bilateral pulmonary uptake of gallium-67 in an asymptomatic, homosexual male with the antibody to the immunodeficiency virus (HIV) who was undergoing staging evaluation for lymphoma clinically localized to a left inguinal lymph node. Chest radiograph and pulmonary function evaluation, including lung volumes, diffusing capacity and arterial blood gases, were within normal limits. Bronchoalveolar lavage revealed Pneumocystis carinii organisms. In this asymptomatic, HIV-positive patient, active alveolar infection, evidenced by abnormal gallium-67 scanning, predated pulmonary physiologic abnormalities. This observation raises questions concerning the natural history of this disease process and the specificity of physiologic tests for excluding disease. It also has implications for the treatment of neoplasia in the HIV-positive patient population.

  6. Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note for caution

    DEFF Research Database (Denmark)

    Jensen, A M; Lundgren, Jens Dilling; Benfield, T;

    1995-01-01

    OBJECTIVE: To examine the importance of cytomegalovirus (CMV) in bronchoalveolar lavage (BAL) fluid of patients with HIV-associated Pneumocystis carinii pneumonia (PCP) treated with adjunctive corticosteroids (CS). DESIGN: Analysis of clinical data during a 5-year period. SETTING: Department of i...... of adjunctive CS in severe PCP, the role of CMV as a pulmonary copathogen may have changed. Active CMV infection may be an important cause of failing treatment of severe PCP in those treated with adjunctive CS....

  7. Prevention of Pneumocystis carinii pneumonia relapse in AIDS patients. The efficacy and tolerability of low-dose sulfamethoxazole-trimethoprim

    DEFF Research Database (Denmark)

    Nielsen, T L; Jensen, Birgitte Nybo; Nelsing, S

    1993-01-01

    The effectiveness and tolerability of Sulfamethoxazole with Trimethoprim (SMX-TMP), a dose of 400mg/80mg given twice a day as secondary prophylaxis (SP) against Pneumocystis carinii pneumonia (PCP) was assessed retrospectively in 166 AIDS patients. The mean observation period was 9.7 months (range...... effects necessitating cessation of SP with SMX-TMP, was reported in eight patients (5%) (95% CI 2.1%-9.3%)....

  8. Bisbenzamidines as Antifungal Agents. Are Both Amidine Functions Required to Observe an Anti-Pneumocystis carinii Activity?

    Directory of Open Access Journals (Sweden)

    Julien Laurent

    2010-06-01

    Full Text Available A library of 19 novel 4-(4-phenylpiperazine-1-ylbenzamidines has been synthesized and evaluated in vitro against Pneumocystis carinii. Among these compounds, N-ethyl- and N-hexyl-4-(4-phenylpiperazine-1-ylbenzamidines emerged as the most promising compounds, with inhibition percentages at 10.0 µg/mL of 87% and 96%, respectively. Those compounds remained active at 0.1 µg/mL.

  9. Effect of oral washes on the diagnosis of Pneumocystis carinii pneumonia with a low parasite burden and on detection of organisms in subclinical infections.

    Science.gov (United States)

    Matos, O; Costa, M C; Lundgren, B; Caldeira, L; Aguiar, P; Antunes, F

    2001-08-01

    This study was designed to assess the efficacy of using oral washes (OWs) to diagnose Pneumocystis carinii pneumonia (PCP) in patients with a low parasite burden and to detect cases of subclinical infection. A total of 104 paired induced sputum (IS) samples and OWs from 104 HIV-seropositive patients and 32 OWs from immunocompetent healthy controls were studied. All of the control samples were negative. Fifty-two IS specimens were positive for Pneumocystis carinii, and 26 of these cases were also detected in the OWs using conventional stain or polymerase chain reaction. Twenty-four of the PCP cases had a high or a moderate parasite load and 28 had a low parasite load; among them, Pneumocystis carinii was detected in the OWs of 15 and 11 cases, respectively. Fifteen of the 104 IS samples studied belonged to patients who were asymptomatic carriers or who had a subclinical infection, and Pneumocystis carinii was detected in the OWs of 4 of these cases. The parasite was not detected in 37 IS samples and in 74 OWs. The results of this study indicate that in patients with a low pulmonary parasite burden, the number of organisms reaching the oral cavity is insufficient for reliable detection in OWs. Thus, OWs are less useful than IS samples for detecting Pneumocystis carinii in cases of pneumonia in which a low parasite burden and/or subclinical infection are present.

  10. Development of a Rapid Real-Time PCR Assay for Quantitation of Pneumocystis carinii f. sp. Carinii

    DEFF Research Database (Denmark)

    Larsen, Hans Henrik; Kovacs, Joseph A; Stock, Frida

    2002-01-01

    . In conclusion, a rapid, sensitive, and reproducible quantitative PCR assay for P. carinii f. sp. carinii has been developed and is applicable to in vivo as well as in vitro systems. The assay should prove useful for conducting studies in which quantification of organism burden or growth assessment is critical...

  11. Pneumocystis pneumonia: importance of gallium scan for early diagnosis and description of a new immunoperoxidase technique to demonstrate Pneumocystis carinii

    Energy Technology Data Exchange (ETDEWEB)

    Levin, M.; McLeod, R.; Young, Q.; Abrahams, C.; Chambliss, M.; Walzer, P.; Kabins, S.A.

    1983-07-01

    Pneumocystis pneumonia presented in a homosexual with fever, a normal chest radiograph, and pulmonary gallium uptake. Bronchial washings yielded Mycobaterium tuberculosis, but despite antituberculosis therapy he remained febrile, and gallium uptake in the lung increased. Subsequently, silver stain of transbronchial lung biopsy obtained 2 months earlier at the time that tuberculosis was diagnosed showed many Pneumocystis cysts in alveolar spaces. In contrast to Pneumocystis cysts in infected lung tissue from other humans, our patient's Pneumocystis cysts reacted more avidly with antiserum to rat Pneumocystis than with antiserum to human pneumocystis, raising the possibility that organisms that infect humans may have varied surface antigenic properties.

  12. Aerosolised pentamidine for Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome Aerosol de pentamidina no tratamento da pneumonia por Pneumocystis carinii em pacientes com a síndrome da imunodeficiência adquirida

    Directory of Open Access Journals (Sweden)

    Adriana Weinberg

    1990-08-01

    Full Text Available The goal of this study was to evaluate inhaled pentamidine for the treatment of patients with mild and moderate Pneumocystis carinii pneumonitis. Eight adults with AIDS and pneumocystis pneumonia (4 with a first episode and 4 with a repeat pneumocystosis received daily inhalations of aerosol pentamidine isethionate for 21 days. Six patients were treated with doses of 300 mg of pentamidine and the remaining 2 received 600 mg every day. In the 300 mg treatment group, 2 individuals showed discrete and transient neutropenia. However, both subjects that received 600 mg of aerosol pentamidine daily developed leukopenia. One of them had major toxicity (overall severe intolerance of 12.5% that required drug discontinuation and did not allow any analysis of the treatment efficacy. Of the 7 evaluable patients, 6 (88% completed the treatment successfuly. One subject of the 300 mg regimen experienced an early recurrence. In conclusion, inhaled pentamidine is an effective treatment for mild and moderate cases of P. carinii pneumonia. It is less toxic than standard anti-pneumocystis therapy and is suitable for outpatient use.O objetivo deste estudo consistiu em avaliar pentamidina inalatória para o tratamento de pneumonia leve a moderada, causada por Pneumocystis carinii. Oito adultos com a síndrome da imunodeficiência humana e pneumocistose (4 apresentando o primeiro episódio e 4 na vigência de pneumocistose de repetição receberam inalações diárias de isetionato de pentamidina por 21 dias. Seis pacientes foram tratados com doses de 300 mg de pentamidina e os 2 restantes receberam 600 mg diariamente. No grupo de 300 mg, 2 indivíduos desenvolveram neutropenia leve e transitória. Porém, ambos os pacientes recebendo 600 mg de pentamidina aerosol apresentaram leucopenia. Um deles teve toxicidade importante (intolerância global de 12,5%, que levou a suspensão da droga e impediu a avaliação da sua eficácia. Entre os 7 pacientes que puderam ser

  13. CPAP, effective respiratory support in patients with AIDS-related Pneumocystis carinii pneumonia.

    Science.gov (United States)

    Prevedoros, H P; Lee, R P; Marriot, D

    1991-11-01

    Human Immunodeficiency Virus (HIV) related Pneumocystis carinii pneumonia (PCP) associated with severe respiratory failure is an increasingly common problem in major centres and is associated with a high mortality in previous and recent studies. Early in the epidemic, alternatives to invasive intensive care treatment were utilized in our institution and found to be successful. When respiratory failure developed, mask CPAP was used instead of intubation and ventilation. A retrospective review of 175 cases of HIV infected patients with confirmed first presentation PCP was undertaken. Treatment with our protocol resulted in an overall hospital mortality of 9%. Those patients who did not require supplemental oxygen or respiratory support had no in-hospital mortality. The group who required supplemental oxygen had a mortality of 10%. If respiratory failure supervened (severe respiratory distress, PaO2 less than 50 mmHg, SaO2 less than 90% on mask oxygen), CPAP was introduced. The mortality in this group was 22%. Only two patients were admitted to the intensive care unit for respiratory support after failure of CPAP. Both patients were intubated and received intermittent positive pressure ventilation (IPPV). Both patients died.

  14. Aerobic bacteria, Chlamydia trachomatis, Pneumocystis carinii and Cytomegalovirus as agents of severe peneumonia in small infants Bactérias aeróbias, Chlamydia trachomatis, Pneumocystis carinii e Cytomegalovirus: agentes causadores de pneumonia grave em pequenos lactentes

    Directory of Open Access Journals (Sweden)

    Bernardo Ejzenberg

    1996-02-01

    Full Text Available The authors studied 58 infants hospitalized for pneumonia in a semi-intensive care unit. Age ranged from 1 complete to 6 incomplete months. The infants were sent from another hospital in 20 cases and from home in a further 38. Pulmonary involvement, which was alveolar in 46 cases and interstitial in 12, was bilateral in 31 children. The investigation was carried out prospectively on the etiological agents associated with respiratory infection to look for evidence of aerobic bacteria (blood cultures, Chlamydia trachomatis and Cytomegalovirus (serology, and Pneumocystis carinii (direct microscopy of tracheal aspirated material. The following infectious agents were diagnosed in 21 children (36.2%: Aerobic bacteria (8, Chlamydia trachomatis (5, Pneumocystis carinii (3, Cytomegalovirus (3, Cytomegalovirus and Chlamydia trachomatis (1, Aerobic bacteria and Cytomegalovirus (1. Seven cases of infection by Chlamydia trachomatis and/or Cytomegalovirus were diagnosed out of the 12 cases with pulmonary interstitial involvement.Os autores estudaram prospectivamente 58 lactentes internados por pneumonia em unidade semi-intensiva. A idade foi limitada entre 1 mês completo e 6 meses incompletos. A procedência das crianças foi de outro hospital em 20 casos e domiciliar em 38. O acometimento pulmonar era alveolar em 46 casos, intersticial em 12 e bilateral em 31 crianças. Foram pesquisados agentes etiológicos associados à infecção respiratória dos lactentes jovens: Bactérias aeróbias (Hemoculturas, Chlamydia trachomatis e Cytomegalovirus (sorologia, e Pneumocystis carinii (microscopia direta do aspirado traqueal. Foram diagnosticadas infecções em 21 crianças (36,2%: Bactérias aeróbias (8, Chlamydia trachomatis (5, Cytomegalovirus (3, Pneumocystis carinii (3, Cytomegalovirus e Chlamydia trachomatis (1, Bactéria aeróbia e Cytomegalovirus (1. Foram diagnosticadas 7 infecções por Chlamydia trachomatis e/ou Cytomegalovirus entre as 12 crianças com

  15. Three-dimensional reconstruction of rabbit-derived Pneumocystis carinii from serial-thin sections. II: Intermediate precyst.

    Science.gov (United States)

    Palluault, F; Pietrzyk, B; Dei-Cas, E; Slomianny, C; Soulez, B; Camus, D

    1991-01-01

    Three-dimensional reconstruction of a binucleate intermediate precyst of Pneumocystis carinii was performed from serial-thin sections using the CATIA (Conception Assistée Tridimensionnelle Inter Active) Dassault system program. The presence of a mitochondrion, complex well-developed endoplasmic structures, and numerous Golgi vesicles was established. A better understanding of the ultrastructure of rabbit-derived P. carinii stages made it possible to formulate hypotheses on the evolution and physiology of the endomembrane system. Thus, the presence of the well-developed endoplasmic saccular structure and more than 230 Golgi vesicles in its vicinity might be implicated in the differentiation of the parasite surface structures and might also be related to nuclear division and individualization of intracystic bodies.

  16. Clinical and experimental studies on inflammatory mediators during AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, Thomas

    2003-01-01

    of the alveolar epithelium was observed in PCP but not for other HIV related lung diseases. By determining concentrations of soluble markers of immune activation we found that anti-microbial therapy exacerbated an ongoing inflammatory reaction. Adjuvant glucocorticosteroids suppressed levels of soluble immune....... This thesis has attempted to delineate important mechanisms of the inflammatory cascade, and to determine how inflammation is initiated during PCP. In histopathological studies of lung specimens it was shown that PCP caused significant inflammation and destruction of tissue. Specific pathological changes...

  17. Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note for caution

    DEFF Research Database (Denmark)

    Jensen, A M; Lundgren, Jens Dilling; Benfield, T

    1995-01-01

    OBJECTIVE: To examine the importance of cytomegalovirus (CMV) in bronchoalveolar lavage (BAL) fluid of patients with HIV-associated Pneumocystis carinii pneumonia (PCP) treated with adjunctive corticosteroids (CS). DESIGN: Analysis of clinical data during a 5-year period. SETTING: Department...... of infectious diseases where clinical and paraclinical data on patients suspected of having PCP have been sampled prospectively. PATIENTS: 148 consecutive patients with a first episode of PCP in a 5-year period. MAIN OUTCOME MEASURE: Vital status 3 months after diagnosis of PCP. RESULTS: Patients with PCP...

  18. Three-dimensional reconstruction of rabbit-derived Pneumocystis carinii from serial-thin sections. I: Trophozoite.

    Science.gov (United States)

    Palluault, F; Pietrzyk, B; Dei-Cas, E; Slomianny, C; Soulez, B; Camus, D

    1991-01-01

    The highly complex ultrastructural morphology of the endomembrane system in Pneumocystis carinii led us to perform three-dimensional reconstruction from serial-thin sections using the CATIA (Conception Assistée Tridimensionnelle Inter Active) Dassault system program. The three-dimensional reconstruction of a small trophozoite made it possible to better understand the morphological relationship among organelles and to suggest cytophysiological hypotheses. By reconstructing other parasite stages, we gathered information about the evolution of organelles during the life cycle and about their physiology.

  19. Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; van Steenwijk, R; Nielsen, T L

    1995-01-01

    Pneumocystis carinii pneumonia (PCP) may cause severe respiratory distress. This is believed to be partly caused by the accumulation of neutrophils in the lung. Interleukin-8 (IL-8) and leukotriene B4 (LTB4) are potent neutrophil chemo-attractants and activators. Eicosanoids [i.e. prostaglandins...

  20. Factors associated with the development of Pneumocystis carinii pneumonia in 5,025 European patients with AIDS. AIDS in Europe Study Group

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Barton, S E; Lazzarin, A;

    1995-01-01

    This study examined the factors associated with the development of a first episode of Pneumocystis carinii pneumonia (PCP) in 5,025 patients with AIDS, including 1,976 patients with primary PCP at the time of AIDS diagnosis and 635 with primary PCP occurring subsequently. Compared with untreated ...

  1. EFFICACY AND TOXICITY OF 2 DOSES OF TRIMETHOPRIM-SULFAMETHOXAZOLE AS PRIMARY PROPHYLAXIS AGAINST PNEUMOCYSTIS-CARINII PNEUMONIA IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS

    NARCIS (Netherlands)

    SCHNEIDER, MME; NIELSEN, TL; NELSING, S; HOEPELMAN, AIM; SCHATTENKERK, JKME; VANDERGRAAF, Y; KOLSTERS, AFP; BORLEFFS, JCC; DANNER, SA; VANLEEUWEN, R; FRISSEN, JPHJ; WEIGEL, HM; VANDERENDE, IME; SPRENGER, HG; KAUFFMANN, RH; MEENHORST, PL; TENNAPEL, CHH; SCHREIJ, G; TENKATE, RW; JUTTMANN, [No Value; KOOPMANS, PP

    1995-01-01

    The efficacy and toxicity of trimethoprim-sulfamethoxazole (TMP-SMZ) as primary prophylaxis against Pneumocystis carinii pneumonia (PCP) for patients with human immunodeficiency virus (HIV) infection was assessed by comparing the effects of two dosages (480 or 960 mg once a day) of the drug. The mul

  2. A CONTROLLED TRIAL OF AEROSOLIZED PENTAMIDINE OR TRIMETHOPRIM SULFAMETHOXAZOLE AS PRIMARY PROPHYLAXIS AGAINST PNEUMOCYSTIS-CARINII PNEUMONIA IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

    NARCIS (Netherlands)

    SCHNEIDER, MME; HOEPELMAN, AIM; SCHATTENKERK, JKME; NIELSEN, TL; VANDERGRAAF, Y; FRISSEN, JPHJ; VANDERENDE, IME; KOLSTERS, AFP; BORLEFFS, JCC

    1992-01-01

    Background. Primary prophylaxis against Pneumocystis carinii pneumonia (PCP) is recommended for patients with human immunodeficiency virus (HIV) infection if their CD4 cell counts are below 200 per cubic millimeter (0.2 x 10(9) per liter). Either aerosolized pentamidine or trimethoprim-sulfamethoxaz

  3. 卡氏肺孢子虫基因的研究%Study on the gene of Pneumocystis carinii

    Institute of Scientific and Technical Information of China (English)

    田喜凤; 卢思奇

    2005-01-01

    卡氏肺孢子虫(Pneumocystis carinii, P.c)是肺孢子虫肺炎(Pneumocystis carinii pneumonia,PCP)的病原体,属机会性致病原虫,感染多见于免疫功能受损人群,如先天性免疫缺陷者、免疫功能低下婴幼儿[如婴儿暴死征候群(Sudden infant death,SIDS )]、长期接受免疫抑制剂和抗代谢药物治疗的器官移植和肿瘤病人.P.c感染引起的肺部炎症,常是导致艾滋病(AIDS)患者死亡的主要原因.PCP被视为AIDS患者的“标志病”.据统计未经药物预防的AIDS患者约80%感染P.c.随着HIV携带者及AIDS患者人数的不断上升,以及器官移植和肿瘤病例的增加,对卡氏肺孢子虫的研究也倍受关注,本文仅就卡氏肺孢子虫的分类及基因特点的研究综述如下.

  4. Cytology of treated and minimal Pneumocystis carinii pneumonia and a pitfall of the Grocott methenamine silver stain.

    Science.gov (United States)

    Naryshkin, S; Daniels, J; Freno, E; Cunningham, L

    1991-01-01

    To clarify the role of foamy alveolar casts (FACs) in the diagnosis of Pneumocystis carinii pneumonia (PCP), we retrospectively reviewed Papanicolaou (Pap)- and Grocott methenamine silver (GMS)-stained slides from 205 bronchial specimens submitted for suspected opportunistic lung infection. FACs containing sporozoites were seen in 86 cases, all with positive GMS. FACs were absent in 119 cases with negative GMS. In patients previously treated for PCP, Pap showed FAC-like material which lacked sporozoites. GMS demonstrated clumped degenerated Pneumocystis carinii (PC) cysts. In 17 GMS-positive cases there were no FACs on Pap due to sampling error and low burden of organisms. Morphologic features of macrophages in these cases can suggest the presence of PC. When FACs are lacking, a special stain is required. When GMS is used, the control must contain PC to avoid a false negative GMS. The inconsistent uptake of GMS by PC is a pitfall which is distinct from sampling error and which to our knowledge has not been previously reported.

  5. Differential effect on serum neopterin and serum beta 2-microglobulin is induced by treatment in Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Schattenkerk, J K; Hofmann, B

    1994-01-01

    Forty-three human immunodeficiency virus-infected patients with Pneumocystis carinii pneumonia (PCP) were enrolled in a study of adjunctive corticosteroid treatment for 10 days versus placebo, in addition to antimicrobial treatment. Levels of neopterin and beta 2-microglobulin (beta 2M) were......% and approximately 30%, respectively, and returned to baseline after discontinuation of corticosteroid treatment. Antimicrobial treatment alone did not affect either neopterin or beta 2M in healthy controls. Results indicate that treatment has a differential effect on the immune response: increased macrophage...... activation leading to neopterin production and decreased production of beta 2M by lymphocytes. Further, addition of corticosteroids modified and decreased this immune activation and may explain the earlier demonstrated beneficial effect of corticosteroids in PCP treatment....

  6. Independent risk of mechanical ventilation for AIDS-related Pneumocystis carinii pneumonia associated with bronchoalveolar lavage neutrophilia

    DEFF Research Database (Denmark)

    Bang, D.; Emborg, J.; Elkjaer, J.;

    2001-01-01

    The use of mechanical ventilation (MV) for AIDS-related Pneumocystis carinii pneumonia (PCP) has varied over time. The introduction of adjunctive corticosteroid therapy has changed the pathophysiology of PCP. In the present study, we attempted to identify factors predictive of severe respiratory...... failure requiring MV amongst patients with PCP treated in the era of adjunctive corticosteroid therapy. Furthermore, we studied factors associated with survival in relation to MV. Of 170 consecutive patients with AIDS-related PCP, 18 (11%) required MV. Thirteen of 18 ventilated patients died (72......-term mortality remained high after the introduction of adjunctive corticosteroid therapy. BAL neutrophilia may be a useful prognostic marker to identify patients at high risk of requiring mechanical ventilation Udgivelsesdato: 2001/8...

  7. Probing the Relationship between Anti-Pneumocystis carinii Activity and DNA Binding of Bisamidines by Molecular Dynamics Simulations

    Directory of Open Access Journals (Sweden)

    Teresa Żołek

    2015-04-01

    Full Text Available The anti-Pneumocystis carinii activity of 13 synthetic pentamidine analogs was analyzed. The experimental differences in melting points of DNA dodecamer 5'-(CGCGAATTCGCG2-3' complexes (ΔTm, and in the biological activity measured using ATP bioluminescence assay (IC50 together with the theoretical free energy of DNA-ligand binding estimated by the proposed computational protocol, showed that the experimental activity of the tested pentamidines appeared to be due to the binding to the DNA minor groove with extended AT sequences. The effect of heteroatoms in the aliphatic linker, and the sulfonamide or methoxy substituents on the compound inducing changes in the interactions with the DNA minor groove was examined and was correlated with biological activity. In computational analysis, the explicit solvent approximation with the discrete water molecules was taken into account, and the role of water molecules in the DNA-ligand complexes was defined.

  8. Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; van Steenwijk, R; Nielsen, T L;

    1995-01-01

    Pneumocystis carinii pneumonia (PCP) may cause severe respiratory distress. This is believed to be partly caused by the accumulation of neutrophils in the lung. Interleukin-8 (IL-8) and leukotriene B4 (LTB4) are potent neutrophil chemo-attractants and activators. Eicosanoids [i.e. prostaglandins...... of IL-8 as a mediator in the pathogenesis of PCP, whereas the role of eicosanoids seems less clear....

  9. Nursing progress on patients with pneumocystis carinii pneumonia%卡氏肺孢子虫肺炎的护理进展

    Institute of Scientific and Technical Information of China (English)

    张自茹; 洪艳丽; 王玲玲

    2014-01-01

    介绍了卡氏肺孢子虫肺炎(PCP)感染的临床特点,从提高病原体的检出率、低氧血症的观察与护理、高热护理、药物护理、保护性隔离、营养支持、心理护理、肺孢子虫病的预防策略方面综述了卡氏肺孢子虫肺炎的护理进展。%It introduced the clinical characteristics of pneumocystis carinii pneumonia(PCP).It reviewed the nursing progress on pneu-mocystis carinii pneumoni from aspects of improving the detection rate of pathogens,observation and care of hypoxemia,fever nursing, medical care,protective isolation,nutritional support and psychologi-cal nursing and prevention strategies of lung cysticercosis.

  10. Diagnostic use of PCR for detection of Pneumocystis carinii in oral wash samples

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Jensen, Jens Ulrik Stæhr; Benfield, T;

    1998-01-01

    and was compared to a previously described PCR protocol (mitochondrial RNA) run in a research laboratory. Both PCR methods amplified a sequence of the mitochondrial rRNA gene of P. carinii. Paired bronchoalveolar lavage (BAL) and oral wash specimens from 76 consecutive human immunodeficiency virus type 1-infected...... specimens and 100, 91, 90, and 100%, respectively, for BAL specimens. Our results suggest that oral wash specimens are a potential noninvasive method to obtain a diagnostic specimen during P. carinii pneumonia infection and that it can be applied in a routine diagnostic laboratory....

  11. Serial indium-111-labelled IgG biodistribution in rat Pneumocystis carinii pneumonia: a tool to monitor the course and severity of the infection

    Energy Technology Data Exchange (ETDEWEB)

    Perenboom, R.M. [Dept. of General Internal Medicine, Univ. Hospital, Nijmegen (Netherlands); Oyen, W.J.G. [Dept. of Nuclear Medicine, Univ. Hospital, Nijmegen (Netherlands); Schijndel, C.H.W. van [Dept. of General Internal Medicine, Univ. Hospital, Nijmegen (Netherlands); Beckers, P. [Dept. of Medical Microbiology, Univ. Hospital, Nijmegen (Netherlands); Corstens, F.H.M. [Dept. of Nuclear Medicine, Univ. Hospital, Nijmegen (Netherlands); Meer, J.W.M. van der [Dept. of General Internal Medicine, Univ. Hospital, Nijmegen (Netherlands)

    1995-10-01

    To study the effect of new therapeutic strategies, we developed an animal model to monitor the course and severity of experimental Pneumocystis carinii pneumonia (PCP) in rats. P. carinii density scores in Giemsa-stained impression smears were used to follow P. carinii load. Indium-111 labelled IgG scintigraphy and biodistribution, histology of paraffin-embedded tissue sections, lung/body weight (L/B wt) ratio and cell count and differentiation of broncho-alveolar lavage (BAL) fluid were used as parameters of host inflammatory response. Statistically significant differences in L/B wt ratio, number of neutrophils in BAL fluid, P. carinii density score, histological extent of inflammation and {sup 111}In-IgG accumulation in the lung were seen between the rats sacrificed at various time points. {sup 111}In-IgG accumulation in the lung correlated well with L/B wt ratio and P. carinii density score and correlated moderately with number of neutrophils in BAL fluid and with the histological extent of inflammation. (orig.)

  12. Detection of Pneumocystis carinii and Characterization of Mutations Associated with Sulfa Resistance in Bronchoalveolar Lavage Samples from Human Immunodeficiency Virus-Infected Subjects

    Science.gov (United States)

    Zingale, Anna; Carrera, Paola; Lazzarin, Adriano; Scarpellini, Paolo

    2003-01-01

    One hundred ninety-four bronchoalveolar specimens were evaluated by microscopic examination and by amplification of a sequence of a Pneumocystis carinii dihidropteroate synthase gene for identification of mutations linked to sulfa resistance. PCR sensitivity and specificity were 100 and 86.7%, respectively, compared to results of microscopic examination. However, 7 out of 19 microscopy-negative, PCR-positive samples were collected from subjects with a clinically high probability of P. carinii pneumonia, suggesting that PCR may be more sensitive than microscopic examination, although the absolute performance of PCR cannot be determined. Mutations were identified in 28 out of 70 (40%) PCR-positive specimens and were significantly more common in patients exposed to sulfa drugs (21 out of 29 [72.4%]) than in those not exposed to sulfa drugs (4 out of 35 [11.4%]). PMID:12791912

  13. The major surface glycoprotein of Pneumocystis carinii induces release and gene expression of interleukin-8 and tumor necrosis factor alpha in monocytes

    DEFF Research Database (Denmark)

    Benfield, T L; Lundgren, Bettina; Levine, S J

    1997-01-01

    Recent studies suggest that interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-alpha) may play a central role in host defense and pathogenesis during Pneumocystis carinii pneumonia. In order to investigate whether the major surface antigen (MSG) of human P. carinii is capable of eliciting...... the release of IL-8 and TNF-alpha, human monocytes were cultured in the presence of purified MSG. MSG-stimulated cells released significant amounts of IL-8 within 4 h, and at 20 h, cells stimulated with MSG released 45.5 +/- 9.3 ng of IL-8/ml versus 3.7 +/- 1.1 ng/ml for control cultures (P = 0...... with 0.2 to 5 microg of MSG/ml (P

  14. 2,4-Diamino-6,7-dihydro-5H-cyclopenta[d]pyrimidine analogues of trimethoprim as inhibitors of Pneumocystis carinii and Toxoplasma gondii dihydrofolate reductase.

    Science.gov (United States)

    Rosowsky, A; Papoulis, A T; Queener, S F

    1998-03-12

    Three previously unreported (R,S)-2,4-diamino-5-[(3,4,5-trimethoxyphenyl) alkyl]-6,7-dihydro-5H-cyclopenta[d]pyrimidines 15a-c were synthesized as analogues of trimethoprim (TMP) and were tested as inhibitors of Pneumocystis carinii, Toxoplasma gondii, and rat liver dihydrofolate reductase (DHFR). The length of the alkyl bridge between the cyclopenta[d]pyrimidine and trimethoxyphenyl moiety ranged from one in 15a to three carbons in 15c. The products were tested as competitive inhibitors of the reduction of dihydrofolate by Pneumocystis carinii, Toxoplasma gondii, and rat liver DHFR. Compounds 15a-c had IC50 values of > 32, 1.8 and 1.3 microM, respectively, against P. carinii DHFR, as compared to 12 microM for TMP. Against the T. gondii enzyme, 15a-c had IC50 values of 21, 0.14 and 0.14 microM, respectively, as compared to 2.7 microM for TMP. Inhibitors 15b and 15c with two- and three-carbon bridges were significantly more potent than 15a against all three enzymes. Unlike TMP, 15b and 15c were better inhibitors of the rat liver enzyme than of the microbial enzymes. The potency of 15b and 15c against rat liver DHFR was less than has been reported for the corresponding 6,7-dihydro-5H-cyclopenta[d]pyrimidines with a classical p-aminobenzoyl-L-glutamate side chain as inhibitors of bovine, murine, and human DHFR.

  15. 2,4-Diaminothieno[2,3-d]pyrimidine lipophilic antifolates as inhibitors of Pneumocystis carinii and Toxoplasma gondii dihydrofolate reductase.

    Science.gov (United States)

    Rosowsky, A; Papoulis, A T; Queener, S F

    1997-10-24

    Ten previously unreported 2,4-diaminothieno[2,3-d]pyrimidine lipophilic dihydrofolate reductase inhibitors were synthesized as potential inhibitors of Pneumocystis carinii and Toxoplasma gondii dihydrofolate reductase. Pivaloylation of 2,4-diamino-5-methylthieno[2,3-d]pyrimidine followed by dibromination with N-bromosuccinimide in the presence of benzoyl peroxide gave 2,4-bis(pivaloylamino)-6-bromo-5-(bromomethyl)thieno[2,3-d]pyrimid ine, which after condensation with substituted anilines or N-methylanilines and deprotection with base yielded 2,4-diamino-6-bromo-5-[(substituted anilino)methyl]thieno[2,3-d]pyrimidines. Removal of the 6-bromo substituent was accomplished with sodium borohydride and palladium chloride. The reaction yields were generally good to excellent. The products were tested as inhibitors of dihydrofolate reductase (DHFR) from P. carinii, T. gondii, and rat liver. Although the IC50 could not be reached for the 6-unsubstituted compounds because of their extremely poor solubility, three of the five 6-bromo derivatives were soluble enough to allow the IC50 to be determined against all three enzymes. 2,4-Diamino-5-[3,5-dichloro-4-(1-pyrrolo)anilino]methyl]- 6-bromothieno[2,3-d]pyrimidine was the most active of the 6-bromo derivatives, with an IC50 of 7.5 microM against P. carinii DHFR, but showed no selectivity for either P. carinii or T. gondii DHFR relative to the enzyme from rat liver.

  16. Efficacy of caspofungin, a 1,3-β-D-glucan synthase inhibitor, on Pneumocystis carinii pneumonia in rats.

    Science.gov (United States)

    Sun, Peipei; Tong, Zhaohui

    2014-11-01

    Pneumocystis carinii pneumonia (PcP) is a common and potentially fatal opportunistic infection in immunosuppressed patients, and the standard trimethoprim-sulfamethoxazole (TMP-SMZ) treatment has serious side effects. The cell wall of the causative fungal pathogen is enriched in 1-3-β-D-glucan, providing an alternative therapeutic target. We directly compared the efficacy of the 1,3-β-D-glucan synthase inhibitor caspofungin to TMP-SMZ for promoting survival and reducing lung cyst number during the early phase of treatment in a rat model of PcP. Rats were immunosuppressed using dexamethasone for 8 weeks and PcP infection confirmed in test animals by lung print smear. The remaining rats were randomly divided into three control groups, a baseline group and two observed for 7 or 14 days, two caspofungin groups treated intravenously for 7 or 14 days (1 mg/kg/d), and 2 TMP-SMZ positive control groups treated by oral gavage for 7 or 14 days (300 mg/kg/d). Mortality was markedly reduced by both caspofungin and TMP-SMZ after 14 days (caspofungin: 20.0%, TMP-SMZ: 13.3%, Control: 40.0%). Body weight gain in caspofungin-treated rats after 7 (3.04 ± 3.54%) and 14 (4.27 ± 2.79%) days was similar to that in TMP-SMZ-treated rats (3.35 ± 1.88% and 5.85 ± 2.78%, respectively), whereas untreated controls showed weight loss. Lung weight to body weight ratio, and mean cyst number per 50 microscopic fields were significantly lower (all P caspofungin-treated rats than untreated controls at both 7 and 14 days, and similar to those in the TMP-SMZ-treated rats (all P > 0.05 vs. caspofungin). Caspofungin exhibited similar efficacy to TMP-SMZ for enhancing survival and reducing lung edema and cyst load in a rat model of PcP, suggesting potential clinical utility against PcP.

  17. Factors associated with the development of Pneumocystis carinii pneumonia in 5,025 European patients with AIDS. AIDS in Europe Study Group

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Barton, S E; Lazzarin, A;

    1995-01-01

    This study examined the factors associated with the development of a first episode of Pneumocystis carinii pneumonia (PCP) in 5,025 patients with AIDS, including 1,976 patients with primary PCP at the time of AIDS diagnosis and 635 with primary PCP occurring subsequently. Compared with untreated...... patients, patients treated with zidovudine were at similar risk of developing PCP during the first year of therapy but were at greater risk after longer intervals of treatment. The following factors were associated with an increased risk of PCP (either at the time of AIDS diagnosis or thereafter): lack...... of primary PCP prophylaxis, male homosexuality/bisexuality, diagnosis of AIDS in northern Europe, and CD4 cell count below 200 x 10(6)/L at the time of AIDS diagnosis. Patients with severe weight loss had a 60% higher risk of developing PCP during follow-up than those without such weight loss. Thus...

  18. The major surface glycoprotein of Pneumocystis carinii induces release and gene expression of interleukin-8 and tumor necrosis factor alpha in monocytes

    DEFF Research Database (Denmark)

    Benfield, T L; Lundgren, Bettina; Levine, S J;

    1997-01-01

    with 0.2 to 5 microg of MSG/ml (P TNF-alpha from MSG-stimulated monocytes at 20 h was inhibited by 60 and 86%, respectively, after coincubation with soluble yeast mannan (P = 0.01). With an RNase protection assay, increases in steady-state mRNA levels for IL-8 and TNF......Recent studies suggest that interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-alpha) may play a central role in host defense and pathogenesis during Pneumocystis carinii pneumonia. In order to investigate whether the major surface antigen (MSG) of human P. carinii is capable of eliciting...... the release of IL-8 and TNF-alpha, human monocytes were cultured in the presence of purified MSG. MSG-stimulated cells released significant amounts of IL-8 within 4 h, and at 20 h, cells stimulated with MSG released 45.5 +/- 9.3 ng of IL-8/ml versus 3.7 +/- 1.1 ng/ml for control cultures (P = 0...

  19. Rapid detection of Pneumocystis carinii in bronchoalveolar lavage specimens from human immunodeficiency virus-infected patients: use of a simple DNA extraction procedure and nested PCR.

    Science.gov (United States)

    Rabodonirina, M; Raffenot, D; Cotte, L; Boibieux, A; Mayençon, M; Bayle, G; Persat, F; Rabatel, F; Trepo, C; Peyramond, D; Piens, M A

    1997-11-01

    We report on the development of a rapid nested PCR protocol for the detection of Pneumocystis carinii DNA in bronchoalveolar lavage (BAL) specimens in which the protocol included the use of a commercially available DNA extraction kit (GeneReleaser). GeneReleaser enabled us to obtain amplification-ready DNA within 20 min without requiring the purification of the DNA. The nested PCR was performed with the primers pAZ102-E, pAZ102-H, and pAZ102-L2 (A. E. Wakefield, F. J. Pixley, S. Banerji, K. Sinclair, R. F. Miller, E. R. Moxon, and J. M. Hopkin, Lancet 336:451-453, 1990.). Results were obtained in about 4 h with the adoption of denaturation, annealing, and extension steps shortened to 20 seconds. The sensitivity of the nested PCR was tested with a P. carinii cyst suspension and was found to be less than one cyst (one to eight nuclei). The detection limit was the same with the use of GeneReleaser or proteinase K-phenol chloroform for DNA extraction. The nested PCR assay was prospectively compared with staining with Giemsa and methenamine silver stains for the detection of P. carinii in 127 BAL samples from 105 human immunodeficiency virus-infected patients investigated for acute respiratory illness. Twenty-five BAL specimens (20%) were positive by staining and the nested PCR and 25 (20%) were negative by staining and positive by the nested PCR. These 25 BAL specimens with conflicting results were obtained from 23 patients, 82% of whom were receiving prophylactic therapy against P. carinii pneumonia (PCP). Only two patients were diagnosed with possible PCP. The final diagnosis was not PCP for 20 patients who were considered to be colonized or to have a low level of infection. This colonization is not of clinical importance but is of epidemiological importance. Our rapid, simple, and sensitive amplification protocol may be performed in clinical laboratories for the routine diagnosis of PCP with BAL specimens.

  20. Humoral and cellular responses to Pneumocystis carinii, CMV, and herpes simplex in patients with AIDS and in controls

    DEFF Research Database (Denmark)

    Hofmann, B; Nielsen, P B; Ødum, Niels;

    1988-01-01

    in the second of paired samples taken about 6 months apart, compared with whose with PCP (9%; p = 0.05). All patients had high titers of antibodies to CMV and HSV and normal total concentrations of immunoglobulins. None of the patients responded in lymphocyte transformation to P. carinii, CMV, or HSV antigens...

  1. HRCT Diagnosis of Pneumocystis Carinii Pneumonia in AIDS%艾滋病合并卡氏肺囊虫肺炎的 HRCT 诊断价值

    Institute of Scientific and Technical Information of China (English)

    张海泉; 孙汉雷

    2012-01-01

      Purpose:to study the signs and value of HRCT diagnosis of pneumocystis carinii pneumonia in AIDS. Methods:The HRCT images of 10 patients with PCP in AIDS proved by clinical were analysed retrospectively.Results:on HRCT images there were groud-glass opacification (GGO) type 6 cases,mesho or reticulo-nodular type 2 cases and mixed type 2cases.Conclusion:PCP has certain characteristic HRCT sings and the most of cases can be diagnosed,combining with clinical data.%  目的:探讨AIDS合并卡氏肺囊虫肺炎(PCP)的HRCT表现及其诊断价值。方法:回顾性分析10例经临床证实的AIDS合并的PCP 的HRCT表现。结果: HRCT表现:磨玻璃型6例、网状及网织结节型2例和混合型2例。结论: PCP有一定的HRCT表现特点,结合临床大多数病例可提示诊断。

  2. 卡氏肺孢子菌肺炎的诊断治疗分析%Clinical analysis of Pneumocystis carinii pneumonia

    Institute of Scientific and Technical Information of China (English)

    林明; 林晟; 陈愉生; 李鸿茹

    2011-01-01

    Clinical data and therapeutics in 8 cases of Pneumocystiscarinii pneumonia, which was misdiagnosised as bac-terial pneumonia from May 2010 to April 2011 in Fujian Provincial Hospital, were reviewed in order to explore the clinical fea-tures and methods of early diagnosis of Pneumocystis carinii pneumonia. In these 8 cases, 1 had a mitral valve replacement with rheumatic heart disease 10 year ago, 3 cases had autoimmune diseases and took immunosuppressor for a long time, and others didn't have underlying diseases. All the 8 cases appeared fever of unknown origin, dry cough, shortness of breath and different degree of respiratory failure. The five non-rheumatic disease cases proved lower CD4 cell percentage of T ymphocyte and positive serum anti-H/V antibody. Then Pneumocystis carinii was found in two cases among them,one from bronchoalveo-lar lavage fluid (BALF),another from sputum. Other 3 cases was diagnosed according to clinical diagnosis criterion. Another 3 non-HIV cases were diagnosis by detecting Pneumocystis carinii in BALF through bronchoscopy for 14 days. The 8 cases were all treated by sulfamethoxazole and trimethoprim (SMZ-TMP) and clindamycin, then 6 got better, 1 was transferred to the lazaret, and 1 was dead. In conclusion, for the patients appearing fever with unknown origin, unintelligible respiratory failure, rapidly progressing in chest imaging and failure in conventional anti-infection treatment, pneumocystis carinii pneumonia should-be taken into account, and their immune condition should be concerned. Whether the patients had immunosuppressed diseases or were taking immunosuppressor should be carefully confirmed and they had better plan to detect anti-HIV antibody too. Early treatment, sufficient dose, and full course therapy may contribute to improve the prognosis of patients.%目的 分析探讨卡氏肺孢子菌肺炎的早期诊断和治疗.方法 分析福建省立医院2010年5月-2011年4月收治的曾误诊为细菌性肺炎的8例卡

  3. Diffuse pulmonary gallium accumulation with a normal chest radiogram in a homosexual man with pneumocystis carinii pneumonia. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Moses, S.C.; Baker, S.R.; Seldin, M.F.

    1983-12-01

    A homosexual man with A.I.D.S. (acquired immunologic deficiency syndrome) and pneumocystis infestation was found to have diffuse Ga-67 uptake in the lungs with a coincident negative chest x-ray. While Ga-67 accumulates diffusely in the lungs in a variety of conditions, the present case is the first described in a patient with A.I.D.S. in which Ga-67 was positive before roentgenographic abnormalities were demonstrated. Thus, the use of Ga-67 scan, when A.I.D.S. is suspected, could help establish a diagnosis more promptly.

  4. Observation and nursing care of renal transplantation patients complicated with pneumocystis carinii pneumonia%肾移植术后并发卡氏肺孢子虫肺炎病人的观察及护理

    Institute of Scientific and Technical Information of China (English)

    金莹; 孙田杰

    2008-01-01

    @@ 卡氏肺孢子虫肺炎(pneumocystis carinii pneumonia,PCP)是一种机会性感染疾病,常见于免疫功能缺陷或长期接受免疫抑制剂治疗的人群.肾移植病人术后长期接受免疫抑制剂治疗,增加了感染PCP的机会.据报道,其发病率可达2%~11%[1-3 ].

  5. Trends in overall opportunistic illnesses, Pneumocystis carinii pneumonia, cerebral toxoplasmosis andMycobacterium avium complex incidence rates over the 30 years of the HIV epidemic: a systematic review

    Directory of Open Access Journals (Sweden)

    Lara Coelho

    2014-04-01

    Full Text Available BACKGROUND: The natural history of HIV infection has changed dramatically after the introduction of highly active antiretroviral therapy. Currently, opportunistic illnesses still represent a major cause of death and hospitalization in this population. In this study, we review the trends in opportunistic illnesses incidence rates and compare the results observed in high-income settings with that for low/middle-income settings, with special attention given to studies from Brazil. METHODS: We systematically searched Pubmed, Web of Science, Lilacs and Google scholar for publications on HIV associated opportunistic illness. Studies reporting rates based on person-time for all opportunistic illnesses and/or the three opportunistic infections of interest, namely,Pneumocystis carinii pneumonia, cerebral toxoplasmosis, and Mycobacterium avium complex were included. RESULTS: Significant reductions in the incidence rates were demonstrated for opportunistic illnesses overall and also for the specific opportunistic infections included in the present study, both in high and low/middle-income settings. Out of the 37 studies included in the present review, almost 70% were from high-income settings. All the studies conducted in low/middle-income settings were single center studies and four were from Brazil. We found no study from Brazil reporting annual incidence rates of opportunistic illnesses. CONCLUSIONS: Opportunistic illnesses remain an important public health problem. To better guide health policies in low/middle-income settings, multicenter cohort studies should be encouraged. Studies from Brazil are urgently needed to assess the current burden of opportunistic illnesses in our population and to support the planning of HIV/AIDS health care services organization.

  6. Study of the pneumocystis carinii pneumonia therapy effect of short interfering RNA targeting pneumocystis carinii major surface glycoprotein gene's upstream conserved sequence%siRNA治疗大鼠卡氏肺孢子菌肺炎的实验研究

    Institute of Scientific and Technical Information of China (English)

    骆晓练; 姚云清; 谭燕; 梅林; 龚锐

    2011-01-01

    目的:观察靶向卡氏肺孢子菌(Pneumocystis carinii,PC)主要表面糖蛋白(Major surface glycoprotein,MSG)DNA上游保守序列(Upstream conserved sequence,UCS)基因的siRNA对实验大鼠卡氏肺孢子菌肺炎(Pneumocystis carinii pneumonia,PCP)的治疗效果.方法:地塞米松皮下注射大鼠8周建立PCP动物模型,分为4组:A组,pPC-UCS组;B组,磺胺组;C组,感染对照组;D组,pTZU6+1对照组.大鼠存活率、体重、肺组织病理学变化、肺印片PC包囊数、扫描电镜下PC表面结构变化、ELISA检测大鼠血清IL-8、TNF-α水平作为疗效指标.结果:①各组大鼠均存活,存活率比较无意义.②A组与B组大鼠体重分别增长(13.16±3.97)g与(14.21±3.90)g,明显高于C组(4.32±2.06)g与D组(5.38±1.19)g,P<0.05.③与C组和D组比较,A组和B组大鼠肺组织炎症明显减轻.④A组与B组每视野包囊均数分别为(3.61±0.40)个与(3.17±0.28)个,明显低于C组(8.34±0.55)个与D组(8.74±0.57)个,P<0.05.⑤扫描电镜下,C组与D组PC表面结构完整,有密集的微绒毛结构;A组与B组PC表面微绒毛脱落,表膜出现深大缺损.⑥大鼠血清IL-8水平:A组与B组分别为(232.50±36.27) pg/ml与(201.15±34.52) pg/rnl,明显低于C组(596.85±61.72) pg/ml与D组(555.10±54.31) pg/ml,P<0.05;大鼠血清TNF-o水平:A组与B组分别为(145.20±80.72) pg/ml与(172.65±76.27) pg/ml,明显高于C组(31.58±8.47) pg/ml与D组(39.49±12.03) pg/ml,P<0.05.结论:靶向PC MSG-UCS基因的siRNA对大鼠PCP有治疗作用.

  7. Pneumocystis carinii pneumonia in acquired immunodeficiency syndrome - correlation of high-resolution computed tomography and anatomopathology; Pneumocistose na sindrome da imunodeficiencia adquirida: correlacao da tomografia computadorizada de alta resolucao com a anatomopatologia

    Energy Technology Data Exchange (ETDEWEB)

    Marchiori, Edson; Moreira, Luiza Beatriz [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Capone, Domenico [Universidade do Estado, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina; Moraes, Heleno Pinto de [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Patologia; Pereira, Cyntia Inez Guedes Soares

    2001-12-01

    We present the main findings observed on the high-resolution computed tomography examinations of 15 patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. The high-resolution computed tomography and autopsy findings of 5 patients were also compared. The most frequently observed high-resolution computed tomography patterns were ground-glass attenuation, consolidation areas, crazy-paving pattern and cysts. Nodules and intralobular reticulation were less frequently observed. Ground-glass attenuation and consolidation areas corresponded to alveolar filling with inflammatory exudate. Thickening of the interlobular septa was due to cell infiltration and edema. One patient presented interlobular reticulation, and the pathology study revealed alveolar septa thickening due to cell infiltration and fibrosis. Nodules observed in one of the patients corresponded to a patchy intra alveolar accumulation of microorganisms and inflammatory cells forming a 'granulomatous' pattern. (author)

  8. Study on respiratory infection combined with Pneumocystis carinii infection in rats with immunosuppression%免疫抑制大鼠肺孢子菌合并呼吸道细菌感染的研究

    Institute of Scientific and Technical Information of China (English)

    李盛格; 刘生; 李舒音; 马素丽; 张楠; 王雪莲; 王晓娜; 安春丽

    2012-01-01

    Objective To investigate the distribution of bacteria in co-infection and its influencing factors in the lower respiratory tract of immunosuppressed rats infected with Pneumocystis carinii. Methods The immunosuppressed and Pneumocystis carinii infected rat models were established by injecting dexamethasone intraperitoneally. To study the influence of ether on the respiratory tract infection, the experimental animals were divided into ether-inhalated anesthesia group, non-ether-inhalt-ed anesthesia group, and control group that received no treatments. 8 weeks after injecting immunodepressant, the rats were sacrificed. The lung-print smears were made and stained for diagnosing Pneumocystis carinii. The ends of bronchus were taken for bacteria culture and identification. Results The models of immunosuppressed rat infected with Pneumocystis carinii were established successfully. Pneumocystis infection rate and bacterial load of the ether anesthesia group were higher than those of the non-ether anesthesia group (P < 0. 05). The major infectious bacteria were Bifidobacterium, Escherichia coli, Haemophilus influenzae, Propionibacterium acide-propionici and Staphylococcus aureus, Cellulomonas, Actinomycetes and Klebsiella pneumon-iae. There were differences in the bacteria infections, such as E. coil, Haemophilus influenzae, Propionibacterium acide-propionici, Staphylococcus aureus (P<0.05), between the anesthesia and non-narcotic group. Conclusion With etherization, the P. carinii infection ratio and P. carinii burden of the rat models were increased. Most of the lower respiratory infections are combined infections and influenced by ether anesthesia.%目的 探讨免疫抑制兼肺孢子菌感染大鼠下呼吸道合并细菌感染的菌群种类及其影响因素.方法 用腹膜内注射地塞米松的方法建立免疫抑制大鼠并诱导肺孢子菌感染模型.免疫抑制的实验组动物再分为经呼吸道吸入乙醚麻醉组和不实施乙醚麻醉组,以了

  9. Comparison of methenamine silver nitrate and Giemsa stain for detection of Pneumocystis carinii in bronchoalveolar lavage specimens from HIV infected patients

    DEFF Research Database (Denmark)

    Holten-Andersen, W; Kolmos, H J

    1989-01-01

    found positive with both methods, but a further 10 were diagnosed with Giemsa indicating that the trophozoite stain is more sensitive. As Giemsa stain is simple, quick, cheap and familiar to most microbiological laboratories it should be used for screening of samples to be examined for Pneumocystis...

  10. Image study on pneumocystis carinii of the AIDS/HIV virus infected person%艾滋病患者卡氏肺孢子虫肺炎的影像学研究

    Institute of Scientific and Technical Information of China (English)

    鲁植艳; 田志雄; 徐霁; 毕勇毅

    2006-01-01

    2005年中国现有HIV感染者预计约65万,检测发现的HIV感染者为14.1万人,与估计的感染者相差约51万人。在美国约半数以上的HIV感染者是先诊断卡氏肺孢子虫肺炎(pneumocystis carinii pneumonia,PCP)后才发现艾滋病病毒感染的。PCP的临床诊断十分困难,其主要原因是:虽然患者临床症状明显,但肺部体征较少;患者常常无痰,卡氏肺孢子虫的检出率较低,因无可靠的方法在体外长期培养卡氏肺孢子虫,因此对其生活周期了解较少。为此,作者收集21例PCP患者的临床及影像学资料,现报道如下。

  11. Detection of Pneumocystis DNA in samples from patients suspected of bacterial pneumonia – a case-control study

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Jensen, JS; Dohn, G

    2002-01-01

    Pneumocystis jiroveci (formerly known as P. carinii f.sp. hominis) is an opportunistic fungus that causes Pneumocystis pneumonia (PCP) in immunocompromised individuals. Pneumocystis jiroveci can be detected by polymerase chain reaction (PCR). To investigate the clinical importance of a positive...... Pneumocystis-PCR among HIV-uninfected patients suspected of bacterial pneumonia, a retrospective matched case-control study was conducted....

  12. Strain typing methods and molecular epidemiology of Pneumocystis pneumonia

    DEFF Research Database (Denmark)

    Beard, Charles Ben; Roux, Patricia; Nevez, Gilles

    2004-01-01

    Pneumocystis pneumonia (PCP) caused by the opportunistic fungal agent Pneumocystis jirovecii (formerly P. carinii) continues to cause illness and death in HIV-infected patients. In the absence of a culture system to isolate and maintain live organisms, efforts to type and characterize the organism...

  13. 复方磺胺甲恶唑对肾移植后卡氏肺孢子虫肺炎的预防作用%Prevention effect of compound sulfamethoxazole on pneumocystis carinii pneumonia after kidney transplantation

    Institute of Scientific and Technical Information of China (English)

    陈统清; 林敏娃; 孔耀中; 卢结文; 练桂英; 叶佩仪

    2011-01-01

    背景:卡氏肺孢子虫肺炎是由卡氏肺孢子虫寄生于肺部引起的一种严重的致命性肺炎.复方磺胺甲恶唑是目前用于治疗卡氏肺孢子虫肺炎的一线药物,治疗量往往有明显的不良反应,小剂量预防用药临床疗效及毒副作用尚不清楚.目的:观察复方磺胺甲恶唑对肾移植后卡氏肺孢子虫肺炎的预防效果.方法:选择肾移植后1个月且无复方磺胺甲恶唑过敏者.肾移植后1个月至半年或1年常规服用复方磺胺甲恶唑(0.48 g/d).观察移植肝肾功能,感染情况,药物不良反应.结果与结论:2006年起,随访125例肾移植术后早期患者,73例术后1个月起常规服用复方磺胺甲恶唑(0.48 g/d)至术后半年者,1例停药4个月后感染卡氏肺孢子虫肺炎死亡,47例服用复方磺胺甲恶唑(0.48 g/d)至术后1年者,无感染卡氏肺孢子虫肺炎者,5例因复方磺胺甲恶唑过敏或医从性差未服用复方磺胺甲恶唑者,2例分别在术后4,5个月感染卡氏肺孢子虫肺炎,1例死亡.结果提示,肾移植术后1个月至1年常规服用复方磺胺甲恶唑(0.48 g/d),可有效预防卡氏肺孢子虫肺炎,临床无明显不良反应.%BACKGROUND: Pneumocystis carinii pneumonia (PCP) is a kind of lethal pneumonia caused by pneumocystis carinii (PC) which is parasitize lung. Sulfamethoxazole is a first-line drug for PCP treatment, while there is obvious side effect when using therapeutic dose. The efficacy and side effect of small dose of SMZ is unclear.OBJECTIVE: To observe the effect of small dose of compound sulfamethoxazole (SMZco) for prevention of PCP after kidney transplantation.METHODS: Patients who were taken kidney transplantation for just one month and not sensitive to SMZco were selected. All the participants took SMZco (0.48 g/d) for half a year to one year. The graft and liver function, infection situation and side effects were surveyed.RESULTS AND CONCLUSION: We finally enrolled 125 patients in which 73

  14. 环介导等温扩增技术检测卡氏肺孢子虫的研究%Detection of Pneumocystis carinii DNA by loop-mediated isothermal amplification

    Institute of Scientific and Technical Information of China (English)

    杨秋林; 张如胜; 伍和平; 王可耕; 张愉快

    2008-01-01

    Objective To detect Pneumocystis carinii (Pc) DNA by loop-mediated isothermal amplification (LAMP). Methods After injected with hydrocortisone acetate for 8 weeks, the bronchoalveolar lavage fluid (BALF) of Wistar rats were collected and a portion of BALF were examined for identifying Pc organisms using microscope. Then Pc DNA was extracted by phenol-chloroform extraction. Four primers which recognized 6 distinct regions on the mtrRNA gene of Pc were designed and used for LAMP assay. To evaluate the specificity of the assay, M. tuberculosis, M. pneumoniae, C. pneumoniae, P. gondii and rat leucocyte were used as negative controls. To compare the sensitivity of the LAMP to that of conventional PCR, Pc DNA were 10-fold serially diluted and was amplified by LAMP and PCR. LAMP results were judged by naked eye, electrophoretic analysis and restriction digestion. Results Pc organisms were detected from BALF of rats injected with hydrocortisone acetate. After LAMP reaction, positive signal was observef rats injected with hydrocortisone acetate. By contrast, no positive signal was observed for the negative controls in the study. The amplified product digested by restriction enzyme demonstrated 3 bands (82, 135, 189 lip) upon agarose gel electrophoresis, in good agreement with the predicted sizes. The detection limit of LAMP assay was 1 pg/μl of Pc DNA per reaction and that of PCR was 10 pg/μ1 of Pc DNA per reaction. Conclusion LAMP assay has usefulness for rapid detection of Pc.%目的 环介导等温扩增(LAMP)技术检测卡氏肺孢子虫(Pc).方法 醋酸可的松经皮下注射Wistar大鼠诱导Pc,收集支气管肺泡灌洗液(BALF)提取Pc基因组DNA.设计4条扩增Pc线粒体核糖体大亚基(mtrRNA)基因的LAMP引物,以结核杆菌、肺炎支原体、肺炎衣原体、弓形虫、大鼠白细胞为对照,进行LAMP反应.LAMP产物经显色、电泳及酶切鉴定.将Pc DNA 10倍稀释后同时进行LAMP和PCR,比较其敏感性.结果 Pc检测管经显

  15. In vitro study of the anti-pneumocystis carinii effect of arteminsin derivatives%青蒿素衍生物抗卡氏肺孢子虫体外 作用的研究

    Institute of Scientific and Technical Information of China (English)

    倪小毅; 陈雅棠

    2001-01-01

    目的研究不同浓度青蒿素衍生物双氢青蒿素、青蒿琥酯对体外培养卡氏肺孢子虫的作用。方法接种卡氏肺孢子虫(Pc)于人肝癌细胞系(HepG-2)。4 h后加入试验药物和对照试剂。双氢青蒿素药物浓度分别为:100、50、10、5、0.5 μmol/L;青蒿琥酯药物浓度分别为:100、50、10、5 μmol/L;对照药喷他脒:15 μmol/L。以后每隔1 d取培养液观察,分别作六亚甲基四胺银(GMS)和Diff-Quik (DQ)染色计数Pc包囊和滋养体数目。结果 Pc滋养体和包囊在体外培养细胞上的生长高峰出现于第5 d,双氢青蒿素浓度为50 μmol/L和100 μmol/L时对Pc滋养体的抑制率分别为88.0%与90.1%,与喷他脒15 μmol/L的抑制率90.0%相当;而青蒿琥酯浓度为100 μmol/L时方可达到Pc滋养体抑制率83.4%。Pc包囊抑制率,双氢青蒿素和青蒿琥酯浓度为100 μmol/L时分别为67.5%和67.3%,与喷他脒的抑制率75.0%之间无统计学差异。结论双氢青蒿素和青蒿琥酯在一定浓度时对Pc的抑制作用与喷他脒相当;而双氢青蒿素的抑制作用略高于青蒿琥酯。两者对Pc滋养体的抑制率均高于对Pc包囊。%Objective In vitro study was carried out to assess the effect of dihydroarteminsinin(DHA) and sodium artesunate(ATS) on pneumocystis carinii(Pc). Methods The drugs were added into HepG-2 cell cultures containing Pc cysts. The concentrations of dihydroarteminsinin (DHA) were 100, 50, 10, 5, 0.5 μmol/L respectively. The concentrations of sodium artesunate (ATS) were 100, 50, 10, 5 μmol/L respectively and pentamidine (PTD) was 15 μmol/L as a control. The supernatants were withdrawn every other day and evaluated for Pc trophozoite and cyst counts by GMS and DQ stain. Results The peak of Pc multiplication was observed on 5th day. The inhibition rates of Pc trophozoites by DHA 50 μmol/L, 100 μmol/L and ATS 100 μmol/L were quite similar to that of pentamidine (PTD) 15

  16. 艾滋病合并卡氏肺孢子菌肺炎的CT影像学分析%Analysis on CT images of Pneumocystis carinii pneumonia in patients with AIDS

    Institute of Scientific and Technical Information of China (English)

    郭艳; 刘挨师

    2013-01-01

    Objective To investigate the CT imaging features of Pneumocystis carinii pneumonia ( PCP ) in patients with AIDS. Methods The CT images of 31 patients with PCP in AIDS were analyzed, retrospectively. Results The CT images showed that there were 96. 8% patients with bilateral distribution and 96. 8% patients with diffuse infiltration. A variety of findings of PCP were shown: the ground-glass opacity ( 100% ), diffuse reticular pattern( 51. 6% ), air containing cystic pattern ( 41. 9% ), double-track syndrome ( 35. 5% ), patchy shadows ( 32. 3% ), lobular septum thickening ( 32. 3% ), moon low sign ( 25. 8% ), crazy-paving pattern ( 16. 1% ), consolidation ( 6. 5% ) and pericarditis (3.2% ). Location: ground glass opacity, patchy shadow, bronchial double-track syndrome, syndrome with lobar distribution mainly gravel, reticulocyte nodules and arch syndrome multiple were in the lower lobe of the lung, while pulmonary balloon multiple was in the upper lobe of the lung or lobe. The CT images showing 1 features were 6.5%, 2 features accouted 16. 1%, 3 features accouted 35. 5% and 4 features accouted 41. 9%. Conclusions The CT images of AIDS patients with PCP were complicated with a double lung symmetry distribution. The round-glass, diffuse reticular pattern, double-track syndrome, patchy shadows and lobular septum thickening were common and with moon low sign and crazy-paving pattern as its specificit.%目的 探讨艾滋病(AIDS)合并卡氏肺孢子菌肺炎(PCP)的CT影像学特点.方法 对确诊的31例患者,以入院首次肺部CT影像作为研究资料进行回顾性分析.结果 入组患者CT影像呈双侧对称性分布者占93.5%,表现为弥漫性浸润者占96.8%.影像学表现:呈磨玻璃影者占100.0%、网织结节影者占51.6%、肺气囊者占41.9%、支气管双轨征者占35.5%、斑片状影者占32.3%、小叶间隔增厚者占32.3%、月弓征者占25.8%和碎石征者占16.1%.另外,实变影者占6.5%、胸腔积液者占3.2%.发生部

  17. Molecular phylogeny of Pneumocystis based on 5.8S rRNA gene and the internal transcribed spacers of rRNA gene sequences

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    To clarify the phylogenetic relationships and species status of Pneumocystis, the 5.8S rRNA gene and the internal transcribed spacers (ITS, 1 and 2) of Pneumocystis rRNA derived from rat, gerbil and human were amplified, cloned and sequenced. The genetic distance matrix of six Pneumocystis species compared with other fungi like Taphrina and Saccharomyces indicated that the Pneumocystis genus contained multiple species including Pneumocystis from gerbil. The phylogenetic tree also showed that Pneumocystis from human and monkey formed one group and four rodent Pneumocystis formed another group. Among the four members, Pneumocystis wakefieldiae was most closely related to Pneumocystis murina and Pneumocystis carinii, and was least related to gerbil Pneumocystis.

  18. Application of Non-invasive Ventilation in Treatment of AIDS Patients with Pneumocystis Carinii Pneumonia and Its Nursing%无创通气在治疗艾滋病合并肺孢子菌肺炎患者中的应用及护理

    Institute of Scientific and Technical Information of China (English)

    陈登翠; 石柳春; 韦美进

    2012-01-01

    Objective To investigate the effects and nursing methods of non-invasive ventilation treatment on AIDS patients with severe pneumocystis carinii pneumonia (PCP). Methods The clinical date of 10 cases of noninvasive ventilation in the treatment of AIDS patients complicated with severe PCP were analyzed retrospectively. All patients were treated with anti-PCP therapy. Ventilation assisted with non-invasive ventilator was adopted on the basis of patency of the respiratory tract, appropriate oxygen therapy, control a variety of infections, symptomatic and supportive nutritionl treatment and glucocorticoid treatment. Results In the 10 cases, 6 were cured, 1 gave up therapy, and 3 died. Conclusion The AIDS patients with severe PCP should be treated with early noninvasive ventilation therapy to improve breathing.%目的 探讨无创通气在治疗艾滋病(acquired immune deficiency syndrome,AIDS)合并重症肺孢子菌肺炎(pneumocystis carinii pneumonia,PCP)患者中的应用及护理.方法 回顾性分析2010年10月至2011年6月在广西龙潭医院治疗的10例AIDS合并重症PCP患者的临床资料.所有患者均采用抗PCP治疗,在通畅呼吸道、适当氧疗、控制各种感染、营养对症支持治疗及应用糖皮质激素等治疗基础上,采用无创呼吸机辅助通气治疗.结果 10例患者中,6例好转出院,1例放弃治疗,3例死亡.结论 对AIDS合并重症PCP患者应及早采用无创通气治疗并实施相应的护理措施,以改善其呼吸情况.

  19. Pneumocystis Pneumonia (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia A A A What's in this article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  20. Epidemiological and taxonomic impact of Pneumocystis biodiversity.

    Science.gov (United States)

    Mazars, E; Dei-Cas, E

    1998-09-01

    A cluster of antigenic, genomic, karyotypic, isoenzymatic and morphological differences have been reported among Pneumocystis populations. Multilocus enzyme electrophoresis revealed strong linkage disequilibrium suggesting that Pneumocystis genotypes from different hosts have been genetically isolated from each other for a very long time. At least in some cases, genetic diversity is associated with phenotypic differences as revealed by in vitro, ultrastructural and cross infection studies. Thus, biodiversity in Pneumocystis has obvious epidemiological implications. Cross infection experiments revealed that Pneumocystis host species-related genetic differences are associated with close host species specificity, which suggests that transmission cannot take place between hosts of different species and that immunocompromised patients contract the infection primarily from infected humans. But these affirmations do not preclude other reservoirs for human pneumocystosis and research has to be extended to natural populations of synanthropic or wild mammals. Transmission of human pneumocystosis was also approached by typing human Pneumocystis isolates from patients or carriers, which should allow the follow up of parasite strains in human populations. As the strains of Pneumocystis found in different host species were considered for a long time to be morphologically indistinguishable, only one species of Pneumocystis was accepted for almost one century. At present, the scientific community is progressively accepting that the terminology 'P. carinii' is hiding a heterogeneous group of microorganisms. As available data made it impossible to establish if genetic divergence derives from clonal reproduction or speciation, no new species names have been attributed to Pneumocystis populations, but a trinomial nomenclature, including the Latin name of the host, was adopted in 1994. It has to be outlined finally that works on biodiversity of Pneumocystis populations are basically

  1. Pneumocystis Pneumonia (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia Print A A A What's in this article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  2. Estudo temporal das doenças associadas à AIDS no Brasil, 1980-1999 Temporal trends in AIDS-associated opportunistic infections in Brazil, 1980-1999

    Directory of Open Access Journals (Sweden)

    Mark Drew Crosland Guimarães

    2000-01-01

    Full Text Available Neste trabalho foram estimadas as incidências de condições associadas (CA à AIDS/100 casos de AIDS em adultos (> 12 anos, a nível nacional, de 1980 a maio de 1999. A análise incluiu qui-quadrado e regressão linear simples. As CA analisadas foram candidíase (CD, tuberculose (TB, pneumonia por Pneumocystis carinii (PCP, neurotoxoplasmose(NT, Herpes, Sarcoma de Kaposi (SK, meningite criptocócica (MC e infecções por protozoários (IP. As incidências acumuladas/100 casos de AIDS foram: CD = 59, TB = 26, PCP = 23, NT = 15, Herpes = 12, SK = 5, MC = 4 e IP = 4. A tendência anual indicou queda estatisticamente significativa em todas as CA. Entretando, houve aumento na incidência de TB (b = 0,39 e NT (b = 0,20, para as regiões Nordeste e Centro-Oeste, respectivamente. TB apresentou maior incidência entre aqueles com baixa escolaridade (Trends in annual incidence of reported AIDS-associated opportunistic infections (OI/100 adults > 12 years old among AIDS cases were estimated at the national level in Brazil from 1980 through May 1999. The analysis included chi-square and linear regression modeling. The opportunistic infections included: candidiasis (CD, tuberculosis (TB, Pneumocystis carinii pneumonia (PCP, neurotoxoplasmosis (NT, Kaposi sarcoma (KS, cryptococcal meningitis (CM, and protozoa infections (PI. The overall cumulative incidence rates/100 reported AIDS cases were: CD = 59, TB = 26, PCP = 23, NT = 15, KS = 5, CM = 4, and PI = 4. Annual trends indicated a statistically significant decline in all OIs. However, in the Northeast and Central-West regions there were increases in TB (b = 0.39 and NT (b = 0.20, respectively. TB showed a higher incidence among individuals with less schooling (< 8 years, while PCP and KS had higher incidence rates among those with 8 or more years of schooling, despite similar downward trends. Access to antiretroviral therapy and OI prophylaxis may partially explain these results. However, data reliability

  3. Biochemical research elucidating metabolic pathways in Pneumocystis*

    Directory of Open Access Journals (Sweden)

    Kaneshiro E.S.

    2010-12-01

    Full Text Available Advances in sequencing the Pneumocystis carinii genome have helped identify potential metabolic pathways operative in the organism. Also, data from characterizing the biochemical and physiological nature of these organisms now allow elucidation of metabolic pathways as well as pose new challenges and questions that require additional experiments. These experiments are being performed despite the difficulty in doing experiments directly on this pathogen that has yet to be subcultured indefinitely and produce mass numbers of cells in vitro. This article reviews biochemical approaches that have provided insights into several Pneumocystis metabolic pathways. It focuses on 1 S-adenosyl-L-methionine (AdoMet; SAM, which is a ubiquitous participant in numerous cellular reactions; 2 sterols: focusing on oxidosqualene cyclase that forms lanosterol in P. carinii; SAM:sterol C-24 methyltransferase that adds methyl groups at the C-24 position of the sterol side chain; and sterol 14α-demethylase that removes a methyl group at the C-14 position of the sterol nucleus; and 3 synthesis of ubiquinone homologs, which play a pivotal role in mitochondrial inner membrane and other cellular membrane electron transport.

  4. Pneumocystis jiroveci pneumonia

    Science.gov (United States)

    ... medlineplus.gov/ency/article/000671.htm Pneumocystis jiroveci pneumonia To use the sharing features on this page, please enable JavaScript. Pneumocystis jiroveci pneumonia is a fungal infection of the lungs. The ...

  5. 双水平无创正压通气对艾滋病合并肺孢子菌肺炎的治疗分析%Clinical analysis of non-invasive bi-level positive airway pressure ventilation in the treatment of AIDS patients complicated with pneumocystis carinii pneumonia

    Institute of Scientific and Technical Information of China (English)

    杨梅; 曹培明

    2015-01-01

    目的:探讨双水平无创正压通气(BiPAP)对艾滋病合并肺孢子菌肺炎所致氧合指数(PaO2/PiO2)<300mmHg 的患者的治疗效果。方法将明确诊断 AIDS 合并 PCP,PaO2/ PiO2<300mmHg 的患者99例,以是否接受 BiPAP 治疗分为对照组和观察组,观察 PaO2、PaO2/ PiO2、R 的改善程度和时间;对呼吸困难改善时间、使用有创呼吸机率、住院时间和病死率进行比较。结果观察组与对照组相比,在 PaO2、PaO2/ PiO2、R、住院时间、病死率、有创呼吸机使用率上进行统计学对比分析,P <0.05,有统计学意义。结论 BiPAP 在AIDS 合并 PCP 中的运用能及时有效提高 PaO2/ PiO2,改善症状,降低病死率,可积极推广。%Objective To explore the clinical effect of bi-level positive airway pressure ( BiPAP) in the treatment of AIDS patients complicated with pneumocystis carinii pneumonia (PCP). Methods 99 AIDS patients complicated with PCP (PaO2 / PiO2 < 300mmHg) were divided into 2 groups based on the use of NIPPV or not. The improvement of PaO2 , PaO2 / PiO2 and R was observed, and the improvement time of dyspnea, the time of using inva-sive ventilator, and the duation of hospital stay and mortality were compared between the two groups. Results The improvement of PaO2 , PaO2 / PiO2 , R, duration of hospital stay and mortality was more pronounced in the observation group than in the control group (P < 0. 05). Conclusion It is an effective method to use BiPAP in the treatment AIDS patients complicated with PCP, which can effectively improve PaO2 / PiO2 , and decline mortality.

  6. Glycosylation of the major human Pneumocystis carinii surface antigen

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Koch, C; Mathiesen, Lars Reinhardt

    1993-01-01

    -mannose and bisected complex-type glycans. Using a polyclonal antibody raised against purified gp95 and crossed affinoimmunoelectrophoresis and the lectins Con A and WGA, gp95 exhibited carbohydrate-dependent microheterogeneity. We therefore suggest that gp95 is composed of subtypes which differ in N...

  7. Extra-pulmonary Pneumocystis jiroveciinfection: a case report

    Directory of Open Access Journals (Sweden)

    Mehrdad Bakhshayesh Karam

    2014-12-01

    Full Text Available In physical examination abdominal tenderness, gate disturbance and penile herpetic lesions were detected. Decreased disc height at T11-T12 level was detected in chest X-ray. Abdominal sonography and CT scan revealed hypo dense lesions in Lt left Lobe of liver and multiple hypo dense splenic and pancreatic lesions, ascitis, Lt left sided pleural effusion, thickening of jejuneal mucosa and edema of bowel wall. Vertebral body lesion and paravertebral abscess, bony calvarial involvement and adjacent extra axial brain lesion were observed in imaging were other findings. RNA analysis for HIV was positive. Vertebral lesion biopsy and aspiration of splenic lesion were performed and pathology revealed Pneumocystis jirovecii suggestive of extra pulmonary Pneumocystis carinii infection.

  8. SYTO-13, a Viability Marker as a New Tool to Monitor In Vitro Pharmacodynamic Parameters of Anti-Pneumocystis Drugs.

    Directory of Open Access Journals (Sweden)

    Annie Standaert-Vitse

    Full Text Available While Pneumocystis pneumonia (PcP still impacts the AIDS patients, it has a growing importance in immunosuppressed HIV-negative patients. To determine the anti-Pneumocystis therapeutic efficacy of new compounds, animal and in vitro models have been developed. Indeed, well-designed mouse or rat experimental models of pneumocystosis can be used to describe the in vivo anti-Pneumocystis activity of new drugs. In vitro models, which enable the screening of a large panel of new molecules, have been developed using axenic cultures or co-culture with feeder cells; but no universally accepted standard method is currently available to evaluate anti-Pneumocystis molecules in vitro. Thus, we chose to explore the use of the SYTO-13 dye, as a new indicator of Pneumocystis viability. In the present work, we established the experimental conditions to define the in vitro pharmacodynamic parameters (EC50, Emax of marketed compounds (trimethoprim/sulfamethoxazole, pentamidine, atovaquone in order to specifically measure the intrinsic activity of these anti-P. carinii molecules using the SYTO-13 dye for the first time. Co-labelling the fungal organisms with anti-P. carinii specific antibodies enabled the measurement of viability of Pneumocystis organisms while excluding host debris from the analysis. Moreover, contrary to microscopic observation, large numbers of fungal cells can be analyzed by flow cytometry, thus increasing statistical significance and avoiding misreading during fastidious quantitation of stained organisms. In conclusion, the SYTO-13 dye allowed us to show a reproducible dose/effect relationship for the tested anti-Pneumocystis drugs.

  9. Pneumocystis and Histoplasma infections in wild animals from the Amazon region of Brazil.

    Science.gov (United States)

    Lainson, R; Shaw, J J

    1975-01-01

    Routine examination of tissues from wild forest rodents from Amapá, north Brazil, revealed Pneumocystis carinii in lung smears from a newly captured Oryzomys capito (Cricetidae). Acute, fatal infections with this parasite are also recorded in a number of captive "coatimundis", Nasua narica (Carnivora: Procyonidae) and a sloth, Bradypus tridactylus (Edentata). Pneumocystis was also encountered in lung smears from a newly captured and apparently healthy sloth, Choloepus didactylus. The presence of infection in newly captured animals leads us to believe that the fatal, fulminating pneumocystosis seen in the captive Nasua and Bradypus was due to exacerbation of pre-existant infections acquired in their natural forest environment. Pneumocystis carinii is a well known cause of fatal, interstitial plasma-cell pneumonia in human infants and sometimes the weakened adult: the keeping of exotic pets such as the coatimundi is, therefore, not without some hazard in this respect. Histoplasma, another well known pathogen for man, was isolated from 4 rodents, Proechimys guyanensis (Echimyidae), all from virgin forest along the newly opened Trans Amazon Highway, Pará State, and from a single sloth, Choloepus didactylus, from near Belém, Pará. All these animals showed no symptoms of infection: isolation of the parasite was made by the inoculation of laboratory hamsters with saline suspensions of triturated liver and spleen.

  10. Pneumocystis jirovecii pneumonia

    DEFF Research Database (Denmark)

    Cordonnier, Catherine; Cesaro, Simone; Maschmeyer, Georg

    2016-01-01

    Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from that ...

  11. The Pneumocystis life cycle

    Directory of Open Access Journals (Sweden)

    Cécile-Marie Aliouat-Denis

    2009-05-01

    Full Text Available First recognised as "schizonts" of Trypanosoma cruzi, Pneumocystis organisms are now considered as part of an early-diverging lineage of Ascomycetes. As no robust long-term culture model is available, most data on the Pneumocystis cell cycle have stemmed from ultrastructural images of infected mammalian lungs. Although most fungi developing in animals do not complete a sexual cycle in vivo, Pneumocystis species constitute one of a few exceptions. Recently, the molecular identification of several key players in the fungal mating pathway has provided further evidence for the existence of conjugation and meiosis in Pneumocystisorganisms. Dynamic follow-up of stage-to-stage transition as well as studies of stage-specific proteins and/or genes would provide a better understanding of the still hypothetical Pneumocystislife cycle. Although difficult to achieve, stage purification seems a reasonable way forward in the absence of efficient culture systems. This mini-review provides a comprehensive overview of the historical milestones leading to the current knowledge available on the Pneumocystis life cycle.

  12. Diamidines versus Monoamidines as Anti-Pneumocystis Agents: An in Vivo Study

    Directory of Open Access Journals (Sweden)

    El-Moukhtar Aliouat

    2013-07-01

    Full Text Available Some compounds articulated around a piperazine or an ethylenediamine linker have been evaluated in vitro to determine their activity in the presence of a 3T6 fibroblast cell line and an axenic culture of Pneumocystis carinii, respectively. The most efficient antifungal derivatives, namely N,N′-bis(benzamidine-4-ylethane-1,2-diamine (compound 6, a diamidine and N-(benzamidine-4-yl-N′-phenylethane-1,2-diamine (compound 7, a monoamidine, exhibited no cytotoxicity and were evaluated in vivo in a rat model. Only the diamidine 6 emerged as a promising hit for further studies.

  13. Caspofungin in salvage treatment of severe pneumocystis pneumonia: case report and literature review

    Institute of Scientific and Technical Information of China (English)

    MU Xiang-dong; QUE Cheng-li; HE Bing; WANG Guang-fa; LI Hai-chao

    2009-01-01

    @@ Pneumocystis pneumonia (PCP) is one of the most critical and life-threatening infections in immunocompromised patients with AIDS (especially CD4+ T cell less than 0.2×109/L), hematological malignancies, organ transplantation or connective tissue diseases.1It is caused by a fungus called Pneumocystis firoveci (P. jiroveci, formerly called P. carinii).2Despite treatment with trimethoprim-sulfamethoxazole (TMP/SMZ) and corticosteroids, the morbidity of this disease is often high because of late treatment or contraindications of sulfanilamide. New therapeutic approaches are therefore warranted. Caspofungin, a beta-1, 3-glucan synthesis inhibitor, has shown activity against P. jiroveci in experimental animals,3but clinical trials about this are rare.4-8We here report our clinical experience with caspofungin in salvage treatment of severe PCP in a patient with chronic myelomonocytic leukemia (CMML) and uremia.

  14. Analogs of pentamidine as potential anti-Pneumocystis chemotherapeutics.

    Science.gov (United States)

    Maciejewska, Dorota; Zabinski, Jerzy; Kaźmierczak, Pawel; Rezler, Mateusz; Krassowska-Świebocka, Barbara; Collins, Margaret S; Cushion, Melanie T

    2012-02-01

    A series of 20 pentamidine analogs were prepared using 2 general Schemes that evaluated heteroatoms, sulfobenzene and alkanediamide groups in the aliphatic linker and methoxy substituents attached to the benzene rings for efficacy against the fungal pathogen, Pneumocystis carinii in an ATP bioassay. All but one of the 20 bisamidines reduced the ATP content of the P. carinii over the 72 h of the assay period. The highest activities were associated with the lack of methoxy groups and the presence of the O, N and S heteroatoms. Activity (IC(50)) for compounds 1, 5, 6, 10 ranged from 1.1 to 2.13 μM. The compound 11 with similar activity (1.33 μM), bears a sulfobenzene group at a nitrogen in the aliphatic linker. The alkanediamide-linked bisbenzamidines showed a moderate inhibition of ATP. Generally, the inclusion of a heteroatom in the aliphatic linker and absence of methoxy groups at the benzene rings were associated with higher activities in this assay. Of note, most of the compounds had little to no cytotoxicity in mammalian cell cultures. Although not quite as potent as other pentamidine derivatives, these compounds hold promise for decreased side effects within the mammalian host.

  15. "Rapid Detection of Pneumocystis Carini in Spiratory Specimens of Rats by Calcofluor White Staining"

    Directory of Open Access Journals (Sweden)

    M Mohebali

    2002-09-01

    Full Text Available The present study was carried out for evaluation of calcoflour white staining (CWS as a rapid method for detection of Pneumocystis carinii in respiratory specimens of rats as an animal model for human infection. A total of 35 Spraque – Dawley rats were divided into two groups. Group1 (20 rats received increasing doses of dexamethasone subcutaneously, and Group 2(15 ratsas control group that received no immunosuppressive drugs. After immunosuppressant, all of the rats were killed and necropsy was performed. Broncho-alveolar lavage (BAL and impression smears from the lungs prepared and stained by CWS .The results were compared with a few standard staining methods which have already been used for P.carinii. The calcofluor white staining was found to have more validity (sensitivity and specificity than other staining methods such as Geimsa , Modified Geimsa and Toluidine blue O ( TBO .The study showed the CWS to be more valid , faster and easier to perform for detecting of P. carinii rganism.

  16. Evaluation of the current management protocols for prophylaxis against Pneumocystis jiroveci pneumonia and other opportunistic infections in patients living with HIV/AIDS.

    Science.gov (United States)

    Jain, Sheel Bhadra; Wig, Naveet; Nagpal, Sajan Jiv Singh; Mishra, Nitin; Vajpayee, Madhu; Guleria, Randeep; Pandey, Ravindra Mohan; Sharma, Surendra K

    2011-07-01

    Opportunistic infections (OIs) are a leading cause of mortality and morbidity in patients living with HIV/AIDS. Data on the proper administration of prophylactic regimes for the prevention of OIs in such patients are scarce. A total of 205 confirmed HIV-infected patients were enrolled in the study from the inpatient wards and outpatient services. The treatment given to them for the prevention of Pneumocystis carinii (jiroveci) pneumonia was compared with the established guidelines and the proportions of those receiving proper treatment were calculated. Primary prophylaxis was seen to be satisfactory in the case of P. carinii (jiroveci) pneumonia. The prophylaxis was not given properly for tuberculosis and other common OIs. Secondary prophylaxis was up to the mark. Prophylaxis in AIDS patients seems to be a major problem area and a lot of efforts need to be directed toward it since patients suffering from AIDS are bound to have a downhill course despite provision of all available treatment options.

  17. T cytotoxic-1 CD8+ T cells are effector cells against pneumocystis in mice.

    Science.gov (United States)

    McAllister, Florencia; Mc Allister, Florencia; Steele, Chad; Zheng, Mingquan; Young, Erana; Shellito, Judd E; Marrero, Luis; Kolls, Jay K

    2004-01-15

    Host defenses are profoundly compromised in HIV-infected hosts due to progressive depletion of CD4+ T lymphocytes. A hallmark of HIV infection is Pneumocystis carinii (PC) pneumonia. Recently, CD8+ T cells, which are recruited to the lung in large numbers in response to PC infection, have been associated with some level of host defense as well as contributing to lung injury in BALB/c mice. In this study, we show that CD8+ T cells that have a T cytotoxic-1 response to PC in BALB/c mice, as determined by secretion of IFN-gamma, have in vitro killing activity against PC and effect clearance of the organism in adoptive transfer studies. Moreover, non-T cytotoxic-1 CD8+ T cells lacked in vitro effector activity and contributed to lung injury upon adoptive transfer. This dichotomous response in CD8+ T cell response may in part explain the clinical heterogeneity in the severity of PC pneumonia.

  18. Intravenous pentamidine for Pneumocystis carinii/jiroveci pneumonia prophylaxis in pediatric transplant patients.

    Science.gov (United States)

    Clark, Abigail; Hemmelgarn, Trina; Danziger-Isakov, Lara; Teusink, Ashley

    2015-05-01

    SMX/TMP is the current gold standard for prophylaxis against PCP in immunocompromised pediatric patients. Currently, there are several second-line options for prophylaxis but many, including intravenous (IV) pentamidine, have not been reported to be as effective or as safe as SMX/TMP in the pediatric transplant population. This study is to determine the efficacy and safety of IV pentamidine in preventing PCP in pediatric transplant patients. A retrospective chart review was conducted to evaluate all transplant patients that received at least one dose of IV pentamidine from January 2010 to July 2013. The primary outcome, IV pentamidine efficacy, was evaluated by the incidence of PCP diagnosis for 28 days after the last dose of IV pentamidine if patient was transitioned to another agent for PCP prophylaxis. Patients on IV pentamidine for entire course of PCP prophylaxis were followed at least six months after discontinuation of IV pentamidine. The safety of IV pentamidine was assessed by the incidence of adverse events leading to pentamidine discontinuation. All data were analyzed using descriptive statistics. All transplant patients at CCHMC who had received IV pentamidine were reviewed, and 333 patients met inclusion criteria. The overall incidence of PCP was found to be 0.3% for pediatric transplant patients on pentamidine. Pentamidine was found to be safe, and the incidence of adverse events leading to discontinuation was 6% with the most common reason being tachycardia 2.1%. IV pentamidine is safe and effective as PCP prophylaxis in pediatric transplant patients with a PCP breakthrough rate of 0.3% (1 of 333 patients), and only 20 adverse events led to discontinuation. We recommend that IV pentamidine be considered as a second-line option in pediatric transplant patients who cannot tolerate SMX/TMP.

  19. Aislamiento de Pneumocystis carinni en una colonia de ratones utilizando centinelas de la cepa CDA/Xid

    OpenAIRE

    Milocco, Silvana; Ayala, Miguel Ángel; Laborde, Juan Martín; Carriquiriborde, Martín; Principi, Guido; Maschi, F.; Cagliada, María del Pilar; Carbone, Cecilia

    2010-01-01

    La producción de ratones inmunodeficientes constituye una de las herramientas más importantes para la investigación biomédica. La cepas más utilizadas, son N:NIH(S)-Foxlnu y CBA/N-Xid/Uni (Xid) como modelos animales de elección para estudios de inmunodeficiencia humana, VIH, neumocistosis, terapia génica y trasplantes de tumores humano. La neumocistosis es una infección producida por Pneumocystis carinii; que causa neumonía intersticial en diversas especies de mamíferos, tales como ratas, rat...

  20. Pneumocystis diversity as a phylogeographic tool

    Directory of Open Access Journals (Sweden)

    S Derouiche

    2009-02-01

    Full Text Available Parasites are increasingly used to complement the evolutionary and ecological adaptation history of their hosts. Pneumocystis pathogenic fungi, which are transmitted from host-to-host via an airborne route, have been shown to constitute genuine host markers of evolution. These parasites can also provide valuable information about their host ecology. Here, we suggest that parasites can be used as phylogeographic markers to understand the geographical distribution of intra-specific host genetic variants. To test our hypothesis, we characterised Pneumocystis isolates from wild bats living in different areas. Bats comprise a wide variety of species; some of them are able to migrate. Thus, bat chorology and migration behaviour can be approached using Pneumocystis as phylogeographic markers. In the present work, we find that the genetic polymorphisms of bat-derived Pneumocystis are structured by host chorology. Therefore, Pneumocystis intra-specific genetic diversity may constitute a useful and relevant phylogeographic tool.

  1. Second-line salvage treatment of AIDS-associated Pneumocystis jirovecii pneumonia: a case series and systematic review

    DEFF Research Database (Denmark)

    Benfield, T.; Atzori, C.; Miller, R.F.;

    2008-01-01

    .2] and 2.7 [95% CI: 1.3 to 4.0], respectively) but were considerably lower for intravenous pentamidine (44%; OR = 0.8 [95% CI: 0.6 to 1.0]). CONCLUSIONS: Clindamycin-primaquine is an alternative to intravenous pentamidine as second-line treatment for PCP in patients who fail treatment with TMP-SMX. TMP...

  2. Pneumocystis jiroveci pneumonia and pneumomediastinum in an anti-TNFα naive patient with ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    James C Lee; Deborah C Bell; Richard M Guinness; Tariq Ahmad

    2009-01-01

    We report the case of a 21-year-old man who was noted to have pneumomediast inum dur ing an admission for an acute flare of ulcerative colitis. At that time, he was on maintenance treatment with azathioprine at a dose of 1.25 mg/kg per day, and had not received supplementary steroids for 9 mo. He had never received anti-tumor necrosis factor (TNF)α therapy. Shortly after apparently effective treatment with intravenous steroids and an increased dose of azathioprine, he developed worsening colitic and new respiratory symptoms, and was diagnosed with Pneumocystis jiroveci ( carinii) pneumonia (PCP). Pneumomediastinum is rare in immunocompetent hosts, but is a recognized complication of PCP in human immunodeficiency virus (HIV) patients, although our patient 's HIV test was negative. Treatment of PCP with co-trimoxazole resulted in resolution of both respiratory and gastrointestinal symptoms, without the need to increase the steroid dose. There is increasing vigilance for opportunistic infections in patients with inflammatory bowel disease following the advent of anti-TNFα therapy. This case emphasizes the importance of considering the possibility of such infections in all patients with inflammatory bowel disease, irrespective of the immunosuppressants they receive, and highlights the potential of steroid-responsive opportunistic infections to mimic worsening colitic symptoms in patients with ulcerative colitis.

  3. In vitro systems in pneumocystis research

    DEFF Research Database (Denmark)

    Dei-Cas, E; Cailliez, J C; Lundgren, Bettina

    1996-01-01

    as well as elimination of host cell debris from parasite extracts. In other investigations, such as transmission, infectivity, life cycle, biochemical, in vitro culture or drug-screening studies, viable and infectious Pneumocystis organisms are urgently required. However, there is no generally accepted...

  4. Phylogenetic status of Pneumocystis from corticosteroid-treated gerbils

    Institute of Scientific and Technical Information of China (English)

    RODNEY; D; Adam

    2010-01-01

    Pneumocystis spp. infect the lungs of multiple mammalian species and cause disease in immunosuppressed individuals. The Pneumocystis isolates that have been studied to date fall into two major clades, those from primates and those from rodents. Within each of these clades, different species have been described on the basis of host specificity and differences in sequence and morphology. Here, we demonstrate that dexamethasone immunosuppression consistently results in histologically apparent lung infection in gerbils (28/35 animals). Sequence analysis of the 18S, 5.8S and internal transcribed spacer regions of the rDNA and a portion of the mitochondrial large subunit rDNA demonstrated that this gerbil Pneumocystis is grouped with other rodent Pneumocystis spp., but is distinct from them. Our results suggest that gerbil Pneumocystis differs sufficiently from Pneumocystis species found in other rodents to be considered a separate species.

  5. Distribution of Pneumocystis jirovecii in lungs from colonized COPD patients

    Science.gov (United States)

    Sivam, Sheila; Sciurba, Frank C.; Lucht, Lorrie A.; Zhang, Yingze; Duncan, Steven R.; Norris, Karen A.; Morris, Alison

    2011-01-01

    Pneumocystis jirovecii has been detected in lung tissue from patients with chronic obstructive pulmonary disease (COPD) and is associated with disease severity. The regional distribution of the organism in lungs is unknown, but differences in distribution of Pneumocystis could affect estimates of colonization prevalence. We examined the distribution of Pneumocystis in the lungs of 19 non-HIV-infected patients with COPD who were undergoing lung transplantation. DNA was extracted from explanted lungs. We found Pneumocystis colonization in lung tissue of 42.1% of patients with advanced COPD; however, there was significant regional variation in colonization between lung segments of individual patients. Colonization was detected more commonly in the lower and middle lobes than the upper lobes. These findings suggest that single samples from an individual may underestimate the prevalence of Pneumocystis colonization and future studies may obtain a higher yield of Pneumocystis colonization detection when sampling the lower lobes. PMID:21851870

  6. Pneumocystis Pneumonia Increases the Susceptibility of Mice to Sublethal Hyperoxia

    OpenAIRE

    Beck, James M.; Preston, Angela M.; Wilcoxen, Steven E.; Morris, Susan B.; White, Eric S.; Paine, Robert

    2003-01-01

    Patients with Pneumocystis pneumonia often develop respiratory failure after entry into medical care, and one mechanism for this deterioration may be increased alveolar epithelial cell injury. In vitro, we previously demonstrated that Pneumocystis is not cytotoxic for alveolar epithelial cells. In vivo, however, infection with Pneumocystis could increase susceptibility to injury by stressors that, alone, would be sublethal. We examined transient exposure to hyperoxia as a prototypical stress ...

  7. Rapid detection of dihydropteroate polymorphism in AIDS-related Pneumocystis carinii pneumonia by restriction fragment length polymorphism

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Eugen-Olsen, Jesper; Lundgren, B

    2000-01-01

    are associated with failure of sulpha prophylaxis and increased mortality in HIV-1 positive patients with PCP, suggesting that DHPS mutations may cause sulpha resistance. To facilitate detection of DHPS mutations we developed a restriction fragment length polymorphism (RFLP) assay, detecting mutations at codon...

  8. Differential effect on serum neopterin and serum beta 2-microglobulin is induced by treatment in Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Schattenkerk, J K; Hofmann, B

    1994-01-01

    determined in consecutive serum samples. Initiation of antimicrobial treatment resulted in significantly increased neopterin levels, whereas beta 2M levels slightly decreased from pretreatment levels. In patients treated with corticosteroid, both neopterin and beta 2M decreased, by approximately 50...

  9. Intracranial venous sinus thrombosis complicating AIDS-associated nephropathy.

    Science.gov (United States)

    Afsari, Khosrow; Frank, Jeffrey; Vaksman, Yulia; Nguyen, Thanhan V

    2003-03-01

    An alert and oriented 27-year-old African American woman with AIDS presented with a 10-day history of fever, cough productive of yellow sputum, nausea, and vomiting and a 1-day history of excruciating headache and photophobia. Her condition rapidly deteriorated into a coma with decorticate and then decerebrate posture, and she died 3 weeks later. There was evidence of extensive intracranial venous sinus thrombosis (ICVST), renal vein thrombosis (RVT), and multiple cerebral hemorrhagic infarcts due to a hypercoagulable state complicating AIDS-associated nephrotic syndrome. This is the first reported case of fatal ICVST and RVT with extensive cerebral hemorrhagic infarcts complicating nephrotic syndrome in a patient with AIDS.

  10. Absence of Pneumocystis dihydropteroate synthase mutants in Brittany, France.

    Science.gov (United States)

    Le Gal, Solène; Robert-Gangneux, Florence; Perrot, Maëla; Rouillé, Amélie; Virmaux, Michèle; Damiani, Céline; Totet, Anne; Gangneux, Jean-Pierre; Nevez, Gilles

    2013-05-01

    Archival Pneumocystis jirovecii specimens from 84 patients monitored at Rennes University Hospital (Rennes, France) were assayed at the dihydropteroate synthase (DHPS) locus. No patient was infected with mutants. The results provide additional data showing that P. jirovecii infections involving DHPS mutants do not represent a public health issue in Brittany, western France.

  11. Infecção natural do Holochilus brasiliensis nanus Thomas, 1897 (Rodentia, cricetidae por Litomosoides carinii Natural infection of Holochilius brasiliensis nanus Thomas, 1897 (Rodentia, Cricetidae by Litomosoides carinii

    Directory of Open Access Journals (Sweden)

    J. C. Holanda

    1985-03-01

    Full Text Available É registrada a infecção natural do Holochilus brasiliensis nanus, um pequeno roedor semi-aquático da Baixada Ocidental do Estado do Maranhão, Brasil, por Litomosoides carinii.It is recorded the natural infection of Holochilus brasiliensis nanus, a small semi-aquatic rodent of the Occidental Lowland of Maranhão State, Brazil, by Litomosoides carinii.

  12. Peginterferon alfa-2a for AIDS-associated Kaposi sarcoma: experience with 10 patients.

    Science.gov (United States)

    Rokx, Casper; van der Ende, Marchina E; Verbon, Annelies; Rijnders, Bart J A

    2013-11-01

    In this observational cohort study, 10 patients with extensive or treatment-refractory AIDS-associated Kaposi sarcoma were treated with peginterferon alfa-2a. Tumor responses were observed in 9 patients with a median progression-free survival of 645 days. Peginterferon alfa-2a could be an effective therapy for extensive or treatment-resistant Kaposi sarcoma.

  13. Late Onset Combined Immunodeficiency Presenting with Recurrent Pneumocystis jiroveci Pneumonia

    OpenAIRE

    Ilias Papakonstantinou; Ioannis G. Baraboutis; Lazaros Karnesis

    2014-01-01

    Late onset combined immunodeficiency (LOCID) is a recently described variant of common variable immunodeficiency (CVID), involving adult patients presenting with opportunistic infections and/or low CD4+ lymphocyte counts. A 36-year-old male with unremarkable past medical history presented with fever, respiratory failure, and lymphocytopenia. He was found to have Pneumocystis jiroveci pneumonia (PJP), subsequently complicated by recurrent hospital-acquired Pseudomonas aeruginosa pneumonia and ...

  14. Antibody response to a major human Pneumocystis carinii surface antigen in patients without evidence of immunosuppression and in patients with suspected atypical pneumonia

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Lebech, M; Lind, K;

    1993-01-01

    under evaluation due to atypical pneumonia, 76 patients showed no change in the titre of antibodies to Legionella spp. or Mycoplasma pneumoniae in two consecutive serum samples. Three of these 76 patients (4%) demonstrated an increase in the level of IgG antibodies to gp95 in the paired samples. One...

  15. Pneumocystis carinii major surface glycoprotein induces interleukin-8 and monocyte chemoattractant protein-1 release from a human alveolar epithelial cell line

    DEFF Research Database (Denmark)

    Benfield, T L; Lundgren, Bettina; Shelhamer, J H

    1999-01-01

    (IL-8) and monocyte chemoattractant protein-1 (MCP-1) from an alveolar epithelial cell line (A549). RESULTS: Incubation of A549 cells with MSG in concentrations from 0.4 to 10 microg mL-1 for 24 h caused dose-dependent increases in IL-8 release (3.4-fold above control, P

  16. Research progress on Pneumocystis carinii major protein%卡氏肺孢子菌主要蛋白的研究进展

    Institute of Scientific and Technical Information of China (English)

    龚锐; 姚云清

    2016-01-01

    卡氏肺孢子菌含有大量的蛋白,包括主要表面糖蛋白(Major surface glycoprotein,MSG)、P55蛋白、A12蛋白、主要表面糖蛋白相关抗原(MSG-related,MSR)、PRT1蛋白、Meu10等.肺孢子菌是重要的机会性致病菌,可引起宿主严重的肺炎,卡氏肺孢子菌主要蛋白的研究为开发新疫苗和防控耶氏肺孢子菌肺炎具有重要意义.本文对卡氏肺孢子菌主要蛋白的研究进展进行简要的综述.

  17. STUDY ON PURIFICATION OF CYST ANTIGEN OF PNEUMOCYSTIS CARINII%卡氏肺孢子虫包囊抗原纯化方法的研究

    Institute of Scientific and Technical Information of China (English)

    佟小莺; 纪伟华; 吴增强; 杨秀珍

    2002-01-01

    目的研究卡氏肺孢子虫包囊抗原的纯化方法. 方法肌肉注射地塞米松诱发大鼠卡氏肺孢子虫肺炎,瑞-姬氏染液复合染色法检获肺组织中的肺孢子虫包囊,用改进的胶原酶消化法、Percoll不连续密度梯度离心分离、超声粉碎纯化卡氏肺孢子虫包囊抗原. 结果采用浓度为0.05%胶原酶消化2次,30 min/次,在1.030 g/ml密度层可获得相对纯净而完整的卡氏肺孢子虫包囊抗原. 结论本研究可提供高纯度卡氏肺孢子虫抗原,为进一步建立对卡氏肺孢子虫肺炎的有效诊断方法具有十分重要的意义.

  18. Pneumocystis carinii major surface glycoprotein induces interleukin-8 and monocyte chemoattractant protein-1 release from a human alveolar epithelial cell line

    DEFF Research Database (Denmark)

    Benfield, T L; Lundgren, Bettina; Shelhamer, J H;

    1999-01-01

    (IL-8) and monocyte chemoattractant protein-1 (MCP-1) from an alveolar epithelial cell line (A549). RESULTS: Incubation of A549 cells with MSG in concentrations from 0.4 to 10 microg mL-1 for 24 h caused dose-dependent increases in IL-8 release (3.4-fold above control, P ..., suggesting that MSG stimulates A549 cells in part through carbohydrate moieties. Dexamethasone significantly inhibited MSG-induced IL-8 release in concentrations of 10-6-10-8 mol L-1 compared with control experiments (P

  19. Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

    Institute of Scientific and Technical Information of China (English)

    Bava Javier; Lloveras Susana; Garro Santiago; Troncoso Alcides

    2012-01-01

    We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

  20. Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

    Directory of Open Access Journals (Sweden)

    Bava Javier

    2012-01-01

    Full Text Available We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

  1. Low prevalence of Pneumocystis jirovecii lung colonization in Ugandan HIV-infected patients hospitalized with non-Pneumocystis pneumonia

    Science.gov (United States)

    Taylor, Steve M; Meshnick, Steven R; Worodria, William; Andama, Alfred; Davis, J. Lucian; Cattamanchi, Adithya; Boon, Saskia den; Yoo, Samuel D; Goodman, Carol D.; Huang, Laurence

    2011-01-01

    Pneumocystis jirovecii is an important opportunistic infection in HIV-infected patients. In the developed world, P. jirovecii epidemiology is marked by frequent colonization in immunosuppressed patients, but data on the prevalence of colonization is very limited in sub-Saharan Africa, where the majority of persons living with HIV reside. Our objective was to describe the epidemiology of P. jirovecii colonization among HIV-positive patients in a cross-sectional, hospital-based study of patients admitted with suspected pneumonia in Kampala, Uganda. P. jirovecii was detectable in bronchoalveolar lavage fluid from 7 of 124 (6%) consecutive patients with non-Pneumocystis pneumonia. Colonization was not associated with patient demographic or clinical information. This prevalence is substantially lower than in published studies in the developed world, and suggests that there is a limited reservoir of organisms for clinical infections in this Ugandan population. These findings may partially explain the low incidence of Pneumocystis pneumonia in Uganda and other sub-Saharan African countries. PMID:22153850

  2. Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse.

    Science.gov (United States)

    Kapoor, T M; Mahadeshwar, P; Nguyen, S; Li, J; Kapoor, S; Bathon, J; Giles, J; Askanase, A

    2017-01-01

    Objective In the era of powerful immunosuppression, opportunistic infections are an increasing concern in systemic lupus erythematosus. One of the best-studied opportunistic infections is Pneumocystis pneumonia; however, the prevalence of Pneumocystis pneumonia in systemic lupus erythematosus is not clearly defined. This study evaluates the prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, with a focus on validating the Pneumocystis pneumonia and systemic lupus erythematosus diagnoses with clinical information. Methods This retrospective cohort study evaluates the prevalence of Pneumocystis pneumonia in all systemic lupus erythematosus patients treated at Columbia University Medical Center-New York Presbyterian Hospital between January 2000 and September 2014, using electronic medical record data. Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and patients with renal transplants (including both early and late post-transplant patients) represented immunocompromised control groups. Patients with systemic lupus erythematosus, Pneumocystis pneumonia, HIV/AIDS, or renal transplant were identified using diagnostic codes from the International Classification of Diseases, Ninth Revision (ICD-9). Results Out of 2013 hospitalized systemic lupus erythematosus patients, nine had presumed Pneumocystis pneumonia, yielding a low prevalence of Pneumocystis pneumonia in systemic lupus erythematosus of 0.45%. Three of the nine Pneumocystis pneumonia cases were patients with concomitant systemic lupus erythematosus and HIV/AIDS. Only one of these nine cases was histologically confirmed as Pneumocystis pneumonia, in a patient with concomitant systemic lupus erythematosus and HIV/AIDS and a CD4 count of 13 cells/mm(3). The prevalence of Pneumocystis pneumonia in renal transplant patients and HIV/AIDS patients was 0.61% and 5.98%, respectively. Conclusion Given the reported high rate of adverse effects

  3. INTERVIEW WITH MR. GHEORGHE CHIOARU, PRESIDENT OF „OMENIA” PENSIONERS MUTUAL AID ASSOCIATION

    Directory of Open Access Journals (Sweden)

    Mihaela Pitea

    2012-07-01

    Full Text Available The present paper addresses issues such as reducing the risk of social exclusion and poverty of older people, creating a mutual aid community, increasing the trust of beneficiaries, exploring a social enterprise’s capacity to expand. The paper introduces the activity of „Omenia” Pensioners Mutual Aid Association which provides its members with financial aid based on the mutual aid principle and conducts awide range of social economy-type activities. In this interview, Mr. Gheorghe Chioaru, the association’s president, talks about the challenges faced by the enterprise he’s currently managing and offers relevant stakeholders a few suggestions for promoting social economy.

  4. Cidofovir in combination with HAART and survival in AIDS-associated progressive multifocal leukoencephalopathy.

    Science.gov (United States)

    Kraemer, Christoffer; Evers, Stefan; Nolting, Thorsten; Arendt, Gabriele; Husstedt, Ingo W

    2008-04-01

    Progressive multifocal leukoencephalopathy is a demyelinating disease with a high mortality caused by the JC virus and occurs in about 5% of HIV-infected patients. Highly active anti-retroviral therapy (HAART) has a proven efficacy in prolonging the survival of patients with AIDS-associated PML, but there are differing opinions about adding cidofovir to the treatment of PML. To investigate the benefit of HAART combined with cidofovir, we retrospectively analysed the survival of 33 patients with AIDS-associated PML proven by PCR in CSF, biopsy or at autopsy. Additionally, we also analysed 37 patients with probable PML. Seventeen (51.5%) of the patients with confirmed PML were treated with HAART and 14 (42.4%) with cidofovir in any combination. Of these patients, 13 (39.4%) were treated with HAART and cidofovir in combination, four (12.1%) patients received only HAART without cidofovir and one (3%) patient received only cidofovir without HAART. Fifteen patients did not receive HAART or cidofovir. The cumulative survival was significantly longer in patients with HAART than in patients without HAART (p = 0.006), independent whether cidofovir was given or not. In comparison with single therapy with HAART, the combination of HAART and cidofovir showed no significant increase in survival (p = 0.435). Therefore, a benefit for cidofovir in addition to HAART in the treatment of PML in HIV-infected patients could not be proven.

  5. Prevention of Infection Due to Pneumocystis spp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients

    OpenAIRE

    Rodriguez, Martin; Fishman, Jay A.

    2004-01-01

    Pneumocystis infection in humans was originally described in 1942. The organism was initially thought to be a protozoan, but more recent data suggest that it is more closely related to the fungi. Patients with cellular immune deficiencies are at risk for the development of symptomatic Pneumocystis infection. Populations at risk also include patients with hematologic and nonhematologic malignancies, hematopoietic stem cell transplant recipients, solid-organ recipients, and patients receiving i...

  6. Diagnosis of the primary infection by pneumocystis in autopsy specimens from two infants using lung impression smears (touch preps

    Directory of Open Access Journals (Sweden)

    Carolina A. Ponce

    2014-07-01

    Full Text Available The primary infection by Pneumocystis of normal, healthy infants is asymptomatic and goes undiagnosed. Microscopy diagnosis of Pneumocystis was sought in lung impression smears (LIS from two ~3-month-old infants dying unexpectedly in the community. Pneumocystis nuclei and cysts were identified using Hema-Gurr with subsequent Gomori–Grocott staining in the same spot documenting that these stains may be complementary. LIS provide for an observer–dependent, inexpensive, and ready-available method for detection of Pneumocystis in infant lungs.

  7. Disseminated bone lesions in AIDS-associated Kaposi sarcoma, a bad prognosis? About four cases

    Directory of Open Access Journals (Sweden)

    N Wassilew

    2012-11-01

    Full Text Available Kaposi sarcoma (KS can present with a wide range of clinical features ranging from minimal cutaneous disease to a rapidly progressing neoplasm. Bone lesions are most often discovered accidently in the context of radiological investigations done for the screening of KS-visceral involvement [1]. Little is known on clinical outcome and response to antiretroviral therapy (ART and/or chemotherapy of these lytic osseous lesions. We report four cases with bone involvement in the context of systemic KS and aim at describing the long-term clinical outcome in two of these patients. Cases of AIDS-associated KS with disseminated bone lesions were collected in the HIV Unit, University Hospital Geneva, Switzerland. Patients were compared on clinical, biological and radiological features and therapeutic responses. Between 2002 and 2012, four HIV1-infected patients with T1 stage of KS presented disseminated osseous lesions (Table 1. Mean age was 43 years (range 39 - 47 years, mean time of follow up until our analysis was 48.5 months (SD 53.8, and mean CD4 count at KS diagnosis was 190.5 c/mL (SD 202.8. All patients showed hypodense bone lesions predominating the axial skeleton (figure 1, but no radiological imaging was performed to search for peripheral bone lesions.No patient reported pain or experienced pathological fractures. In one patient a dual-energy X-ray absorptiometry (DXA showed a bone mineral density within normal range after 10 years of KS diagnosis with disseminated bone lesions. No radiological change was observed in that patient despite stable KS disease after 13 cycles of liposomal doxorubicin and ART (figure 1. We describe a well-documented long-term follow up of disseminated osseous AIDS-associated KS disease. In our four cases, lytic bone lesions were asymptomatic and were not associated with bone fragility. We even could confirm the KS nature of the lesions by bone biopsy in patient B (3 months after KS diagnosis, as the differential

  8. Late Onset Combined Immunodeficiency Presenting with Recurrent Pneumocystis jiroveci Pneumonia

    Science.gov (United States)

    Baraboutis, Ioannis G.; Karnesis, Lazaros

    2014-01-01

    Late onset combined immunodeficiency (LOCID) is a recently described variant of common variable immunodeficiency (CVID), involving adult patients presenting with opportunistic infections and/or low CD4+ lymphocyte counts. A 36-year-old male with unremarkable past medical history presented with fever, respiratory failure, and lymphocytopenia. He was found to have Pneumocystis jiroveci pneumonia (PJP), subsequently complicated by recurrent hospital-acquired Pseudomonas aeruginosa pneumonia and immune reconstitution phenomena, attributed to restoration of immunoglobulin levels. Clinicians should be aware of LOCID, which could be confused with HIV infection/AIDS or idiopathic CD4 lymphocytopenia. In the English bibliography there is only one case report, where PJP was the initial presentation of CVID (that case would probably be classified as LOCID). Phenomena of immune reconstitution are described in various settings, including primary immunodeficiency, manifesting as temporary clinical and radiologic deterioration and leading to misperceptions of therapeutic failure and/or presence of alternative/additional diagnoses. PMID:24799913

  9. Late Onset Combined Immunodeficiency Presenting with Recurrent Pneumocystis jiroveci Pneumonia

    Directory of Open Access Journals (Sweden)

    Ilias Papakonstantinou

    2014-01-01

    Full Text Available Late onset combined immunodeficiency (LOCID is a recently described variant of common variable immunodeficiency (CVID, involving adult patients presenting with opportunistic infections and/or low CD4+ lymphocyte counts. A 36-year-old male with unremarkable past medical history presented with fever, respiratory failure, and lymphocytopenia. He was found to have Pneumocystis jiroveci pneumonia (PJP, subsequently complicated by recurrent hospital-acquired Pseudomonas aeruginosa pneumonia and immune reconstitution phenomena, attributed to restoration of immunoglobulin levels. Clinicians should be aware of LOCID, which could be confused with HIV infection/AIDS or idiopathic CD4 lymphocytopenia. In the English bibliography there is only one case report, where PJP was the initial presentation of CVID (that case would probably be classified as LOCID. Phenomena of immune reconstitution are described in various settings, including primary immunodeficiency, manifesting as temporary clinical and radiologic deterioration and leading to misperceptions of therapeutic failure and/or presence of alternative/additional diagnoses.

  10. Reversed halo sign in pneumocystis pneumonia: a case report

    Directory of Open Access Journals (Sweden)

    Hashimoto Kimio

    2010-11-01

    Full Text Available Abstract Background The reversed halo sign may sometimes be seen in patients with cryptogenic organizing pneumonia, but is rarely associated with other diseases. Case presentation We present a case study of a 32-year-old male patient with acquired immunodeficiency syndrome, who had previously been treated with chemotherapy for non-Hodgkin's lymphoma. A chest X-ray showed bilateral patchy infiltrates. High-resolution computed tomography revealed the reversed halo sign in both upper lobes. The patient was diagnosed with pneumocystis pneumonia, which was successfully treated with sulfamethoxazole trimethoprim; the reversed halo sign disappeared, leaving cystic lesions. Cases such as this one are rare, but show that the reversed halo sign may occur in patients who do not have cryptogenic organizing pneumonia. Conclusion Physicians can avoid making an incorrect diagnosis and prescribing the wrong treatment by carefully evaluating all clinical criteria rather than assuming that the reversed halo sign only occurs with cryptogenic organizing pneumonia.

  11. Immune modulation with sulfasalazine attenuates immunopathogenesis but enhances macrophage-mediated fungal clearance during Pneumocystis pneumonia.

    Directory of Open Access Journals (Sweden)

    Jing Wang

    Full Text Available Although T cells are critical for host defense against respiratory fungal infections, they also contribute to the immunopathogenesis of Pneumocystis pneumonia (PcP. However, the precise downstream effector mechanisms by which T cells mediate these diverse processes are undefined. In the current study the effects of immune modulation with sulfasalazine were evaluated in a mouse model of PcP-related Immune Reconstitution Inflammatory Syndrome (PcP-IRIS. Recovery of T cell-mediated immunity in Pneumocystis-infected immunodeficient mice restored host defense, but also initiated the marked pulmonary inflammation and severe pulmonary function deficits characteristic of IRIS. Sulfasalazine produced a profound attenuation of IRIS, with the unexpected consequence of accelerated fungal clearance. To determine whether macrophage phagocytosis is an effector mechanism of T cell-mediated Pneumocystis clearance and whether sulfasalazine enhances clearance by altering alveolar macrophage phagocytic activity, a novel multispectral imaging flow cytometer-based method was developed to quantify the phagocytosis of Pneumocystis in vivo. Following immune reconstitution, alveolar macrophages from PcP-IRIS mice exhibited a dramatic increase in their ability to actively phagocytose Pneumocystis. Increased phagocytosis correlated temporally with fungal clearance, and required the presence of CD4(+ T cells. Sulfasalazine accelerated the onset of the CD4(+ T cell-dependent alveolar macrophage phagocytic response in PcP-IRIS mice, resulting in enhanced fungal clearance. Furthermore, sulfasalazine promoted a TH2-polarized cytokine environment in the lung, and sulfasalazine-enhanced phagocytosis of Pneumocystis was associated with an alternatively activated alveolar macrophage phenotype. These results provide evidence that macrophage phagocytosis is an important in vivo effector mechanism for T cell-mediated Pneumocystis clearance, and that macrophage phenotype can be altered

  12. Association between circulating DNA, serum (1->3)-β-D-glucan, and pulmonary fungal burden in Pneumocystis pneumonia.

    Science.gov (United States)

    Costa, Jean-Marc; Botterel, Françoise; Cabaret, Odile; Foulet, Françoise; Cordonnier, Catherine; Bretagne, Stéphane

    2012-07-01

    Circulating Pneumocystis jirovecii DNA and (1→3)-β-d-glucan determined in 70 serum samples from immunocompromised patients were compared to fungal load in bronchoalveolar lavage fluids assessed using quantitative polymerase chain reaction. Both serum biomarkers are influenced by pulmonary fungal load, which should be taken into account when diagnosing Pneumocystis infection.

  13. Phylogenetic analysis of Pneumocystis from pig lungs obtained from slaughterhouses in southern and midwestern regions of Brazil

    Directory of Open Access Journals (Sweden)

    E.M.C Sanches

    2011-10-01

    Full Text Available The Pneumocystis genus is comprised of pathogens dwelling in the lungs of terrestrial, aerial, and aquatic mammals. Occasionally they induce severe pneumonitis, particularly in hosts with severe impairment of the immune system and progressively may fill pulmonary alveolar cavities causing respiratory failure. Molecular genetic studies revealed that Pneumocystis gene sequences present a marked divergence with the host species concerned. In the present study, the genetic diversity of Pneumocystis obtained from lungs of swines was examined by analyzing mitochondrial large subunit (mtLSU and small subunit (mtSSU rRNA sequences. The samples were obtained from two slaughterhouses located in two Brazilian states. Phylogenetic analysis demonstrated that genetic groupings within Pneumocystis organisms were in accordance with those of the corresponding hosts and that two clusters were formed. In conclusion, these data show that there are genetically distinct porcine Pneumocystis genotypes with at least two separate clusters in Brazil.

  14. Human herpes virus-8 DNA in bronchoalveolar lavage samples from patients with AIDS-associated pulmonary Kaposi's sarcoma

    DEFF Research Database (Denmark)

    Benfield, T L; Dodt, K K; Lundgren, Jens Dilling

    1997-01-01

    Kaposi's sarcoma (KS) is the most frequent AIDS-associated neoplasm, and often disseminates to visceral organs, including the lungs. An ante-mortem diagnosis of pulmonary KS is difficult. Recently, DNA sequences resembling a new human herpes virus (HHV-8), have been identified in various forms...

  15. Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients.

    Science.gov (United States)

    Rodriguez, Martin; Fishman, Jay A

    2004-10-01

    Pneumocystis infection in humans was originally described in 1942. The organism was initially thought to be a protozoan, but more recent data suggest that it is more closely related to the fungi. Patients with cellular immune deficiencies are at risk for the development of symptomatic Pneumocystis infection. Populations at risk also include patients with hematologic and nonhematologic malignancies, hematopoietic stem cell transplant recipients, solid-organ recipients, and patients receiving immunosuppressive therapies for connective tissue disorders and vasculitides. Trimethoprim-sulfamethoxazole is the agent of choice for prophylaxis against Pneumocystis unless a clear contraindication is identified. Other options include pentamidine, dapsone, dapsone-pyrimethamine, and atovaquone. The risk for PCP varies based on individual immune defects, regional differences, and immunosuppressive regimens. Prophylactic strategies must be linked to an ongoing assessment of the patient's risk for disease.

  16. Pneumocystis jirovecii colonization in Chronic Obstructive Pulmonary Disease (COPD

    Directory of Open Access Journals (Sweden)

    Sadegh Khodavaisy

    2015-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is associated with a chronic inflammatory response in airways and lung parenchyma that results in significant morbidity and mortality worldwide. Cigarette smoking considered as an important risk factor plays a role in pathogenesis of disease. Pneumocystis jirovecii is an atypical opportunistic fungus that causes pneumonia in immunosuppressed host, although the low levels of its DNA in patients without signs and symptoms of pneumonia, which likely represents colonization. The increased prevalence of P. jirovecii colonization in COPD patients has led to an interest in understanding its role in the disease. P. jirovecii colonization in these patients could represent a problem for public health since colonized patients could act as a major reservoir and source of infection for susceptible subjects. Using sensitive molecular techniques, low levels of P. jirovecii DNA have been detected in the respiratory tract of certain individuals. It is necessary to elucidate the role of P. jirovecii colonization in the natural history of COPD patients in order to improve the clinical management of this disease. In the current review paper, we discuss P. jirovecii colonization in COPD patients.

  17. Low genetic diversity of Pneumocystis jirovecii among Cuban population based on two-locus mitochondrial typing.

    Science.gov (United States)

    de Armas, Yaxsier; Friaza, Vicente; Capó, Virginia; Durand-Joly, Isabelle; Govín, Anamays; de la Horra, Carmen; Dei-Cas, Eduardo; Calderón, Enrique J

    2012-05-01

    Genotypes of two different loci of the Pneumocystis jirovecii mitochondrial gene were studied in specimens from a total of 75 Pneumocystis pneumonia patients in Spain, France and Cuba. A new genotype of the mitochondrial small subunit rRNA gene of P. jirovecii (160A/196T) was identified, which was revealed to be the most common in these three countries, especially in Cuba where its proportion reached 93.8%. Our data imply that the new genotype might be circulating worldwide and also suggests that the distribution of P. jirovecii genotypes could be narrower in islands such as Cuba.

  18. AIDS-related Pneumocystis jirovecii genotypes in French Guiana.

    Science.gov (United States)

    Le Gal, Solène; Blanchet, Denis; Damiani, Céline; Guéguen, Paul; Virmaux, Michèle; Abboud, Philippe; Guillot, Geneviève; Kérangart, Stéphane; Merle, Cédric; Calderon, Enrique; Totet, Anne; Carme, Bernard; Nevez, Gilles

    2015-01-01

    The study described Pneumocystis jirovecii (P. jirovecii) multilocus typing in seven AIDS patients living in French Guiana (Cayenne Hospital) and seven immunosuppressed patients living in Brest, metropolitan France (Brest Hospital). Archival P. jirovecii specimens were examined at the dihydropteroate synthase (DHPS) locus using a PCR-RFLP technique, the internal transcribed spacer (ITS) 1 and ITS 2 and the mitochondrial large subunit rRNA (mtLSUrRNA) gene using PCR and sequencing. Analysis of typing results were combined with an analysis of the literature on P. jirovecii mtLSUrRNA types and ITS haplotypes. A wild DHPS type was identified in six Guianese patients and in seven patients from metropolitan France whereas a DHPS mutant was infected in the remaining Guianese patient. Typing of the two other loci pointed out a high diversity of ITS haplotypes and an average diversity of mtLSUrRNA types in French Guiana with a partial commonality of these haplotypes and types described in metropolitan France and around the world. Combining DHPS, ITS and mtLSU types, 12 different multilocus genotypes (MLGs) were identified, 4 MLGs in Guianese patients and 8 MLGs in Brest patients. MLG analysis allows to discriminate patients in 2 groups according to their geographical origin. Indeed, none of the MLGs identified in the Guianese patients were found in the Brest patients and none of the MLGs identified in the Brest patients were found in the Guianese patients. These results show that in French Guiana (i) PCP involving DHPS mutants occur, (ii) there is a diversity of ITS and mtLSUrRNA types and (iii) although partial type commonality in this territory and metropolitan France can be observed, MLG analysis suggests that P. jirovecii organisms from French Guiana may present specific characteristics.

  19. Pneumocystis jirovecii pneumonia in patients with end-stage renal disease

    DEFF Research Database (Denmark)

    Leth, Steffen; Jensen-Fangel, Søren; Østergaard, Lars Jørgen

    2014-01-01

    Background: Data on occurrence and risk factors for pneumocystis pneumonia (PCP) in patients with end-stage renal disease (ESRD) are sparse. Methods: This was a nationwide population-based study assessing occurrence and risk factors for PCP among patients with ESRD and population controls over a 21...

  20. Finding your way through Pneumocystis sequences in the NCBI gene database.

    Science.gov (United States)

    Weissenbacher-Lang, Christiane; Nedorost, Nora; Weissenböck, Herbert

    2014-01-01

    Pneumocystis sequences can be downloaded from GenBank for purposes as primer/probe design or phylogenetic studies. Due to changes in nomenclature and assignment, available sequences are presented with a variety of inhomogeneous information, which renders practical utilization difficult. The aim of this study was the descriptive evaluation of different parameters of 532 Pneumocystis sequences of mitochondrial and ribosomal origin downloaded from GenBank with regard to completeness and information content. Pneumocystis sequences were characterized by up to four different names. Official changes in nomenclature have only been partly implemented and the usage of the "forma specialis", a special feature of Pneumocystis, has only been established fragmentary in the database. Hints for a mitochondrial or ribosomal genomic origin could be found, but can easily be overlooked, which renders the download of wrong reference material possible. The specification of the host was either not available or variable regarding the used language and the localization of this information in the title or several subtitles, which limits their applicability in phylogenetic studies. Declaration of products and geographic origin was incomplete. The print version of this manuscript is completed by an online database which contains detailed information to every accession number included in the meta-analysis.

  1. Inhaled pentamidine for Pneumocystis jiroveci prophylaxis in a heart transplant recipient with allergy for trimethoprim sulfamethoxazole.

    Science.gov (United States)

    Altintas, Garip; Diken, Adem Ilkay; Diken, Ozlem Ercen; Hanedan, Onur; Kucuker, Seref Alp

    2011-02-01

    Pneumocystis jiroveci is an important cause of mortality and morbidity among heart transplant recipients. This raises the question of prophylactic treatment for this infection. Trimethoprimsulfamethoxazole is commonly used in P. jiroveci pneumonia prophylaxis with mild to severe adverse effects. We present the use of inhaled pentamidine as P. jiroveci prophylaxis in a patient with an allergy to trimethoprim sulfamethoxazole.

  2. Efficacy and tolerability of intravenous pentamidine isethionate for Pneumocystis jiroveci prophylaxis in a pediatric oncology population.

    Science.gov (United States)

    Orgel, Etan; Rushing, Teresa

    2014-03-01

    Cancer therapy routinely requires Pneumocystis jiroveci prophylaxis. In those intolerant of trimethoprim/sulfamethoxazole, aerosolized pentamidine is convenient and effective. Intravenous pentamidine is often substituted in young children but its efficacy remains controversial. In this retrospective study of a large pediatric oncology cohort, we confirm intravenous pentamidine to be effective and well-tolerated as second-line prophylaxis across all ages.

  3. Pneumocystis jirovecii pneumonia prophylaxis during temozolomide treatment for high-grade gliomas

    NARCIS (Netherlands)

    Vos, F.Y. de; Gijtenbeek, J.M.M.; Bleeker-Rovers, C.P.; Herpen, C.M.L. van

    2013-01-01

    High-grade glioma patients receiving concomitant chemoradiotherapy with temozolomide 75mg/m(2) during six to seven weeks or dose-dense temozolomide regimens especially in combination with chronic use of corticosteroids have a high risk for developing Pneumocystis jirovecii pneumonia. In this review,

  4. PNEUMOCYSTIS JIROVECII PNEUMONIA: PREVALENCE IN HOSPITALISED PATIENTS, A STUDY CONDUCTED IN A TERTIARY CENTRE IN PUNJAB

    Directory of Open Access Journals (Sweden)

    Dilip

    2016-04-01

    Full Text Available BACKGROUND Pneumocystis jirovecii is a pathogen causing a life-threatening infection, Pneumocystis Pneumonia (PCP in T helper cell deficient hosts. METHODS A retrospective analysis was done from 6th April 2012 to 11th September 2015. The clinical data of the positive patients for PCP by Silver Methenamine Staining of the samples were collected. CD4 counts were done for the HIV positive patients. RESULTS A total of 486 samples were sent to the Microbiology Lab during this period for Silver Methenamine Staining. Among the patients, 13 (35.15% were diagnosed cases of HIV; 9 were Stage IV AIDS and all of these patients had CD4 counts less than 200/µL. Fungal pneumonia was found to be a significant comorbidity in these patients and is of particular significance due to the diagnostic dilemma it can cause, since the radiological and physiological changes in both fungal and pneumocystis pneumonia are similar. CONCLUSION There should be a high index of suspicion for pneumocystis pneumonia in susceptible patients who show signs of atypical pneumonia and who do not respond to treatment with antibiotics or antifungals.

  5. Outcomes and duration of Pneumocystis jiroveci pneumonia therapy in infants with severe combined immunodeficiency.

    Science.gov (United States)

    Lundgren, Ingrid S; Englund, Janet A; Burroughs, Lauri M; Torgerson, Troy R; Skoda-Smith, Suzanne

    2012-01-01

    This retrospective review of patients with severe combined immunodeficiency and Pneumocystis jiroveci pneumonia (PCP) evaluated the relationship between duration of therapy to treat PCP and overall survival. We found that 80% of patients receiving only 21 days of antibiotics survived to 12 months beyond hematopoietic cell transplant, whereas only 25% of patients who required longer treatment for PCP survived to stem cell engraftment.

  6. Presentation of severe combined immunodeficiency with respiratory syncytial virus and pneumocystis co-infection.

    Science.gov (United States)

    Domínguez-Pinilla, Nerea; Allende-Martínez, Luis; Corral Sánchez, María Dolores; Arocena, Jaime de Inocencio; González-Granado, Luis Ignacio

    2015-04-01

    Severe combined immunodeficiency can cause severe, life-threatening viral, bacterial and fungal infections at an early age. We report a case of a 4-month-old boy with co-infection by respiratory syncytial virus and Pneumocystis jiroveci infection that led to recognition of severe combined immunodeficiency.

  7. ECIL guidelines for the diagnosis of Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients

    DEFF Research Database (Denmark)

    Alanio, Alexandre; Hauser, Philippe M; Lagrou, Katrien

    2016-01-01

    The Fifth European Conference on Infections in Leukaemia (ECIL-5) convened a meeting to establish evidence-based recommendations for using tests to diagnose Pneumocystis jirovecii pneumonia (PCP) in adult patients with haematological malignancies. Immunofluorescence assays are recommended as the ...

  8. Clinical analysis of pneumocystis pneumonia in 15 children%儿童肺胞子菌肺炎15例临床分析及文献复习

    Institute of Scientific and Technical Information of China (English)

    廖琨; 钱素云; 宋红艳; 高恒妙

    2015-01-01

    Objective To investigate the early diagnosis, treatment and prognosis of pneumocystis pneumonia( PCP) in children. Method Retrospectively analysis the clinical data of 15 non-HIV-infected children with pneumocystis pneumonia diagnosed in Beijing Children’s Hospital from October 2007 to October 2012. Result All of 15 patients diagnosed as PCP were non-HIV-infected. In 9 of them,the PCP was cured or improved before discharge. Four of them leave hospital on their parent’ s order for various reasons. Two of them dead from PCP. Conclusion PCP is a serious opportunistic lung infection,which is the common complication and the common cause of death in patients with immunodeficiency or immunosuppression. In recent years,PCP happened in non-HIV-infected patients are more common than HIV-infected pateints. Clinical and imaging manifestations of PCP are nonspecific,the diagnosis of PCP is depend on the alert to the disease and a positive result of etiological examination. The first-choice of drug for PCP is TMP-SMZ. Early diagnosis and early treatment of PCP is the key to improve the cure rate and get a better progno-sis. For serious PCP patients,appropriate respiratory support is most important. The primary disease,serious compli-cations,early TMP-SMZ treatment and early appropriate respiratory support have important effect on the prognosis. Prophylactic treatment with TMP-SMZ in high-risk patients with impaired immunity can decrease the morbidity of PCP.%目的:探讨儿童肺孢子菌肺炎( pneumocystis carinii pneumonia,PCP)的早期诊断、治疗及预后。方法回顾性分析15例非人类免疫缺陷病毒( human immunodeficiency virus,HIV)感染PCP患儿的临床资料。结果15例患儿中9例好转,4例自动离院,2例死于PCP。结论 PCP是严重的肺部机会性感染,临床和影像学表现无特异性,诊断依赖于对该病的警惕和病原学检查证明有病原体存在。治疗首选药物为甲氧苄啶-磺胺甲基异恶唑( trimethoprim

  9. Cryptosporidium,Giardia, Cryptococcus, Pneumocystis genetic variability: cryptic biological species or clonal near-clades?

    OpenAIRE

    2014-01-01

    An abundant literature dealing with the population genetics and taxonomy of Giardia duodenalis, Cryptosporidium spp., Pneumocystis spp., and Cryptococcus spp., pathogens of high medical and veterinary relevance, has been produced in recent years. We have analyzed these data in the light of new population genetic concepts dealing with predominant clonal evolution (PCE) recently proposed by us. In spite of the considerable phylogenetic diversity that exists among these pathogens, we have found ...

  10. Outcomes and Duration of Pneumocystis jirovecii Pneumonia Therapy in Infants with Severe Combined Immunodeficiency

    Science.gov (United States)

    Lundgren, Ingrid S.; Englund, Janet A.; Burroughs, Lauri M.; Torgerson, Troy R.; Skoda-Smith, Suzanne

    2011-01-01

    This retrospective review of patients with severe combined immunodeficiency and Pneumocystis jirovecii pneumonia (PCP) evaluated the relationship between duration of therapy to treat PCP and overall survival. We found that 80% of patients receiving only 21 days of antibiotics survived to 12 months beyond hematopoetic cell transplant, whereas only 25% of patients who required longer treatment for PCP survived to stem cell engraftment. PMID:21817949

  11. The unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: Case reports and literature review

    OpenAIRE

    Hui David S; Lee Rodney A; Hung Ivan FN; Tang Bone SF; Cheng Vincent CC; Wu Alan KL; Yuen Kwok Y

    2004-01-01

    Abstract Background Pneumocystis jiroveci pneumonia (PCP) is an important opportunistic infection among immunosuppressed patients, especially in those infected with human immunodeficiency virus (HIV). The clinical presentation of PCP in immunosuppressed patients have been well-reported in the literature. However, the clinical importance of PCP manifesting in the setting of an immunorestitution disease (IRD), defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexi...

  12. Ventilação mecânica não-invasiva em paciente com provável pneumonia por pneumocystis jirovecii: relato de caso Noninvasive mechanical ventilation in patient with pneumocystis jirovecii pneumonia: case report

    Directory of Open Access Journals (Sweden)

    Élida Mara Carneiro

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A pneumonia por Pneumocystis jirovecii tem sido uma das doenças mais comuns e uma complicação infecciosa fatal em pacientes com síndrome da imunodeficiência adquirida. O objetivo deste estudo foi apresentar uma paciente com provável diagnóstico de pneumonia por Pneumocystis jirovecii que recebeu ventilação não-invasiva com pressão positiva. RELATO DO CASO: Paciente do sexo feminino, 25 anos, com diagnóstico provável de pneumonia por Pneumocystis jirovecii grave, recebeu ventilação mecânica não-invasiva com pressão positiva. CONCLUSÕES: Todos os parâmetros melhoraram progressivamente nos primeiros cinco dias. Os resultados sugeriram a eficácia desta medida para otimizar a oxigenação, reverter a hipoxemia e prevenir a intubação traqueal.BACKGROUND AND OBJECTIVES: Pneumocystis jirovecii pneumonia has been one of the most common diseases and life-threatening infectious complications in acquired immunodeficiency syndrome patients. The objective of the case report was to present a patient with probable diagnosis of Pneumocystis jirovecii pneumonia who received noninvasive positive pressure ventilation. CASE REPORT: A female patient, 25 years old, with probable diagnosis of Pneumocystis jirovecii pneumonia received noninvasive positive pressure ventilation. CONCLUSIONS: All respiratory parameters progressively improved in the first five days. Results suggest the efficacy of this support to improve oxygenation, to revert hypoxemia and to prevent orotracheal intubation.

  13. Human herpes virus-8 DNA in bronchoalveolar lavage samples from patients with AIDS-associated pulmonary Kaposi's sarcoma

    DEFF Research Database (Denmark)

    Benfield, T L; Dodt, K K; Lundgren, Jens Dilling

    1997-01-01

    Kaposi's sarcoma (KS) is the most frequent AIDS-associated neoplasm, and often disseminates to visceral organs, including the lungs. An ante-mortem diagnosis of pulmonary KS is difficult. Recently, DNA sequences resembling a new human herpes virus (HHV-8), have been identified in various forms...... of KS. We hypothesized that these sequences are present in samples obtained by bronchoalveolar lavage (BAL) in patients with pulmonary KS. Utilizing a nested polymerase chain reaction (PCR), 7/12 BAL cell samples from HIV-infected patients with endobronchial KS were positive for HHV-8 DNA. In contrast......, only 2/39 samples from HIV-infected patients without evidence of KS were positive (p = 0.007). Detection of HHV-8 in BAL cells of patients with pulmonary KS was highly specific (95%), with a sensitivity of 58% and a positive predictive value of 78%. In conclusion, HHV-8 is associated with pulmonary KS...

  14. Diversity of Pneumocystis jirovecii during Infection Revealed by Ultra-Deep Pyrosequencing.

    Science.gov (United States)

    Alanio, Alexandre; Gits-Muselli, Maud; Mercier-Delarue, Séverine; Dromer, Françoise; Bretagne, Stéphane

    2016-01-01

    Pneumocystis jirovecii is an uncultivable fungal pathogen responsible for Pneumocystis pneumonia (PCP) in immunocompromised patients, the physiopathology of which is only partially understood. The diversity of the Pneumocystis strains associated with acute infection has mainly been studied by Sanger sequencing techniques precluding any identification of rare genetic events (< 20% frequency). We used next-generation sequencing to detect minority variants causing infection, and analyzed the complexity of the genomes of infection-causing P. jirovecii. Ultra-deep pyrosequencing (UDPS) of PCR amplicons of two nuclear target region [internal transcribed spacer 2 (ITS2) and dihydrofolate reductase (DHFR)] and one mitochondrial DNA target region [the mitochondrial ribosomal RNA large subunit gene (mtLSU)] was performed on 31 samples from 25 patients. UDPS revealed that almost all patients (n = 23/25, 92%) were infected with mixtures of strains. An analysis of repeated samples from six patients showed that the proportion of each variant change significantly (by up to 30%) over time on treatment in three of these patients. A comparison of mitochondrial and nuclear UDPS data revealed heteroplasmy in P. jirovecii. The recognition site for the homing endonuclease I-SceI was recovered from the mtLSU gene, whereas its two conserved motifs of the enzyme were not. This suggests that heteroplasmy may result from recombination induced by unidentified homing endonucleases. This study sheds new light on the biology of P. jirovecii during infection. PCP results from infection not with a single microorganism, but with a complex mixture of different genotypes, the proportions of which change over time due to intricate selection and reinfection mechanisms that may differ between patients, treatments, and predisposing diseases.

  15. Single Nodula opacity of granulomatous Pneumocystis jirovecii pneumoniain an asymptomatic lymphoma patient

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Soo; Shin, Kyung Eun; Lee, Ju Hie [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2015-04-15

    The radiologic findings of a single nodule from Pneumocystis jirovecii pneumonia (PJP) have been rarely reported. We described a case of granulomatous PJP manifesting as a solitary pulmonary nodule with a halo sign in a 69-year-old woman with diffuse large B cell lymphoma during chemotherapy. The radiologic appearance of the patient suggested an infectious lesion such as angioinvasive pulmonary aspergillosis or lymphoma involvement of the lung; however, clinical manifestations were not compatible with the diseases. The nodule was confirmed as granulomatous PJP by video-assisted thoracoscopic surgery biopsy.

  16. Lack of Response in Severe Pneumocystis Pneumonia to Combined Caspofungin and Clindamycin Treatment: a Case Report

    Institute of Scientific and Technical Information of China (English)

    Yao Zhang; Hua Zhang; Jun XU; Chan Wu; Xiao-jun Ma

    2011-01-01

    PNEUMOCYSTIS pneumonia (PCP) is among the most common opportunistic infections in patients with acquired immune deficiency syndrome (AIDS).Although trimethoprim-sulfamethoxazole (TMP-SMX) is the first line therapy for that condition given its efficacy,approximately one third of patients experienced dose-limiting toxicity.1 For cases of severe to moderate PCP,if TMP-SMX treatment fails or is contraindicated,primaquine combined with clindamycin or intravenous pentamidine is recommended as second line therapy.2 However,both primaquine and pentamidine are associated with severe adverse reactions and often unavailable at hospitals in China.3 As a result,other treatment options have been explored.

  17. Detection of Pneumocystis in lungs of bats from Brazil by PCR amplification Detecção de Pneumocystis em pulmões de morcegos no Brasil por Nested-PCR

    Directory of Open Access Journals (Sweden)

    Edna Maria Cavallini Sanches

    2009-06-01

    Full Text Available Pneumocystis has been isolated from a wide range of unrelated mammalian hosts, including humans, domestic and wild animals. It has been demonstrated that the genome of Pneumocystis of one host differs markedly from that of other hosts. Also, variation in the chromosome and DNA sequence of Pneumocystis within a single host species has been observed. Since information about the occurrence and nature of infections in wild animals is still limited, the objective of this work was to detect the presence of Pneumocystis sp. in lungs of bats from two states from Brazil by Nested-PCR amplification. The bats, captured in caves and in urban areas, were obtained from the Program of Rabies Control of two States in Brazil, Mato Grosso and Rio Grande do Sul, located in the Mid-Western and Southern regions of the country, respectively. DNAs were extracted from 102 lung tissues and screened for Pneumocystis by nested PCR at the mtLSU rRNA gene and small subunit of mitochondrial ribosomal RNA (mtSSU rRNA. Gene amplification was performed using the mtLSU rRNA, the primer set pAZ102H - pAZ102E and pAZ102X - pAZY, and the mtSSU rRNA primer set pAZ102 10FRI - pAZ102 10R-RI and pAZ102 13RI - pAZ102 14RI. The most frequent bats were Tadarida brasiliensis (25, Desmodus rotundus (20, and Nyctinomops laticaudatus (19. Pneumocystis was more prevalent in the species Nyctinomops laticaudatus (26.3% = 5/19, Tadarida brasiliensis (24% = 6/25, and Desmodus rotundus (20% = 4/20. Besides these species, Pneumocystis also was detected in lungs from Molossus molossus (1/11, 9.1%, Artibeus fimbriatus (1/1, 100%, Sturnira lilium (1/3, 33.3%, Myotis levis (2/3, 66.7%and Diphylla ecaudata (1/2, 50%. PCR products which could indicate the presence of Pneumocystis (21.56% were identified in DNA samples obtained from 8 out of 16 classified species from both states (5 bats were not identified. This is the first report of detection of Pneumocystis in bats from Brazil.Pneumocystis tem sido

  18. Memory CD4+ T cells are required for optimal NK cell effector functions against the opportunistic fungal pathogen Pneumocystis murina.

    Science.gov (United States)

    Kelly, Michelle N; Zheng, Mingquan; Ruan, Sanbao; Kolls, Jay; D'Souza, Alain; Shellito, Judd E

    2013-01-01

    Little is known about the role of NK cells or their interplay with other immune cells during opportunistic infections. Using our murine model of Pneumocystis pneumonia, we found that loss of NK cells during immunosuppression results in substantial Pneumocystis lung burden. During early infection of C57B/6 CD4(+) T cell-depleted mice, there were significantly fewer NK cells in the lung tissue compared with CD4(+) T cell-intact animals, and the NK cells present demonstrated decreased upregulation of the activation marker NKp46 and production of the effector cytokine, IFN-γ. Furthermore, coincubation studies revealed a significant increase in fungal killing when NK cells were combined with CD4(+) T cells compared with either cell alone, which was coincident with a significant increase in perforin production by NK cells. Finally, however, we found through adoptive transfer that memory CD4(+) T cells are required for significant NK cell upregulation of the activation marker NK group 2D and production of IFN-γ, granzyme B, and perforin during Pneumocystis infection. To the best of our knowledge, this study is the first to demonstrate a role for NK cells in immunity to Pneumocystis pneumonia, as well as to establish a functional relationship between CD4(+) T cells and NK cells in the host response to an opportunistic fungal pathogen.

  19. Conserved natural IgM antibodies mediate innate and adaptive immunity against the opportunistic fungus Pneumocystis murina.

    Science.gov (United States)

    Rapaka, Rekha R; Ricks, David M; Alcorn, John F; Chen, Kong; Khader, Shabaana A; Zheng, Mingquan; Plevy, Scott; Bengtén, Eva; Kolls, Jay K

    2010-12-20

    Host defense against opportunistic fungi requires coordination between innate and adaptive immunity for resolution of infection. Antibodies generated in mice vaccinated with the fungus Pneumocystis prevent growth of Pneumocystis organisms within the lungs, but the mechanisms whereby antibodies enhance antifungal host defense are poorly defined. Nearly all species of fungi contain the conserved carbohydrates β-glucan and chitin within their cell walls, which may be targets of innate and adaptive immunity. In this study, we show that natural IgM antibodies targeting these fungal cell wall carbohydrates are conserved across many species, including fish and mammals. Natural antibodies bind fungal organisms and enhance host defense against Pneumocystis in early stages of infection. IgM antibodies influence recognition of fungal antigen by dendritic cells, increasing their migration to draining pulmonary lymph nodes. IgM antibodies are required for adaptive T helper type 2 (Th2) and Th17 cell differentiation and guide B cell isotype class-switch recombination during host defense against Pneumocystis. These experiments suggest a novel role for the IgM isotype in shaping the earliest steps in recognition and clearance of this fungus. We outline a mechanism whereby serum IgM, containing ancient specificities against conserved fungal antigens, bridges innate and adaptive immunity against fungal organisms.

  20. ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients

    DEFF Research Database (Denmark)

    Maertens, Johan; Cesaro, Simone; Maschmeyer, Georg

    2016-01-01

    The 5th European Conference on Infections in Leukaemia (ECIL-5) meeting aimed to establish evidence-based recommendations for the prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in non-HIV-infected patients with an underlying haematological condition, including allogeneic HSCT recipients. R...

  1. AIDS - associated parasitic diarrhoea

    Directory of Open Access Journals (Sweden)

    Arora D

    2009-01-01

    Full Text Available Since the advent of human immunodeficiency virus infection, with its profound and progressive effect on the cellular immune system, a group of human opportunistic pathogens has come into prominence. Opportunistic parasitic infection can cause severe morbidity and mortality. Because many of these infections are treatable, an early and accurate diagnosis is important. This can be accomplished by a variety of methods such as direct demonstration of parasites and by serological tests to detect antigen and/or specific antibodies. However, antibody response may be poor in these patients and therefore immunodiagnostic tests have to be interpreted with caution. Cryptosporidium parvum , Isospora belli , Cyclospora cayetanensis , Microsporidia, Entamoeba histolytica and Strongyloides stercoralis are the commonly detected parasites. Detection of these parasites will help in proper management of these patients because drugs are available for most of these parasitic infections.

  2. AIDS-associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa

    Directory of Open Access Journals (Sweden)

    Chu Kathryn M

    2010-07-01

    Full Text Available Abstract Background AIDS-associated Kaposi's sarcoma is an important, life-threatening opportunistic infection among people living with HIV/AIDS in resource-limited settings. In western countries, the introduction of combination antiretroviral therapy (cART and new chemotherapeutic agents has resulted in decreased incidence and improved prognosis of AIDS-associated Kaposi's sarcoma. In African cohorts, however, mortality remains high. In this study, we describe disease characteristics and risk factors for mortality in a public sector HIV programme in South Africa. Methods We analysed data from an observational cohort study of HIV-infected adults with AIDS-associated Kaposi's sarcoma, enrolled between May 2001 and January 2007 in three primary care clinics. Paper records from primary care and tertiary hospital oncology clinics were reviewed to determine the site of Kaposi's sarcoma lesions, immune reconstitution inflammatory syndrome stage, and treatment. Baseline characteristics, cART use and survival outcomes were extracted from an electronic database maintained for routine monitoring and evaluation. Cox regression was used to model associations with mortality. Results Of 6292 patients, 215 (3.4% had AIDS-associated Kaposi's sarcoma. Lesions were most commonly oral (65% and on the lower extremities (56%. One quarter of patients did not receive cART. The mortality and lost-to-follow-up rates were, respectively, 25 (95% CI 19-32 and eight (95% CI 5-13 per 100 person years for patients who received cART, and 70 (95% CI 42-117 and 119 (80-176 per 100 person years for patients who did not receive cART. Advanced T stage (adjusted HR, AHR = 5.3, p Patients with AIDS-associated Kaposi's sarcoma presented with advanced disease and high rates of mortality and loss to follow up. Risk factors for mortality included advanced Kaposi's sarcoma disease and lack of chemotherapy use. Contributing factors to the high mortality for patients with AIDS-associated

  3. Cryptosporidium,Giardia, Cryptococcus, Pneumocystis genetic variability: cryptic biological species or clonal near-clades?

    Science.gov (United States)

    Tibayrenc, Michel; Ayala, Francisco J

    2014-04-01

    An abundant literature dealing with the population genetics and taxonomy of Giardia duodenalis, Cryptosporidium spp., Pneumocystis spp., and Cryptococcus spp., pathogens of high medical and veterinary relevance, has been produced in recent years. We have analyzed these data in the light of new population genetic concepts dealing with predominant clonal evolution (PCE) recently proposed by us. In spite of the considerable phylogenetic diversity that exists among these pathogens, we have found striking similarities among them. The two main PCE features described by us, namely highly significant linkage disequilibrium and near-clading (stable phylogenetic clustering clouded by occasional recombination), are clearly observed in Cryptococcus and Giardia, and more limited indication of them is also present in Cryptosporidium and Pneumocystis. Moreover, in several cases, these features still obtain when the near-clades that subdivide the species are analyzed separately ("Russian doll pattern"). Lastly, several sets of data undermine the notion that certain microbes form clonal lineages simply owing to a lack of opportunity to outcross due to low transmission rates leading to lack of multiclonal infections ("starving sex hypothesis"). We propose that the divergent taxonomic and population genetic inferences advanced by various authors about these pathogens may not correspond to true evolutionary differences and could be, rather, the reflection of idiosyncratic practices among compartmentalized scientific communities. The PCE model provides an opportunity to revise the taxonomy and applied research dealing with these pathogens and others, such as viruses, bacteria, parasitic protozoa, and fungi.

  4. An Unusual Case of Cystic Fibrosis Associated Pneumocystis jiroveci Pneumonia in an Infant

    Directory of Open Access Journals (Sweden)

    Ravinder Kaur

    2016-01-01

    Full Text Available Pneumocystis jiroveci pneumonia (PJP is one of the major infections in patients with impaired immunity. The entity is common in HIV-seropositive individuals but quite very rare in HIV-seronegative individuals especially children. We report here a case of 16-week-old HIV-seronegative infant with chief complaint of chronic cough of one month of evolution. Sweat chloride test for diagnosis of cystic fibrosis was positive. Bronchoalveolar lavage (BAL fluid was collected and Pseudomonas aeruginosa was isolated on culture. Empirical antibiotic regimen comprising ceftriaxone and azithromycin was initiated that was switched to meropenem as per antimicrobial susceptibility report, but the patient did not improve. Subsequently, an immunofluorescence staining of BAL fluid was performed and P. jiroveci cysts were detected. Following a laboratory confirmation of Pneumocystis pneumonia, cotrimoxazole was added and the clinical condition of the patient significantly improved. This is an unusual case wherein unsuspected PJP occurred and since signs and symptoms of the patient persisted even after the initiation of antimicrobial therapy for Pseudomonas infection and resolved only after treatment for PJP was started, it suggests a causative role of P. jiroveci rather than colonization/contamination.

  5. Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions

    Directory of Open Access Journals (Sweden)

    Jose G Castro

    2010-06-01

    Full Text Available Jose G Castro1, Maya Morrison-Bryant21Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA; 2Jackson Memorial Hospital/University of Miami Infectious Diseases Fellowship Program, Miami, Florida, USAAbstract: The discovery of the Human Immunodeficiency Virus (HIV was led by the merge of clustered cases of Pneumocystis jirovecii Pneumonia (PCP in otherwise healthy people in the early 80’s.1,2 In the face of sophisticated treatment now available for HIV infection, life expectancy approaches normal limits. It has dramatically changed the natural course of HIV from a nearly fatal infection to a chronic disease.3–5 However, PCP still remains a relatively common presentation of uncontrolled HIV. Despite the knowledge and advances gained in the prevention and management of PCP infection, it continues to have high morbidity and mortality rates. Trimethoprim-sulfamethoxazole (TMP-SMZ remains as the recommended first-line treatment. Alternatives include pentamidine, dapsone plus trimethoprim, clindamycin administered with primaquine, and atovaquone. For optimal management, clinicians need to be familiar with the advantages and disadvantages of the available drugs. The parameters used to classify severity of infection are also important, as it is well known that the adjunctive use of steroids in moderate to severe cases have been shown to significantly improve outcome. Evolving management practices, such as the successful institution of early antiretroviral therapy, may further enhance overall survival rates.Keywords: HIV, Pneumocystis Jirovecii, PCP, TMP-SMZ

  6. Cryptosporidium,Giardia, Cryptococcus, Pneumocystis genetic variability: cryptic biological species or clonal near-clades?

    Directory of Open Access Journals (Sweden)

    Michel Tibayrenc

    2014-04-01

    Full Text Available An abundant literature dealing with the population genetics and taxonomy of Giardia duodenalis, Cryptosporidium spp., Pneumocystis spp., and Cryptococcus spp., pathogens of high medical and veterinary relevance, has been produced in recent years. We have analyzed these data in the light of new population genetic concepts dealing with predominant clonal evolution (PCE recently proposed by us. In spite of the considerable phylogenetic diversity that exists among these pathogens, we have found striking similarities among them. The two main PCE features described by us, namely highly significant linkage disequilibrium and near-clading (stable phylogenetic clustering clouded by occasional recombination, are clearly observed in Cryptococcus and Giardia, and more limited indication of them is also present in Cryptosporidium and Pneumocystis. Moreover, in several cases, these features still obtain when the near-clades that subdivide the species are analyzed separately ("Russian doll pattern". Lastly, several sets of data undermine the notion that certain microbes form clonal lineages simply owing to a lack of opportunity to outcross due to low transmission rates leading to lack of multiclonal infections ("starving sex hypothesis". We propose that the divergent taxonomic and population genetic inferences advanced by various authors about these pathogens may not correspond to true evolutionary differences and could be, rather, the reflection of idiosyncratic practices among compartmentalized scientific communities. The PCE model provides an opportunity to revise the taxonomy and applied research dealing with these pathogens and others, such as viruses, bacteria, parasitic protozoa, and fungi.

  7. Platypnea and orthodeoxia associated with Pneumocystis jiroveci and Cytomegalovirus pneumonia: a case report

    Directory of Open Access Journals (Sweden)

    Bikas Christoforos

    2009-12-01

    Full Text Available Abstract Introduction Platypnea-orthodeoxia is an uncommon syndrome characterized by dyspnea and deoxygenation accompanying a change to a sitting or standing posture from a recumbent position. It is usually related to interatrial communications, although several other disorders associated with platypnea-orthodeoxia syndrome have been reported. However, the precise mechanisms are unknown. Case presentation We present the case of a 75-year-old Caucasian woman with chronic renal failure due to vasculitis who was admitted with fever and respiratory failure. She was found to have both Pneumocystis jiroveci and Cytomegalovirus pneumonia. She was HIV negative. Severe platypnea and orthodeoxia were major features of her illness with no history of respiratory, liver or cardiac disease. Further investigation with contrast echocardiography revealed no intracardiac or intrapulmonary shunts. Although one case involving Pneumocystis jiroveci pneumonia and platypnea has been previously reported, to the best of our knowledge, this is the first time that two opportunistic pathogens have been accompanied by platypnea and orthodeoxia. As both lung bases were predominantly affected and no obvious explanation was found, platypnea and orthodeoxia were attributed to significant areas of low or zero ventilation/perfusion (V/Q ratio. Conclusion Platypnea-orthodeoxia is a rare and usually underestimated syndrome. Intracardiac shunts and anatomic pulmonary vascular shunts are the most common etiologic associations. However, if a detailed examination reveals no obvious intracardiac or intrapulmonary shunting combined with extensive pulmonary lesions, then severe V/Q mismatching should be considered as the probable explanation.

  8. Critical Roles of Inflammation and Apoptosis in Improved Survival in a Model of Hyperoxia-Induced Acute Lung Injury in Pneumocystis murina-Infected Mice▿

    OpenAIRE

    Beck, James M.; Preston, Angela M.; Wilcoxen, Steven E.; Morris, Susan B.; Sturrock, Anne; Paine, Robert

    2009-01-01

    Pneumocystis infections increase host susceptibility to additional insults that would be tolerated in the absence of infection, such as hyperoxia. In an in vivo model using CD4-depleted mice, we previously demonstrated that Pneumocystis murina pneumonia causes significant mortality following an otherwise nonlethal hyperoxic insult. Infected mice demonstrated increased pulmonary inflammation and alveolar epithelial cell apoptosis compared to controls. To test the mechanisms underlying these ob...

  9. Detection of Pneumocystis jirovecii in oral wash from immunosuppressed patients as a diagnostic tool

    DEFF Research Database (Denmark)

    Hviid, Cecilie Juul; Lund, Marianne; Sørensen, Allan Klitgaard

    2017-01-01

    BACKGROUND: Diagnosis of Pneumocystis jirovecii (PJ) pneumonia ordinarily requires invasive procedures that could be avoided by PCR methodologies, if these could be designed with adequate cut-off values for confounding background carriage. METHODS: We designed a novel quantitative real-time PCR......), rheumatologic patients (n = 102), patients with inflammatory bowel diseases (n = 98), and healthy blood donors (controls, n = 50). The fungal burden in patients with PJ pneumonia (PCP, n = 7) was also investigated. RESULTS: Danish HIV-infected patients (with viremia/low CD4) and recent transplant recipients...... were at most risk of being carriers (prevalence of 23% and 16.7% respectively), whereas PJ was rarely detected among rheumatologic patients, patients with inflammatory bowel diseases, and untreated West African HIV patients. PJ was not detected among healthy controls. The fungal burden in patients...

  10. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients

    DEFF Research Database (Denmark)

    Maschmeyer, Georg; Helweg-Larsen, Jannik; Pagano, Livio

    2016-01-01

    The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay...... and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis....... the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred...

  11. Clindamycin-primaquine versus pentamidine for the second-line treatment of pneumocystis pneumonia.

    Science.gov (United States)

    Kim, Tark; Kim, Sung-Han; Park, Ki-Ho; Cho, Oh Hyun; Sung, Heungsup; Kim, Mi-Na; Choi, Sang-Ho; Jeong, Jin-Yong; Woo, Jun Hee; Kim, Yang Soo; Lee, Sang-Oh

    2009-10-01

    There are limited data on the efficacy of alternative regimens for treating patients with pneumocystis pneumonia (PCP). We compared the efficacy of clindamycin-primaquine (C-P) with that of pentamidine as a second line treatment for PCP. Among 91 patients receiving trimethoprim-sulfamethoxazole (TMP-SMX) as a first-line treatment for PCP, 31 (34%) did not respond and 7 (8%) had adverse reactions. Fourteen patients received C-P and 9 received pentamidine as a second-line regimen because of treatment failure or an adverse reaction to TMP-SMX. The response rate of patients to C-P was higher than the response rate to pentamidine (9/14; 64% vs 1/9; 11%; P = 0.03).

  12. Síndrome de reconstitución inmune en HIV y neumonía por Pneumocystis jirovecii

    Directory of Open Access Journals (Sweden)

    Agustina Sosa Belaustegui

    2014-04-01

    Full Text Available El síndrome de reconstitución inmune es un conjunto de fenómenos inflamatorios agudos, que se producen como consecuencia de la recuperación de la inmunidad, generando un empeoramiento paradójico de una infección o de un proceso inflamatorio previo. En los pacientes infectados con el virus de inmunodeficiencia humana este síndrome se produce luego de iniciado el tratamiento antirretroviral. Las infecciones más frecuentes asociadas a esta entidad son las producidas por micobacterias, herpes, criptococosis, hepatitis B, citomegalovirus, Pneumocystis jirovecii y el empeoramiento de la leucoencenfalopatía multifocal progresiva por el virus JC. Presentamos un paciente con virus de inmunodeficiencia humana que desarrolló el síndrome de reconstitución inmune por Pneumocystis jirovecii.

  13. Therapeutic potential of caspofungin combined with trimethoprim-sulfamethoxazole for pneumocystis pneumonia: a pilot study in mice.

    Science.gov (United States)

    Lobo, Maria Luísa; Esteves, Francisco; de Sousa, Bruno; Cardoso, Fernando; Cushion, Melanie T; Antunes, Francisco; Matos, Olga

    2013-01-01

    Pneumocystis pneumonia (PcP) is a major cause of mortality and morbidity in immunocompromised patients. There are limited alternative therapeutic choices to trimethoprim-sulfamethoxazole (TMP-SMX) which is the standard first line therapy/prophylaxis for PcP. The efficacy of low doses of caspofungin and caspofungin in association with TMP-SMX standard-prophylactic dose was evaluated in an experimental model of Pneumocystis. Susceptibility of Pneumocystis spp. to low doses of caspofungin and caspofungin/TMP-SMX was evaluated in Balb/c immunosuppressed mice, infected intranasally with P. murina. Caspofungin was administered once daily at 0.1 mg/kg, 0.05 mg/kg, and 0.001 mg/kg and TMP-SMX was administered by oral gavage (12.25 mg/62.5 mg/day), for 21 days. Efficacy was calculated based on the reduction in organism burden determined through quantitative fluorescent-based real-time PCR (qPCR). Serum β-1,3-D-glucan was measured as an additional marker of infection. The present data showed that caspofungin demonstrated anti-Pneumomocystis effect. However, the doses administrated were too low to achieve Pneumocystis eradication, which suggests that echinocandin treatment should not be administrated as mono-therapy. After 21 days of treatment, P. murina was not detected in the lungs of mice with either TMP-SMX or caspofungin/TMP-SMX. The results showed that, even at the lowest concentrations tested, the efficacy of caspofungin in association with TMP-SMX was higher than the efficacy of either drug used alone. The administration of caspofungin/TMP-SMX was at least 1.4 times more effective against P. murina infection than TMP-SMX used alone. The most promising result was achieved with the combination of caspofungin 0.05 mg/kg/day with TMP-SMX 12.5 mg-62.5 mg/day, which reduced the parasite burden to undetectable levels immediately at the 14(th) day of treatment, showing a highly marked anti-Pneumomocystis effect. These data suggest that the administration of low doses of

  14. Therapeutic potential of caspofungin combined with trimethoprim-sulfamethoxazole for pneumocystis pneumonia: a pilot study in mice.

    Directory of Open Access Journals (Sweden)

    Maria Luísa Lobo

    Full Text Available Pneumocystis pneumonia (PcP is a major cause of mortality and morbidity in immunocompromised patients. There are limited alternative therapeutic choices to trimethoprim-sulfamethoxazole (TMP-SMX which is the standard first line therapy/prophylaxis for PcP. The efficacy of low doses of caspofungin and caspofungin in association with TMP-SMX standard-prophylactic dose was evaluated in an experimental model of Pneumocystis. Susceptibility of Pneumocystis spp. to low doses of caspofungin and caspofungin/TMP-SMX was evaluated in Balb/c immunosuppressed mice, infected intranasally with P. murina. Caspofungin was administered once daily at 0.1 mg/kg, 0.05 mg/kg, and 0.001 mg/kg and TMP-SMX was administered by oral gavage (12.25 mg/62.5 mg/day, for 21 days. Efficacy was calculated based on the reduction in organism burden determined through quantitative fluorescent-based real-time PCR (qPCR. Serum β-1,3-D-glucan was measured as an additional marker of infection. The present data showed that caspofungin demonstrated anti-Pneumomocystis effect. However, the doses administrated were too low to achieve Pneumocystis eradication, which suggests that echinocandin treatment should not be administrated as mono-therapy. After 21 days of treatment, P. murina was not detected in the lungs of mice with either TMP-SMX or caspofungin/TMP-SMX. The results showed that, even at the lowest concentrations tested, the efficacy of caspofungin in association with TMP-SMX was higher than the efficacy of either drug used alone. The administration of caspofungin/TMP-SMX was at least 1.4 times more effective against P. murina infection than TMP-SMX used alone. The most promising result was achieved with the combination of caspofungin 0.05 mg/kg/day with TMP-SMX 12.5 mg-62.5 mg/day, which reduced the parasite burden to undetectable levels immediately at the 14(th day of treatment, showing a highly marked anti-Pneumomocystis effect. These data suggest that the administration of

  15. Fungal colonization with Pneumocystis correlates to increasing chloride channel accessory 1 (hCLCA1 suggesting a pathway for up-regulation of airway mucus responses, in infant lungs

    Directory of Open Access Journals (Sweden)

    Francisco J. Pérez

    2014-01-01

    Full Text Available Fungal colonization with Pneumocystis is associated with increased airway mucus in infants during their primary Pneumocystis infection, and to severity of COPD in adults. The pathogenic mechanisms are under investigation. Interestingly, increased levels of hCLCA1 – a member of the calcium-sensitive chloride conductance family of proteins that drives mucus hypersecretion – have been associated with increased mucus production in patients diagnosed with COPD and in immunocompetent rodents with Pneumocystis infection. Pneumocystis is highly prevalent in infants; therefore, the contribution of Pneumocystis to hCLCA1 expression was examined in autopsied infant lungs. Respiratory viruses that may potentially increase mucus, were also examined. hCLCA1 expression was measured using actin-normalized Western-blot, and the burden of Pneumocystis organisms was quantified by qPCR in 55 autopsied lungs from apparently healthy infants who died in the community. Respiratory viruses were diagnosed using RT-PCR for RSV, metapneumovirus, influenza, and parainfluenza viruses; and by PCR for adenovirus. hCLCA1 levels in virus positive samples were comparable to those in virus-negative samples. An association between Pneumocystis and increased hCLCA1 expression was documented (P=0.028. Additionally, increasing Pneumocystis burden correlated with increasing hCLCA1 protein expression levels (P=0.017. Results strengthen the evidence of Pneumocystis-associated up-regulation of mucus-related airway responses in infant lungs. Further characterization of this immunocompetent host-Pneumocystis-interaction, including assessment of potential clinical significance, is warranted.

  16. Activation-induced cytidine deaminase (AID-associated multigene signature to assess impact of AID in etiology of diseases with inflammatory component.

    Directory of Open Access Journals (Sweden)

    Diana Mechtcheriakova

    Full Text Available Activation-induced cytidine deaminase (AID is expressed in B cells within germinal centers and is critically involved in class switch recombination and somatic hypermutation of immunoglobulin loci. Functionally active AID can additionally be detected within ectopic follicular structures developed at sites of chronic inflammation. Furthermore, AID may target non-Ig genes in B- and non-B-cell background. Therefore, AID-associated effects are of increasing interest in disease areas such as allergy, inflammation, autoimmunity, and cancer.Pathway- or disease-relevant multigene signatures have attracted substantial attention for therapeutic target proposal, diagnostic tools, and monitoring of therapy response. To delineate the impact of AID in etiology of multifactorial diseases, we designed the AID-associated 25-gene signature. Chronic rhinosinusitis with nasal polyps was used as an inflammation-driven airway disease model; high levels of IgE have been previously shown to be present within polyp tissue. Expression levels of 16 genes were found to be modulated in polyps including AID, IgG and IgE mature transcripts which reflect AID activity; clustering algorithm revealed an AID-specific gene signature for the disease state with nasal polyp. Complementary, AID-positive ectopic lymphoid structures were detected within polyp tissues by in situ immunostaining. Our data demonstrate the class switch recombination and somatic hypermutation events likely taking place locally in the airways and in addition to the previously highlighted markers and/or targets as IL5 and IgE suggest novel candidate genes to be considered for treatment of nasal polyposis including among others IL13 and CD23. Thus, the algorithm presented herein including the multigene signature approach, analysis of co-regularities and creation of AID-associated functional network gives an integrated view of biological processes and might be further applied to assess role of altered AID

  17. Common invasive fungal diseases: an overview of invasive candidiasis, aspergillosis, cryptococcosis, and Pneumocystis pneumonia.

    Science.gov (United States)

    Schmiedel, Yvonne; Zimmerli, Stephan

    2016-01-01

    Every year, Candida, Aspergillus, Cryptococcus and Pneumocystis infect an estimated two million individuals worldwide. Most are immunocompromised or critically ill. Candida is the most common fungal pathogen of the critically ill and of recipients of transplanted abdominal organs. In high-risk haemato-oncological patients, in contrast, the introduction of antifungal prophylaxis with fluconazole and later with mould-active posaconazole has led to a remarkable reduction of invasive candidiasis and is likely to have a similar effect on invasive aspergillosis. Invasive aspergillosis remains the dominant invasive fungal disease (IFD) of haemato-oncological patients and solid-organ transplant recipients and is increasingly found in individuals with exacerbated chronic obstructive pulmonary disease on corticosteroids. In the developed world, owing to antiretroviral therapy Pneumocystis pneumonia and cryptococcosis have become rare in patients with human immunodeficiency virus (HIV) and are mainly found in solid-organ transplant recipients or immunocompromised patients. In the developing world, cryptococcosis remains a common and highly lethal disease of HIV positive individuals. With invasive candidiasis and invasive aspergillosis, timely diagnosis is the principal challenge. The clinical presentation is nonspecific and current diagnostic tests lack sensitivity and specificity. The combination of several tests improves sensitivity, but not specificity. Standardised polymerase chain-reaction-based assays may be promising tools for more rapid and specific diagnosis of candidiasis and invasive aspergillosis. Nevertheless, initiation of treatment is often based solely on clinical suspicion. Empirical therapy, however, may lead to over-treatment of patients without IFD or it may miss its target in the case of resistance. Despite the success of antifungal prophylaxis in reducing the incidence of IFDs in haemato-oncological patients, there are a considerable number of

  18. A case report of pulmonary coinfection of Strongyloides stercoralis and Pneumocystis jiroveci

    Institute of Scientific and Technical Information of China (English)

    Bava AJ; Romero MM; Prieto R; Troncoso A

    2011-01-01

    A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muñiz Hospital. At diagnosis, the patient presented cough with mucopurulent expectoration, dyspnea, fever, bilateral pulmonary infiltrates on the chest X-ray, negative bacilloscopy for acid fast bacteria and a CD4+ T lymphocytes count of 52 cells/μL. The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage, while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates, pathognomonic of the pulmonary pneumocystosis. It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy. Other complementary stains (a rapid modification of Grocott, Kinyoun and Giemsa) were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy. Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients, such as those with AIDS.

  19. Intermittent Courses of Corticosteroids Also Present a Risk for Pneumocystis Pneumonia in Non-HIV Patients

    Science.gov (United States)

    Calero-Bernal, Maria L.; Martin-Garrido, Isabel; Donazar-Ezcurra, Mikel; Limper, Andrew H.

    2016-01-01

    Introduction. Pneumocystis pneumonia (PCP) is rising in the non-HIV population and associates with higher morbidity and mortality. The aggressive immunosuppressive regimens, as well as the lack of stablished guidelines for chemoprophylaxis, are likely contributors to this increased incidence. Herein, we have explored the underlying conditions, immunosuppressive therapies, and clinical outcomes of PCP in HIV-negative patients. Methods. Retrospective analysis of PCP in HIV-negative patients at Mayo Clinic from 2006–2010. The underlying condition, immunosuppressive therapies, coinfection, and clinical course were determined. PCP diagnosis required symptoms of pneumonia and identification of the organisms by visualization or by a real-time polymerase chain reaction. Results. A total of 128 cases of PCP were identified during the study period. Hematological malignancies were the predisposing condition for 50% of the patients. While 87% had received corticosteroids or other immunosuppressive therapies for >4 weeks prior to the diagnosis, only 7 were receiving PCP prophylaxis. Up to 43% of patients were not on daily steroids. Sixty-seven patients needed Intensive Care Unit (ICU) and 53 received mechanical ventilation. The mortality for those patients requiring ICU was 40%. Conclusions. PCP diagnosis in the HIV-negative population requires a high level of suspicion even if patients are not receiving daily corticosteroids. Mortality remains high despite adequate treatment. PMID:27721666

  20. A case report of pulmonary coinfection of Strongyloides stercoralis and Pneumocystis jiroveci

    Directory of Open Access Journals (Sweden)

    AJ Bava

    2011-08-01

    Full Text Available A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muñiz Hospital. At diagnosis, the patient presented cough with mucopurulent expectoration, dyspnea, fever, bilateral pulmonary infiltrates on the chest X-ray, negative bacilloscopy for acid fast bacteria and a CD4+ T lymphocytes count of 52 cells/μL. The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage, while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates, pathognomonic of the pulmonary pneumocystosis. It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy. Other complementary stains (a rapid modification of Grocott, Kinyoun and Giemsa were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy. Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients, such as those with AIDS.

  1. Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients.

    Science.gov (United States)

    Cordonnier, Catherine; Cesaro, Simone; Maschmeyer, Georg; Einsele, Hermann; Donnelly, J Peter; Alanio, Alexandre; Hauser, Philippe M; Lagrou, Katrien; Melchers, Willem J G; Helweg-Larsen, Jannik; Matos, Olga; Bretagne, Stéphane; Maertens, Johan

    2016-09-01

    Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from that associated with HIV infection, with the disease being acute and more often severe, having a lower fungal burden and being more frequently linked to treatment with corticosteroids. Most cases occur in patients not receiving adequate prophylaxis. The development of new therapies, including targeted treatments and monoclonal antibodies in various haematological diseases, justifies constant vigilance in order to identify new at-risk populations and give prophylaxis accordingly. The fifth and sixth European Conferences on Infections in Leukaemia (ECIL-5 and ECIL-6) aimed to review risk factors for PCP in haematology patients and to establish evidence-based recommendations for PCP diagnosis, prophylaxis and treatment. This article focuses on the magnitude of the problem, the main differences in clinical presentation between haematology patients and other immunocompromised populations, especially HIV-infected patients, and the main risk factors.

  2. Utility of adding Pneumocystis jirovecii DNA detection in nasopharyngeal aspirates in immunocompromised adult patients with febrile pneumonia.

    Science.gov (United States)

    Guigue, Nicolas; Alanio, Alexandre; Menotti, Jean; Castro, Nathalie De; Hamane, Samia; Peyrony, Olivier; LeGoff, Jérôme; Bretagne, Stéphane

    2015-04-01

    Detection of viral and bacterial DNA in nasopharyngeal aspirates (NPAs) is now a routine practice in emergency cases of febrile pneumonia. We investigated whether Pneumocystis jirovecii DNA could also be detected in these cases by conducting retrospective screening of 324 consecutive NPAs from 324 adult patients (198 or 61% were immunocompromised) admitted with suspected pulmonary infections during the 2012 influenza epidemic season, using a real-time quantitative polymerase chain reaction (PCR) assay (PjqPCR), which targets the P. jirovecii mitochondrial large subunit ribosomal RNA gene. These NPAs had already been tested for 22 respiratory pathogens (18 viruses and 4 bacteria), but we found that 16 NPAs (4.9%) were PjqPCR-positive, making P. jirovecii the fourth most prevalent of the 23 microorganisms in the screen. Eleven of the 16 PjqPCR-positive patients were immunocompromised, and five had underlying pulmonary conditions. Nine NPAs were also positive for another respiratory pathogen. Six had PjqPCR-positive induced sputa less than 3 days after the NPA procedure, and five were diagnosed with pneumocystis pneumonia (four with chronic lymphoproliferative disorders and one AIDS patient). In all six available pairs quantification of P. jirovecii DNA showed fewer copies in NPA than in induced sputum and three PjqPCR-negative NPAs corresponded to PjqPCR-positive bronchoalveolar lavage fluids, underscoring the fact that a negative PjqPCR screen does not exclude a diagnosis of pneumocystosis. Including P. jirovecii DNA detection to the panel of microorganisms included in screening tests used for febrile pneumonia may encourage additional investigations or support use of anti-pneumocystis pneumonia prophylaxis in immunocompromised patients.

  3. Experimental chemotherapy of filariasis: comparative evaluation of the efficacy of filaricidal compounds in Mastomys coucha infected with Litomosoides carinii, Acanthocheilonema viteae, Brugia malayi and B. pahangi.

    Science.gov (United States)

    Zahner, H; Schares, G

    1993-01-01

    Eleven types/classes of compound with antifilarial activity were comparatively evaluated in Mastomys coucha infected with Litomosoides carinii, Acanthocheilonema viteae, Brugia malayi or B. pahangi. The paper deals with the efficacy of (i) predominantly microfilaricidal compounds [diethylcarbamazine, levamisole, avermectins (ivermectin, milbemycin), nitrofurans (nitrofurantoin, hydroxymethylnitrofurantoin, nifurtimox, furazolidone, furapyrimidone), organophosphorals (metrifonate, haloxon), and aminophenyl-amidines], (ii) predominantly macrofilaricidal compounds [suramin, benzimidazoles (flubendazole, mebendazole, oxfendazole, ciclobendazole, albendazole, cambendazole, fenbendazole), and arsenicals (thiacetarsamide, Mel PH, R7/45)], and (iii) micro- and macrofilaricidal compounds [benzazole derivatives (CGP 20376 and other benzothiazoles) and nitrophenylamines (amoscanate, CGP 6140)]. Minimum effective doses against microfilariae and minimum curative doses against adult filariae as well as detailed data on dose-efficacy relationships are reported for the various drugs. The results obtained in M. coucha are compared with those published for other experimental in vivo filarial systems, thus attempting to describe a general status of in vivo antifilarial activity of the compounds.

  4. Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP.

    Directory of Open Access Journals (Sweden)

    Julie R Harris

    Full Text Available BACKGROUND: Diagnosis of Pneumocystis jirovecii pneumonia (PCP is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. METHODS AND FINDINGS: We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68-90% of patients at costs of $189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients. Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained compared with several molecular diagnostic options. CONCLUSIONS: For diagnosis of PCP, use of PCR technologies, when

  5. Lung fibrosis in deceased HIV-infected patients with Pneumocystis pneumonia

    Directory of Open Access Journals (Sweden)

    Erica J Shaddock

    2012-06-01

    Full Text Available Background. Pneumocystis pneumonia (PcP is one of the most common opportunistic infections found in patients with HIV. The prognosis if ventilation is required is poor, with mortality of 36 - 80%. Although more recent studies have shown improved survival, our experience has been that close to 100% of such patients die, and we therefore decided to investigate further. Methods. All patients with confirmed or suspected PcP who died owing to respiratory failure were eligible for the study. Where consent was obtained, trucut lung biopsies were performed post mortem, stored in formalin and sent for histopathological assessment. Results. Twelve adequate lung biopsies were obtained from 1 July 2008 to 28 February 2011 – 3 from men and 9 from women. The mean age was 34.7 years (range 24 - 46, and the mean admission CD4 count was 20.8 (range 1 - 68 cells/μl and median 18.5 cells/μl. All specimens demonstrated typical PcP histopathology; in addition, 9 showed significant interstitial fibrosis. Three had co-infection with cytomegalovirus (CMV, two of which had fibrosis present. There was no evidence of TB or other fungal infections. Conclusion. The high mortality seen in this cohort of PcP patients was due to intractable respiratory failure from interstitial lung fibrosis. whereas the differential includes ventilator induced lung injury, drug resistance or co-infections, we suggest that this is part of the disease progression in certain individuals. Further studies are required to identify interventions that could modify this process and improve outcomes in patients with PcP who require mechanical ventilation. S Afr J HIV Med 2012;13(2:64-67.

  6. Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes

    Directory of Open Access Journals (Sweden)

    Ito Yutaka

    2011-03-01

    Full Text Available Abstract 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.

  7. Pneumocystis colonization, airway inflammation, and pulmonary function decline in acquired immunodeficiency syndrome.

    Science.gov (United States)

    Norris, Karen A; Morris, Alison; Patil, Sangita; Fernandes, Eustace

    2006-01-01

    As a result of improved diagnosis, treatment, and supportive care for HIV-infected patients, AIDS in developed countries has now become a chronic infection with prolonged survival time, but longterm complications are increasing contributors to morbidity and mortality. HIV-infected patients are at increased risk for the development of pulmonary complications, including chronic obstructive pulmonary disease (COPD); however, the mechanisms associated with this increased susceptibility have not been defined. Infectious agents may contribute to the development of COPD by upregulating inflammatory mediators in the lung that act in concert with cigarette smoke to promote lung pathology. Studies in human subjects and non-human primate models of AIDS suggest that the inflammatory response to asymptomatic carriage or colonization by the opportunistic pathogen, Pneumocystis sp. (Pc), is similar to that of COPD, which is characterized by influx of CD8+ T cells, neutrophils, and macrophages into the lungs. We have shown a high frequency of Pc colonization among asymptomatic HIV-infected subjects and in non-HIV infected subjects with COPD. To investigate the role of Pc in the progression of obstructive lung disease in HIV infections, we developed a non-human primate model of Pc colonizatoin and infection in simian immunodeficiency virus (SIV)-infected macaques. These animals develop a prolonged colonization state characterized by a persistent influx of CD8+ T cells and neutrophils, and local increases in IL-8, IFN-gamma, and TNF-alpha. SIV-infected Pc-colonized monkeys show progressive decline in pulmonary function compared to SIV-infected monkeys. We hypothesize that in the context of AIDS-immune dysfunction, Pc colonization induces inflammatory responses leading to changes in pulmonary function and architecture similar to that seen in emphysema. Information gained from these studies will lead to the development of interventions to prevent lung injury associated with Pc

  8. Prevalence and genotype distribution of Pneumocystis jirovecii in Cuban infants and toddlers with whooping cough.

    Science.gov (United States)

    Monroy-Vaca, Ernesto X; de Armas, Yaxsier; Illnait-Zaragozí, María T; Toraño, Gilda; Diaz, Raúl; Vega, Dania; Alvarez-Lam, Ileana; Calderón, Enrique J; Stensvold, Christen R

    2014-01-01

    This study describes the prevalence and genotype distribution of Pneumocystis jirovecii obtained from nasopharyngeal (NP) swabs from immunocompetent Cuban infants and toddlers with whooping cough (WC). A total of 163 NP swabs from 163 young Cuban children with WC who were admitted to the respiratory care units at two pediatric centers were studied. The prevalence of the organism was determined by a quantitative PCR (qPCR) assay targeting the P. jirovecii mitochondrial large subunit (mtLSU) rRNA gene. Genotypes were identified by direct sequencing of mtLSU ribosomal DNA (rDNA) and restriction fragment length polymorphism (RFLP) analysis of the dihydropteroate synthase (DHPS) gene amplicons. qPCR detected P. jirovecii DNA in 48/163 (29.4%) samples. mtLSU rDNA sequence analysis revealed the presence of three different genotypes in the population. Genotype 2 was most common (48%), followed in prevalence by genotypes 1 (23%) and 3 (19%); mixed-genotype infections were seen in 10% of the cases. RFLP analysis of DHPS PCR products revealed four genotypes, 18% of which were associated with resistance to sulfa drugs. Only contact with coughers (prevalence ratio [PR], 3.51 [95% confidence interval {CI}, 1.79 to 6.87]; P = 0.000) and exposure to tobacco smoke (PR, 1.82 [95% CI, 1.14 to 2.92]; P = 0.009) were statistically associated with being colonized by P. jirovecii. The prevalence of P. jirovecii in infants and toddlers with WC and the genotyping results provide evidence that this population represents a potential reservoir and transmission source of P. jirovecii.

  9. Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania

    DEFF Research Database (Denmark)

    Jensen, Lotte; Jensen, Andreas V.; Praygod, George;

    2010-01-01

    HIV positive and have a higher mortality than smear-positive TB patients. Lack of access to diagnose Pneumocystis jirovecii pneumonia might be a contributing reason. We therefore assessed the prevalence of P. jirovecii by PCR in oral wash specimens among TB patients and healthy individuals in an HIV...

  10. Inter-laboratory comparison of three different real-time PCR assays for the detection of Pneumocystis jiroveci in bronchoalveolar lavage fluid samples.

    NARCIS (Netherlands)

    Linssen, C.F.; Jacobs, J.A.; Beckers, P.; Templeton, K.E.; Bakkers, J.; Kuijper, E.J.; Melchers, W.J.; Drent, M.; Vink, C.

    2006-01-01

    Pneumocystis jiroveci pneumonia (PCP) is an opportunistic infection affecting immunocompromised patients. While conventional diagnosis of PCP by microscopy is cumbersome, the use of PCR to diagnose PCP has great potential. Nevertheless, inter-laboratory validation and standardization of PCR assays i

  11. Evaluation of different real time PCRs for the detection of Pneumocystis jirovecii DNA in formalin-fixed paraffin-embedded bronchoalveolar lavage samples

    NARCIS (Netherlands)

    de Leeuw, Bertie H C G M; Voskuil, W Sebastiaan; Maraha, Boulos; van der Zee, Anneke; Westenend, Pieter J; Kusters, Johannes G

    2015-01-01

    The presence of Pneumocystis jirovecii in fresh clinical materials can be detected by PCR with high sensitivity and is thus preferred over microscopic methods. However, fresh materials are not always available, and on formalin-fixed paraffin-embedded materials, PCR may result in reduced detection ra

  12. Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania

    DEFF Research Database (Denmark)

    Jensen, Lotte; Jensen, Andreas V.; Praygod, George;

    2010-01-01

    HIV positive and have a higher mortality than smear-positive TB patients. Lack of access to diagnose Pneumocystis jirovecii pneumonia might be a contributing reason. We therefore assessed the prevalence of P. jirovecii by PCR in oral wash specimens among TB patients and healthy individuals in an HIV...

  13. Levels of murine, but not human, CXCL13 are greatly elevated in NOD-SCID mice bearing the AIDS-associated Burkitt lymphoma cell line, 2F7.

    Science.gov (United States)

    Widney, Daniel P; Olafsen, Tove; Wu, Anna M; Kitchen, Christina M R; Said, Jonathan W; Smith, Jeffrey B; Peña, Guadalupe; Magpantay, Larry I; Penichet, Manuel L; Martinez-Maza, Otoniel

    2013-01-01

    Currently, few rodent models of AIDS-associated non-Hodgkin's lymphoma (AIDS-NHL) exist. In these studies, a novel mouse/human xenograft model of AIDS-associated Burkitt lymphoma (AIDS-BL) was created by injecting cells of the human AIDS-BL cell line, 2F7, intraperitoneally into NOD-SCID mice. Mice developed tumors in the peritoneal cavity, with metastases to the spleen, thymus, and mesenteric lymph nodes. Expression of the chemokine receptor, CXCR5, was greatly elevated in vivo on BL tumor cells in this model, as shown by flow cytometry. CXCL13 is the ligand for CXCR5, and serum and ascites levels of murine, but not human, CXCL13 showed a striking elevation in tumor-bearing mice, with levels as high as 200,000 pg/ml in ascites, as measured by ELISA. As shown by immunohistochemistry, murine CXCL13 was associated with macrophage-like tumor-infiltrating cells that appeared to be histiocytes. Blocking CXCR5 on 2F7 cells with neutralizing antibodies prior to injection into the mice substantially delayed tumor formation. The marked elevations in tumor cell CXCR5 expression and in murine CXCL13 levels seen in the model may potentially identify an important link between tumor-interacting histiocytes and tumor cells in AIDS-BL. These results also identify CXCL13 as a potential biomarker for this disease, which is consistent with previous studies showing that serum levels of CXCL13 were elevated in human subjects who developed AIDS-lymphoma. This mouse model may be useful for future studies on the interactions of the innate immune system and AIDS-BL tumor cells, as well as for the assessment of potential tumor biomarkers for this disease.

  14. Levels of murine, but not human, CXCL13 are greatly elevated in NOD-SCID mice bearing the AIDS-associated Burkitt lymphoma cell line, 2F7.

    Directory of Open Access Journals (Sweden)

    Daniel P Widney

    Full Text Available Currently, few rodent models of AIDS-associated non-Hodgkin's lymphoma (AIDS-NHL exist. In these studies, a novel mouse/human xenograft model of AIDS-associated Burkitt lymphoma (AIDS-BL was created by injecting cells of the human AIDS-BL cell line, 2F7, intraperitoneally into NOD-SCID mice. Mice developed tumors in the peritoneal cavity, with metastases to the spleen, thymus, and mesenteric lymph nodes. Expression of the chemokine receptor, CXCR5, was greatly elevated in vivo on BL tumor cells in this model, as shown by flow cytometry. CXCL13 is the ligand for CXCR5, and serum and ascites levels of murine, but not human, CXCL13 showed a striking elevation in tumor-bearing mice, with levels as high as 200,000 pg/ml in ascites, as measured by ELISA. As shown by immunohistochemistry, murine CXCL13 was associated with macrophage-like tumor-infiltrating cells that appeared to be histiocytes. Blocking CXCR5 on 2F7 cells with neutralizing antibodies prior to injection into the mice substantially delayed tumor formation. The marked elevations in tumor cell CXCR5 expression and in murine CXCL13 levels seen in the model may potentially identify an important link between tumor-interacting histiocytes and tumor cells in AIDS-BL. These results also identify CXCL13 as a potential biomarker for this disease, which is consistent with previous studies showing that serum levels of CXCL13 were elevated in human subjects who developed AIDS-lymphoma. This mouse model may be useful for future studies on the interactions of the innate immune system and AIDS-BL tumor cells, as well as for the assessment of potential tumor biomarkers for this disease.

  15. Outcome of AIDS-associated cryptococcal meningitis initially treated with 200 mg/day or 400 mg/day of fluconazole

    Directory of Open Access Journals (Sweden)

    Morroni C

    2006-07-01

    Full Text Available Abstract Background AIDS-associated cryptococcal meningitis has a high mortality. Fluconazole was the only systemic antifungal therapy available in our centre. From 1999–2001 we used low-dose fluconazole (200 mg daily initially, and did not offer therapy to patients perceived to have poor prognoses. In 2001 donated fluconazole became available, allowing us to use standard doses (400 mg daily initially. Antiretroviral therapy was not available during the study period. Methods Retrospective chart review of adult patients before and after the fluconazole donation. Results 205 patients fulfilled the inclusion criteria, 77 before and 128 after the donation. Following the donation fewer patients received no antifungal treatment (5% vs 19%, p = 0.002, and more patients received standard-dose fluconazole (90% vs 6%, p 1,000 were independent predictors of in-hospital mortality. Concomitant rifampicin did not affect in-hospital survival. Thirteen patients were referred to the tertiary referral hospital and received initial treatment with amphotericin B for a mean of 6 days – their in-hospital survival was not different from patients who received only fluconazole (p = 0.9. Kaplan-Meier analysis showed no differences in length of survival by initial treatment with standard or low doses of fluconazole (p = 0.27 log rank test; median survival was 76 and 82 days respectively. Conclusion Outcome of AIDS-associated cryptococcal meningitis is similar with low or standard doses of fluconazole. The early mortality is high. Initial therapy with amphotericin B and other measures may be needed to improve outcome.

  16. Loop-mediated isothermal amplification with the Procedure for Ultra Rapid Extraction kit for the diagnosis of pneumocystis pneumonia.

    Science.gov (United States)

    Kawano, Shuichi; Maeda, Takuya; Suzuki, Takefumi; Abe, Tatsuhiro; Mikita, Kei; Hamakawa, Yusuke; Ono, Takeshi; Sonehara, Wataru; Miyahira, Yasushi; Kawana, Akihiko

    2015-03-01

    Loop-mediated isothermal amplification (LAMP) is an innovative molecular technique requiring only a heating device and isothermal conditions to amplify a specific target gene. The results of current microscopic diagnostic tools for pneumocystis pneumonia are not sufficiently consistent for detecting infection with a low-density of Pneumocystis jirovecii. Although polymerase chain reaction (PCR) is highly sensitive, it is not suitable for resource-limited facilities. LAMP is a potential diagnostic replacement for PCR in such settings but a critical disadvantage of DNA extraction was still remained. Therefore, we employed the Procedure for Ultra Rapid Extraction (PURE) kit, which uses a porous material, to isolate the DNA from clinical samples in a simple way in combination with previously reported LAMP procedure for diagnosing PCP. The detection limit of the PURE-LAMP method applied to artificial bronchoalveolar lavage fluid samples was 100 copies/tube, even with the use of massive blood-contaminated solutions. In addition, we concluded the diagnostic procedure within 1 h without the need for additional equipment. PURE-LAMP coupled with suitable primers for specific pathogens has good potential for diagnosing various infectious diseases.

  17. Pentamidine Injection

    Science.gov (United States)

    Pentamidine injection is used to treat pneumonia caused by a fungus called Pneumocystis carinii. It is in ... Pentamidine injection comes as powder to be mixed with liquid to be injected intramuscularly (into a muscle) ...

  18. Safe interruption of maintenance therapy against previous infection with four common HIV-associated opportunistic pathogens during potent antiretroviral therapy

    DEFF Research Database (Denmark)

    Kirk, Ole; Reiss, Peter; Uberti-Foppa, Caterina;

    2002-01-01

    BACKGROUND: The safety of interrupting maintenance therapy for previous opportunistic infections other than Pneumocystis carinii pneumonia among patients with HIV infection who respond to potent antiretroviral therapy has not been well documented. OBJECTIVE: To assess the safety of interrupting m...

  19. Pneumocystis pneumonia in HIV-positive patients in Spain: epidemiology and environmental risk factors

    Directory of Open Access Journals (Sweden)

    Alejandro Alvaro-Meca

    2015-05-01

    Full Text Available Introduction: Specific environmental factors may play a role in the development of Pneumocystis pneumonia (PCP in HIV-positive patients. The aim of this study was to estimate the PCP incidence and mortality in hospitalized HIV-positive patients in Spain during the combination antiretroviral therapy (cART era (1997 to 2011, as well as to analyze the climatological factors and air pollution levels in relation to hospital admissions and deaths. Methods: We carried out a retrospective study. Data were collected from the National Hospital Discharge Database and the State Meteorological Agency of Spain. A case-crossover analysis was applied to identify environmental risk factors related to hospitalizations and deaths. For each patient, climatic factors and pollution levels were assigned based on readings from the nearest meteorological station to his or her postal code. Results: There were 13,139 new PCP diagnoses and 1754 deaths in hospitalized HIV-positive patients from 1997 to 2011. The PCP incidence (events per 1000 person-years dropped from 11.6 in 1997 to 2000, to 5.4 in 2004 to 2011 (p<0.001. The mortality (events per 10,000 person-years also decreased from 14.3 in 1997 to 2000, to 7.5 in 2004 to 2011 (p<0.001. Most hospital admissions and deaths occurred in the winter season and the fewest occurred in the summer, overlapping respectively with the lowest and highest temperatures of the year in Spain. Moreover, lower temperatures prior to PCP admission, as well as higher concentrations of NO2 and particulate matter up to 10 m in size (PM10 at the time of admission were associated with higher likelihoods of hospital admission due to PCP when two weeks, one month, 1.5 months or two months were used as controls (p<0.01. Furthermore, higher concentrations of ozone at one month (p=0.007, 1.5 months (p<0.001 and two months (p=0.006 prior to admission were associated with higher likelihoods of hospital admission with PCP. For PCP-related deaths, lower

  20. The unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: case reports and literature review

    Directory of Open Access Journals (Sweden)

    Hui David S

    2004-12-01

    Full Text Available Abstract Background Pneumocystis jiroveci pneumonia (PCP is an important opportunistic infection among immunosuppressed patients, especially in those infected with human immunodeficiency virus (HIV. The clinical presentation of PCP in immunosuppressed patients have been well-reported in the literature. However, the clinical importance of PCP manifesting in the setting of an immunorestitution disease (IRD, defined as an acute symptomatic or paradoxical deterioration of a (presumably preexisting infection, which is temporally related to the recovery of the immune system and is due to immunopathological damage associated with the reversal of immunosuppressive processes, has received relatively little attention until recently. Case presentation We aim to better define this unique clinical syndrome by reporting two cases of PCP manifesting acutely with respiratory failure during reversal of immunosuppression in non-HIV infected patients, and reviewed the relevant literature. We searched our databases for PCP cases manifesting in the context of IRD according to our predefined case definition, and reviewed the case notes retrospectively. A comprehensive search was performed using the Medline database of the National Library of Medicine for similar cases reported previously in the English literature in October 2003. A total of 28 non-HIV (excluding our present case and 13 HIV-positive patients with PCP manifesting as immunorestitution disease (IRD have been reported previously in the literature. During immunorestitution, a consistent rise in the median CD4 lymphocyte count (28/μL to 125/μL, with a concomitant fall in the median HIV viral load (5.5 log10 copies/ml to 3.1 log10 copies/ml was observed in HIV-positive patients who developed PCP. A similar upsurge in peripheral lymphocyte count was observed in our patients preceding the development of PCP, as well as in other non-HIV immunosuppressed patients reported in the literature. Conclusions PCP

  1. Dicty_cDB: CFG318 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available 967 |pid:none) Pneumocystis carinii f. sp. carinii he... 343 1e-92 EU679414_1( EU679414 |pid:none) Tetranychus cinnabari...nus heat shoc... 340 5e-92 EU679412_1( EU679412 |pid:none) Tetranychus cinnabari

  2. Dicty_cDB: VFF787 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available 7_1( U80967 |pid:none) Pneumocystis carinii f. sp. carinii he... 340 5e-92 EU679414_1( EU679414 |pid:none) Tetranychus cinnabari...nus heat shoc... 340 7e-92 EU679412_1( EU679412 |pid:none) Tetranychus cinnabari

  3. Dicty_cDB: AFB280 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available |pid:none) Pneumocystis carinii f. sp. carinii he... 352 2e-95 EU679414_1( EU679414 |pid:none) Tetranychus cinnabari...nus heat shoc... 351 2e-95 EU679412_1( EU679412 |pid:none) Tetranychus cinnabari

  4. Persistent Campylobacter Jejuni Infections in Patients Infected with Human Immunodeficiency Virus (HIV)

    Science.gov (United States)

    1988-04-01

    resolve after several days, recurrent infection rather than reinfection with unrelated often without specific antimicrobial therapy (3). Al- strains...course, lack of sufficient therapy led to the in-vivo development of resistance to cultures, or the special growth requirements of the organ- this...dementia Pneumocystis P. carinii carinii pneumoria. pneumonia; Cytomegalovirus herpes retinitis proctitis Other enteric infections* None None Giardia None

  5. Expression and Function of the Chemokine, CXCL13, and Its Receptor, CXCR5, in Aids-Associated Non-Hodgkin's Lymphoma

    Directory of Open Access Journals (Sweden)

    Daniel P. Widney

    2010-01-01

    Full Text Available Background. The homeostatic chemokine, CXCL13 (BLC, BCA-1, helps direct the recirculation of mature, resting B cells, which express its receptor, CXCR5. CXCL13/CXCR5 are expressed, and may play a role, in some non-AIDS-associated B cell tumors. Objective. To determine if CXCL13/CXCR5 are associated with AIDS-related non-Hodgkin's lymphoma (AIDS-NHL. Methods. Serum CXCL13 levels were measured by ELISA in 46 subjects who developed AIDS-NHL in the Multicenter AIDS Cohort Study and in controls. The expression or function of CXCL13 and CXCR5 was examined on primary AIDS-NHL specimens or AIDS-NHL cell lines. Results. Serum CXCL13 levels were significantly elevated in the AIDS-NHL group compared to controls. All primary AIDS-NHL specimens showed CXCR5 expression and most also showed CXCL13 expression. AIDS-NHL cell lines expressed CXCR5 and showed chemotaxis towards CXCL13. Conclusions. CXCL13/CXCR5 are expressed in AIDS-NHL and could potentially be involved in its biology. CXCL13 may have potential as a biomarker for AIDS-NHL.

  6. AIDS-associated diarrhea and wasting in northeast Brazil is associated with subtherapeutic plasma levels of antiretroviral medications and with both bovine and human subtypes of Cryptosporidium parvum

    Directory of Open Access Journals (Sweden)

    Richard K. Brantley

    2003-02-01

    Full Text Available Advanced HIV infection is frequently complicated by diarrhea, disruption of bowel structure and function, and malnutrition. Resulting malabsorption of or pharmacokinetic changes in antiretroviral agents might lead to subtherapeutic drug dosing and treatment failure in individual patients, and could require dose adjustment and/or dietary supplements during periods of diarrheal illness. We determined the plasma levels of antiretroviral medications in patients that had already been started on medication by their physicians in an urban infectious diseases hospital in northeast Brazil. We also obtained blood samples from patients hospitalized for diarrhea or AIDS-associated wasting, and we found reduced stavudine and didanosine levels in comparison with outpatients without diarrhea or wasting who had been treated at the same hospital clinic. There was a predominance of the protozoal pathogens Cryptosporidium and Isospora belli, typical opportunistic pathogens of AIDS-infected humans, in the stool samples of inpatients with diarrhea. We conclude that severe diarrhea and wasting in this population is associated with both protozoal pathogens and subtherapeutic levels of antiretroviral medications.

  7. A clinical comparative study of polymerase chain reaction assay for diagnosis of pneumocystis pneumonia in non-AIDS patients

    Institute of Scientific and Technical Information of China (English)

    MU Xiang-dong; WANG Guang-fa; SU Li

    2011-01-01

    Background Pneurnocystis jirovecii pneumonia (PCP) is one of the most common and fatal infections in non-AIDS immunocompromised patients,which is difficult to diagnose by traditional morphologic methods.This study evaluated polymerase chain reaction (PCR) assays of Pneumocystis jirovecii mitochondrial large subunits ribosomal RNA in sputum and bronchioalveolar lavage fluid (BALF) for diagnosing PCP.Methods Sputum and BALF specimens from two groups were collected:one group (PCP group) included 20 patients definitely diagnosed of PCP by Gomori methenamine silver (GMS) stains of BALF;the other group (non-PCP group) included 40 patients.Each specimen was examined by GMS stains and PCR assays.Results GMS stains of BALF in PCP group were 100% positive (20/20),GMS stains of sputum in PCP group were 35% positive (7/20);GMS stains of BALF in non-PCP group were 100% negative (40/40),GMS stains of sputum in non-PCP group were 100% negative (40/40).PCR assays of BALF in PCP group were 100% positive (20/20),PCR assays of sputum in PCP group were 100% positive (20/20);PCR assays of BALF in non-PCP group were 100% negative (40/40),PCR assays of sputum in non-PCP group were 100% negative (40/40).Sensitivity and specificity of PCR assays of sputum and BALF were both 100%;positive and negative predictive values were also both 100%.Conclusion The diagnostic value of PCR assays of Pneumocystisjirovecii mitochondrial large subunits ribosomal RNA on sputum and BALF for pneumocystis pneumonia are both high and equivalent.

  8. Copy number variation of mitochondrial genes in Pneumocystis jirovecii according to the fungal load in BAL specimens

    Directory of Open Access Journals (Sweden)

    clara valero

    2016-09-01

    Full Text Available AbstractPneumocystis jirovecii is an unculturable fungus and the causative agent of Pneumocystis pneumonia, a life-threatening opportunistic infection. Although molecular diagnosis is often based on the mtLSU rRNA mitochondrial gene due to its greater sensitivity, physiology and the dynamics of the mitochondria in this fungus remains largely unknown. We developed and optimized six real-time PCR assays in order to determine the copy number of four mitochondrial genes (mtSSU rRNA, mtLSU rRNA, NAD1 and CYTB in comparison to nuclear genome (DHPS and HSP70 and tested 84 bronchoalveolar fluids of patients at different stages of the infection. Unexpectedly, we found that copy number of mitochondrial genes varied from gene to gene with mtSSU rRNA gene being more represented (37 copies than NAD1 (23 copies, mtLSU rRNA (15 copies and CYTB (6 copies genes compared to nuclear genome. Hierarchical clustering analysis (HCA allowed us to define five major clusters, significantly associated with fungal load (p=0.029, in which copy number of mitochondrial genes was significantly different among them. More importantly, copy number of mtLSU rRNA, NAD1 and CYTB but not mtSSU rRNA differed according to P. jirovecii physiological state with a decreased number of copies when the fungal load is low. This suggests the existence of a mixture of various subspecies of mtDNA that can harbor different amplification rates. Overall, we revealed here an unexpected plasticity and dynamics of P. jirovecii mitochondrial DNA that vary according to P. jirovecii’s physiological state.

  9. [Pneumocystis Pneumonia in 107 HIV Infected Patients Admitted to the Department of Infectious Diseases at Santa Maria Hospital, Lisbon (2002 - 2013)].

    Science.gov (United States)

    Grilo, Vilma; Pereira, Aida

    2016-10-01

    Introdução: A pneumonia por Pneumocystis jirovecii é das doenças infecciosas oportunistas mais comuns em infectados por vírus da imunodeficiência humana, sendo, actualmente, em Portugal a infecção definidora de sida mais reportada. Os objectivos deste estudo foram, analisar as características de uma população co-infectada por vírus da imunodeficiência humana e pneumonia por Pneumocystis jirovecii, comparando-a com as referências disponíveis, e avaliar comparativamente subpopulações de doentes, consoante o conhecimento prévio da infecção por vírus da imunodeficiência humana, o método de diagnóstico de pneumonia por Pneumocystis jirovecii e o resultado na alta. Material e Métodos: Realizámos um estudo restrospectivo pela análise dos registos clínicos de 107 doentes internados no Serviço de Doenças Infecciosas do Hospital de Santa Maria, entre 1 de janeiro de 2002 e 31 de dezembro de 2013, com o diagnóstico de pneumonia por Pneumocystis jirovecii e vírus da imunodeficiência humana. As características epidemiológicas e clínicas foram avaliadas, incluindo o estado imunitário, a carga vírica e a terapêutica instituída e foi realizado um estudo estatístico das variáveis.Resultados: Nesta população, os resultados demonstraram predomínio do sexo masculino (81,3%), idade entre 20 - 39 anos (59,2%), transmissão de vírus da imunodeficiência humana por via heterossexual (48,6%), e que 24,3% eram imigrantes. Apesar do conhecimento da infecção por vírus da imunodeficiência humana (62,6%), 76,2% destes doentes não apresentava seguimento médico sustentado. A contagem de linfócitos TCD4+ ≤ 200 células/mm3 (96,3%), carga vírica elevada e candidose orofaríngea (72%) foram os principais factores de risco para o desenvolvimento de pneumonia por Pneumocystis jirovecii, e os marcadores de gravidade, como a hipoxemia (78,5%) e a elevação da LDH (82,2%) não traduziram pior prognóstico. Apenas foi possível isolar

  10. Absence of Pneumocystis jirovecii colonization in human immunodeficiency virus-infected individuals with and without airway obstruction and with undetectable viral load

    DEFF Research Database (Denmark)

    Ronit, Andreas; Klitbo, Ditte Marie; Kildemoes, Anna Overgaard;

    2016-01-01

    Pneumocystis jirovecii colonization has been associated with non-acquired immune deficiency syndrome (AIDS) pulmonary comorbidity. We used spirometry to measure pulmonary function and analyzed oral wash specimens by quantitative polymerase chain reaction (PCR), targeting the large mitochondrial...... ribosomal subunit. For sensitivity control, a blinded subsample was subjected to touch-down PCRs, targeting both large and small ribosomal subunits and the major surface glycoprotein. Pneumocystis jirovecii deoxyribonucleic acid (DNA) was detected in 1 of 156 (95% confidence interval, .1......%-3.5%) virologically suppressed human immunodeficiency virus (HIV)-infected individuals confirmed by all PCR methods. Thus, prevalence of P jirovecii colonization was low and unlikely to be a major cause of pulmonary comorbidity in this group of well treated HIV-infected individuals....

  11. Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Reiss, Peter; Kirk, Ole;

    2010-01-01

    Current guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count >200 cells/microL. There are few data ...... regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL....

  12. Role of radiotherapy in local control of non-AIDS associated Kaposi's sarcoma patients in Korea: a single institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ji Hyun; Kim, Il Han [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2012-12-15

    There has been no definite consensus on standard treatment, either local or systemic, for the Kaposi's sarcoma (KS). Radiotherapy (RT) can be a good local therapeutic choice especially in non-AIDS associated KS (NAKS) for its indolent behavior. Medical records of 17 KS patients treated with RT at the Seoul National University Hospital from February 1998 to January 2012 were retrospectively reviewed. One human immunodeficiency virus (HIV)+ patient with 3 lesions was excluded. The total number of the lesion was 23 among the 16 patients. The median follow-up period was 27.9 months. Correlation between response and variables was analyzed using the logistic regression model. Median age of the patients was 75 years. All the 23 lesions were located at the extremities. Fourteen (61%) of those had pain or local swelling as the initial presentation. Ten patients had possible causes of immunodeficiency and were regarded as iatrogenic, and other 6 were classic KS. Median dose of RT was 36 Gy. No KS-related death was observed. Excluding 2 with short-term follow-up only, complete response and partial response were obtained in 2 (9%) and 19 (73%) lesions, respectively. Of those, 3 lesions underwent local progression. Six had out-of-field recurrence after RT. Symptom improvement was achieved in 13 (93%) of 14 patients. Grade 2 skin toxicities were found in 9 lesions but all got improvement after treatment. When divided into responsive and progressive group, free from progression was not related to any of the possible variables. RT is effective in local control of NAKS resulting great response rate.

  13. 肺孢子菌繁殖方式的进一步研究%Further Observation on Reproduction Mode of Pneumocystis from Dexamethasone-treated Rats

    Institute of Scientific and Technical Information of China (English)

    邴玉艳; 安春丽; 刘月华; 刘冬娟

    2012-01-01

    目的 研究大鼠源肺孢子菌的增殖方式.方法 从10只肺孢子菌肺炎(PCP)大鼠模型肺脏灌洗液中分离肺孢子菌,用四胺银染色法确定感染情况.用扫描电镜观察灌洗液中肺孢子菌的增殖情况;用透射电镜观察大鼠肺组织内肺孢子菌的增殖情况.结果 PCP大鼠造模成功,GMS染色下肺孢子菌阳性.扫描电镜下观察到肺孢子菌滋养体的二分裂增殖及接合生殖.透射电镜下观察到肺孢子菌滋养体的二分裂增殖、接合生殖与外出芽生殖,同时观察到包囊的内出芽生殖.结论 肺孢子菌有性生殖、无性增殖方式同时存在.在本研究中无性增殖方式包括滋养体的二分裂增殖、外出芽生殖及包囊的内出芽生殖;有性生殖方式为滋养体的接合生殖.%Objective To study the reproduction mode of Pneumocystis from dexamethasone- treated Wistar rats. Methods Ten female Wistar rats were injected subcutaneously with 1 mg of dexamethasone acetate twice a week to establish the Pneumocystis pneumonia (PCP) model . The rats were sacrificed at 9 weeks after the initiation of treatment. The organisms of Pneumocystis (p.c) were obtained from the bronchoalveolar lavage fluid (BALF) of the ten rats with Pneumocystis pneumonia (PCP). The pellets of BALF were stained with Gomori methenamine silver stain (GMS) to ensure the presence of p.c. The reproduction of Pneumocystis organisms from bronchoalveolar lavage fluid (BALF) of rats was studied with scanning electron microscopy (SEM),and the reproduction of Pneumocystis organisms in rats' lungs was studied with the transmission electron microscopy (TEM). Results The PCP rat model was successfully established and the organisms were found on full of the visual fields. In addition to the observation of binary fission and the conjugation of the trophic forms from the BALF and the lung sections with SEM and TEM, the exogenous budding of the trophic form and the endogenous budding of the cyst

  14. Investigation of Pneumocystis jirovecii colonization in patients with chronic pulmonary diseases in the People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Wang DD

    2015-09-01

    Full Text Available Dong-Dong Wang,1 Ming-Quan Zheng,2,3 Nan Zhang,2 Chun-Li An2 1Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, People’s Republic of China; 2Department of Microbiology and Parasitology, College of Basic Medical Science, China Medical University, Shenyang, People’s Republic of China; 3Richard King Mellon Foundation Institute for Pediatric Research, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USABackground: The detection of Pneumocystis jirovecii DNA in respiratory specimen from individuals who do not have signs or symptoms of pneumonia has been defined as colonization. The role of P. jirovecii colonization in the development or progression of various lung diseases has been reported, but little information about P. jirovecii colonization in patients is available in the People’s Republic of China.Objective: To determine the prevalence of P. jirovecii colonization in patients with various pulmonary diseases, including the acute and stable stage of COPD, interstitial lung diseases, cystic fibrosis, and chronic bronchiectasis.Materials and methods: A loop-mediated isothermal amplification (LAMP and a conventional polymerase chain reaction (PCR method for detecting P. jirovecii were developed. Ninety-eight HIV-negative patients who were followed-up and who had undergone bronchoscopy for diagnosis of various underlying respiratory diseases were included in the study. Sputa of these patients were analyzed with LAMP amplification of P. jirovecii gene. In addition, conventional PCR, Giemsa and Gomori’s methenamine silver nitrate staining assays were applied to all specimens.Results: The sensitivity and specificity test showed that there was no cross-reaction with other fungi or bacteria in detecting the specific gene of P. jirovecii by LAMP, and the minimum detection limits by LAMP was 50 copies/mL. P. jirovecii DNA was detected in 62 of 98 (63.3% sputa specimens by LAMP assay and 22

  15. Rising incidence of Pneumocystis jirovecii pneumonia suggests iatrogenic exposure of immune-compromised patients may be becoming a significant problem.

    Science.gov (United States)

    Coyle, Peter V; McCaughey, Conall; Nager, Aaron; McKenna, James; O'Neill, Hugh; Feeney, Susan A; Fairley, Derek; Watt, Alison; Cox, Ciara; Curran, Tanya

    2012-07-01

    Against a background of point-source outbreaks of Pneumocystis pneumonia (PCP) in renal transplant units in Europe, we undertook a retrospective 3 year observational review of PCP in Northern Ireland. This showed an unexpected increase in incidence, with a mortality rate of 30 %. Fifty-one cases were confirmed compared to 10 cases confirmed in the preceding 7 years. Where undiagnosed HIV infection had previously been the main risk factor for PCP, this was now equally matched by chemotherapy for haematological and non-haematological malignancy and immune suppression for a range of autoimmune conditions. Congenital immunodeficiency and transplantation were less common predisposing factors, but renal grafts also showed a rising incidence. Asymptomatic carriage was uncommon. At presentation both upper and lower respiratory samples were of equal use in establishing the diagnosis, and treatment resulted in rapid clearance. These data suggest the need for considering PCP in at-risk patients, reviewing its mode of acquisition and whether iatrogenic colonization is a treatable pre-condition.

  16. ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients.

    Science.gov (United States)

    Maertens, Johan; Cesaro, Simone; Maschmeyer, Georg; Einsele, Hermann; Donnelly, J Peter; Alanio, Alexandre; Hauser, Philippe M; Lagrou, Katrien; Melchers, Willem J G; Helweg-Larsen, Jannik; Matos, Olga; Bretagne, Stéphane; Cordonnier, Catherine

    2016-09-01

    The 5th European Conference on Infections in Leukaemia (ECIL-5) meeting aimed to establish evidence-based recommendations for the prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in non-HIV-infected patients with an underlying haematological condition, including allogeneic HSCT recipients. Recommendations were based on the grading system of the IDSA. Trimethoprim/sulfamethoxazole given 2-3 times weekly is the drug of choice for the primary prophylaxis of PCP in adults ( A-II: ) and children ( A-I: ) and should be given during the entire period at risk. Recent data indicate that children may benefit equally from a once-weekly regimen ( B-II: ). All other drugs, including pentamidine, atovaquone and dapsone, are considered second-line alternatives when trimethoprim/sulfamethoxazole is poorly tolerated or contraindicated. The main indications of PCP prophylaxis are ALL, allogeneic HSCT, treatment with alemtuzumab, fludarabine/cyclophosphamide/rituximab combinations, >4 weeks of treatment with corticosteroids and well-defined primary immune deficiencies in children. Additional indications are proposed depending on the treatment regimen.

  17. ECIL guidelines for the diagnosis of Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients.

    Science.gov (United States)

    Alanio, Alexandre; Hauser, Philippe M; Lagrou, Katrien; Melchers, Willem J G; Helweg-Larsen, Jannik; Matos, Olga; Cesaro, Simone; Maschmeyer, Georg; Einsele, Hermann; Donnelly, J Peter; Cordonnier, Catherine; Maertens, Johan; Bretagne, Stéphane

    2016-09-01

    The Fifth European Conference on Infections in Leukaemia (ECIL-5) convened a meeting to establish evidence-based recommendations for using tests to diagnose Pneumocystis jirovecii pneumonia (PCP) in adult patients with haematological malignancies. Immunofluorescence assays are recommended as the most sensitive microscopic method (recommendation A-II: ). Real-time PCR is recommended for the routine diagnosis of PCP ( A-II: ). Bronchoalveolar lavage (BAL) fluid is recommended as the best specimen as it yields good negative predictive value ( A-II: ). Non-invasive specimens can be suitable alternatives ( B-II: ), acknowledging that PCP cannot be ruled out in case of a negative PCR result ( A-II: ). Detecting β-d-glucan in serum can contribute to the diagnosis but not the follow-up of PCP ( A-II: ). A negative serum β-d-glucan result can exclude PCP in a patient at risk ( A-II: ), whereas a positive test result may indicate other fungal infections. Genotyping using multilocus sequence markers can be used to investigate suspected outbreaks ( A-II: ). The routine detection of dihydropteroate synthase mutations in cases of treatment failure is not recommended ( B-II: ) since these mutations do not affect response to high-dose co-trimoxazole. The clinical utility of these diagnostic tests for the early management of PCP should be further assessed in prospective, randomized interventional studies.

  18. Description of Eimeria motelo sp. n. (Apicomplexa: Eimeriidae from the yellow footed tortoise, Geochelone denticulata (Chelonia: Testudinidae, and replacement of Eimeria carinii Lainson, Costa & Shaw, 1990 by Eimeria lainsoni nom. nov.

    Directory of Open Access Journals (Sweden)

    Lada Hurková

    2000-12-01

    Full Text Available Eimeria motelo sp. n. is described from faeces of the yellow-footed tortoise, Geochelone denticulata (L.. Oocysts are irregularly ellipsoidal or cylindrical, with slightly expressed lobed protrusions and irregularities at the poles, possibly caused by wrinkling of the oocyst wall, 17 (15-19 × 9.4 (8.5-11 µm, shape index (length/width being 1.81 (1.45-2. The oocyst wall is smooth, single-layered, 0.5 µm thick with no micropyle. There are no polar bodies. Sporocysts are ellipsoidal, 8.9 (7.5-10 × 4.4 (4-5 µm, shape index 2.03 (1.7-2.5. A sporocyst residuum is present, composed of many granules of irregular size. The sporozoites are elongate, lying lengthwise in the sporocysts. Comparison with other species of the genus Eimeria parasitising members of family Testudinidae indicates that the presently described coccidium represents a new species. The name of Eimeria carinii Lainson, Costa & Shaw, 1990 is found to be preoccupied by a homonym, Eimeria carinii Pinto 1928 given to a coccidium from Rattus norvegicus. Therefore, it is replaced by Eimeria lainsoni nom. nov.

  19. Evaluation of a new commercial real-time PCR assay for diagnosis of Pneumocystis jirovecii pneumonia and identification of dihydropteroate synthase (DHPS) mutations.

    Science.gov (United States)

    Montesinos, Isabel; Delforge, Marie-Luce; Ajjaham, Farida; Brancart, Françoise; Hites, Maya; Jacobs, Frederique; Denis, Olivier

    2017-01-01

    The PneumoGenius® real-time PCR assay is a new commercial multiplex real-time PCR method, which detects the Pneumocystis mitochondrial ribosomal large subunit (mtLSU) and two dihydropteroate synthase (DHPS) point mutations. To evaluate the clinical performance of this new real-time PCR assay we tested 120 extracted DNA samples from bronchoalveolar lavage specimens. These set of extracted DNA samples had already tested positive for Pneumocystis and patients had been classified in probable and unlikely PCP in a previous study. To evaluate de accuracy of the DHPS mutant's identification, an "in house" PCR and sequencing was performed. The sensitivity and specificity of PneumoGenius® PCR in discriminating between probable and unlikely Pneumocystis pneumonia (PCP) were 70% and 82% respectively. PneumoGenius® PCR was able to genotype more samples than "in house" DHPS PCR and sequencing. The same DHPS mutations were observed by both methods in four patients: two patients with a single mutation in position 171 (Pro57Ser) and two patients with a double mutation in position 165 (Thr55Ala) and in position 171 (Pro57Ser). A low rate of P. jirovecii (4.5%) harboring DHPS mutations was found, comparable to rates observed in other European countries. The PneumoGenius® real-time PCR is a suitable real-time PCR for PCP diagnosis and detection of DHPS mutants. The added value of DHPS mutation identification can assist in understanding the role of these mutations in prophylaxis failure or treatment outcome.

  20. Multicentre study highlighting clinical relevance of new high-throughput methodologies in molecular epidemiology of Pneumocystis jirovecii pneumonia.

    Science.gov (United States)

    Esteves, F; de Sousa, B; Calderón, E J; Huang, L; Badura, R; Maltez, F; Bassat, Q; de Armas, Y; Antunes, F; Matos, O

    2016-06-01

    Pneumocystis jirovecii causes severe interstitial pneumonia (PcP) in immunosuppressed patients. This multicentre study assessed the distribution frequencies of epidemiologically relevant genetic markers of P. jirovecii in different geographic populations from Portugal, the USA, Spain, Cuba and Mozambique, and the relationship between the molecular data and the geographical and clinical information, based on a multifactorial approach. The high-throughput typing strategy for P. jirovecii characterization consisted of DNA pooling using quantitative real-time PCR followed by multiplex-PCR/single base extension. The frequencies of relevant P. jirovecii single nucleotide polymorphisms (mt85, SOD110, SOD215, DHFR312, DHPS165 and DHPS171) encoded at four loci were estimated in ten DNA pooled samples representing a total of 182 individual samples. Putative multilocus genotypes of P. jirovecii were shown to be clustered due to geographic differences but were also dependent on clinical characteristics of the populations studied. The haplotype DHFR312T/SOD110C/SOD215T was associated with severe AIDS-related PcP and high P. jirovecii burdens. The frequencies of this genetic variant of P. jirovecii were significantly higher in patients with AIDS-related PcP from Portugal and the USA than in the colonized patients from Portugal, and Spain, and children infected with P. jirovecii from Cuba or Mozambique, highlighting the importance of this haplotype, apparently associated with the severity of the disease and specific clinical groups. Patients from the USA and Mozambique showed higher rates of DHPS mutants, which may suggest the circulation of P. jirovecii organisms potentially related with trimethoprim-sulfamethoxazole resistance in those geographical regions. This report assessed the worldwide distribution of P. jirovecii haplotypes and their epidemiological impact in distinct geographic and clinical populations.

  1. Comparison of a commercial real-time PCR assay, RealCycler® PJIR kit, progenie molecular, to an in-house real-time PCR assay for the diagnosis of Pneumocystis jirovecii infections.

    Science.gov (United States)

    Guillaud-Saumur, Thibaud; Nevez, Gilles; Bazire, Amélie; Virmaux, Michèle; Papon, Nicolas; Le Gal, Solène

    2017-04-01

    We compared the RealCycler® PJIR kit (Progenie Molecular), available in Europe, to an in-house real-time PCR assay for the diagnosis of Pneumocystis jirovecii infections. Excellent agreement was found (concordance rate, 97.4%; Cohen's kappa, 0.918>0.8) showing that this commercial assay represents an alternative method for the diagnosis of P. jirovecii infections.

  2. AB027. Newly diagnosed chronic granulomatous disease in a thirty four year old woman with pneumocystis jiroveci pneumonia

    Science.gov (United States)

    Georgakopoulou, Vasiliki; Mermigkis, Dimitrios; Kourtelessi, Eftychia; Kanellopoulou, Maria; Nikolakopoulos, Ioannis; Tsiafaki, Xanthi

    2016-01-01

    Background Chronic granulomatous disease is a rare primary immunodeficiency disorder which results from the absence or dysfunction of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunits in phagocytic cells. Chronic granulomatous disease is usually inherited in an X-linked recessive fashion and is associated with recurrent intracellular bacterial and fungal infections and granulomatous inflammation. To describe a 34-year-old woman with pneumocystis jiroveci pneumonia who was newly diagnosed as having chronic granulomatous disease. Methods A 34-year-old woman, current smoker, was admitted with high-grade fever, chills and pain in right hemithorax. A chest X-ray was performed which showed right lower lobe consolidation. The patient was recently hospitalized for community acquired pneumonia in the right lower lung lobe and received medication with ceftriaxone and azithromycin. There was no difference between the chest X-ray that was performed in her hospitalization and the one was performed at her admission. The patient was treated with intravenous ciprofloxacin and clindamycin. Computerized-tomography of the chest was performed which showed consolidation with air bronchogram in the right lower lobe and consolidation infiltrate partially with cavitation in the left lower lobe. The patient had no clinical and radiographic improvement. She underwent bronchoscopy with bronchoalveolar lavage and microbiological and immunological tests. Results The direct immunofluorescence test in bronchoalveolar lavage for P. jiroveci was positive. Trimethoprim-sulfamethoxazole was added to her treatment and the patient had complete resolution of clinical symptoms and radiographic improvement. The patient’s immune system was assessed. The subpopulations of lymphocytes were normal, the ranges of immunoglobulins were increased and the test for HIV was negative. There was lower residual superoxide production which confirmed the diagnosis of chronic granulomatous disease

  3. Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients.

    Science.gov (United States)

    Botterel, Françoise; Cabaret, Odile; Foulet, Françoise; Cordonnier, Catherine; Costa, Jean-Marc; Bretagne, Stéphane

    2012-02-01

    Quantitative PCR (qPCR) is more sensitive than microscopy for detecting Pneumocystis jirovecii in bronchoalveolar lavage (BAL) fluid. We therefore developed a qPCR assay and compared the results with those of a routine immunofluorescence assay (IFA) and clinical data. The assay included automated DNA extraction, amplification of the mitochondrial large-subunit rRNA gene and an internal control, and quantification of copy numbers with the help of a plasmid clone. We studied 353 consecutive BAL fluids obtained for investigation of unexplained fever and/or pneumonia in 287 immunocompromised patients. No qPCR inhibition was observed. Seventeen (5%) samples were both IFA and qPCR positive, 63 (18%) were IFA negative and qPCR positive, and 273 (77%) were both IFA and qPCR negative. The copy number was significantly higher for IFA-positive/qPCR-positive samples than for IFA-negative/qPCR-positive samples (4.2 ± 1.2 versus 1.1 ± 1.1 log(10) copies/μl; P < 10(-4)). With IFA as the standard, the qPCR assay sensitivity was 100% for ≥2.6 log(10) copies/μl and the specificity was 100% for ≥4 log(10) copies/μl. Since qPCR results were not available at the time of decision-making, these findings did not trigger cotrimoxazole therapy. Patients with systemic inflammatory diseases and IFA-negative/qPCR-positive BAL fluid had a worse 1-year survival rate than those with IFA-negative/qPCR-negative results (P < 10(-3)), in contrast with solid-organ transplant recipients (P = 0.88) and patients with hematological malignancy (P = 0.26). Quantifying P. jirovecii DNA in BAL fluids independently of IFA positivity should be incorporated into the investigation of pneumonia in immunocompromised patients. The relevant threshold remains to be determined and may vary according to the underlying disease.

  4. Pneumocystis jiroveci pneumonia prophylaxis during maintenance therapy influences methotrexate/6-mercaptopurine dosing but not event-free survival for childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Levinsen, Mette; Shabaneh, Diana; Bohnstedt, Cathrine

    2012-01-01

    Trimethoprim-sulfamethoxazole (TMP/SMX) is used in children with acute lymphoblastic leukemia (ALL) to prevent Pneumocystis pneumonia (PCP). We explored to which extent TMP/SMX influenced methotrexate (MTX)/6-mercaptopurine (6MP) dosage, myelosuppression, and event-free survival (EFS) during.......06) were related to reduced EFS. ANC had no effect on EFS among TMP/SMX2–7 patients (P = 0.40) but did for TMP/SMXnever patients (P = 0.02). The difference in the effect on EFS between TMP/SMX2–7 and TMP/SMXnever patients was not significant (P = 0.46). EFS did not differ between TMP/SMX2–7 and TMP....../SMXnever patients (0.83 vs. 0.83; P = 0.82). These results suggest that TMP/SMX is effective in preventing PCP and may have an antileukemic effect. TMP/SMX should be given the entire duration of maintenance therapy...

  5. Evaluation of different real time PCRs for the detection of Pneumocystis jirovecii DNA in formalin-fixed paraffin-embedded bronchoalveolar lavage samples.

    Science.gov (United States)

    de Leeuw, Bertie H C G M; Voskuil, W Sebastiaan; Maraha, Boulos; van der Zee, Anneke; Westenend, Pieter J; Kusters, Johannes G

    2015-06-01

    The presence of Pneumocystis jirovecii in fresh clinical materials can be detected by PCR with high sensitivity and is thus preferred over microscopic methods. However, fresh materials are not always available, and on formalin-fixed paraffin-embedded materials, PCR may result in reduced detection rates. In this study the diagnostic sensitivity of P. jirovecii real time PCR on DNA isolated from fresh bronchoalveolar lavage (BAL) samples versus that from matched FFPE derived DNA is analyzed. Our results indicate that when targeting a small DNA fragment P. jirovecii PCR can be performed on FFPE BAL samples with acceptable sensitivity (up to 83.3%). This is considerably higher than the 33.3% positives observed by classical staining of these samples.

  6. Development and evaluation of a real-time PCR assay for detection of Pneumocystis jirovecii on the fully automated BD MAX platform.

    Science.gov (United States)

    Dalpke, Alexander H; Hofko, Marjeta; Zimmermann, Stefan

    2013-07-01

    Pneumocystis jirovecii is an opportunistic pathogen in immunocompromised and AIDS patients. Detection by quantitative PCR is faster and more sensitive than microscopic diagnosis yet requires specific infrastructure. We adapted a real-time PCR amplifying the major surface glycoprotein (MSG) target from Pneumocystis jirovecii for use on the new BD MAX platform. The assay allowed fully automated DNA extraction and multiplex real-time PCR. The BD MAX assay was evaluated against manual DNA extraction and conventional real-time PCR. The BD MAX was used in the research mode running a multiplex PCR (MSG, internal control, and sample process control). The assay had a detection limit of 10 copies of an MSG-encoding plasmid per PCR that equated to 500 copies/ml in respiratory specimens. We observed accurate quantification of MSG targets over a 7- to 8-log range. Prealiquoting and sealing of the complete PCR reagents in conical tubes allowed easy and convenient handling of the BD MAX PCR. In a retrospective analysis of 54 positive samples, the BD MAX assay showed good quantitative correlation with the reference PCR method (R(2) = 0.82). Cross-contamination was not observed. Prospectively, 278 respiratory samples were analyzed by both molecular assays. The positivity rate overall was 18.3%. The BD MAX assay identified 46 positive samples, compared to 40 by the reference PCR. The BD MAX assay required liquefaction of highly viscous samples with dithiothreitol as the only manual step, thus offering advantages for timely availability of molecular-based detection assays.

  7. Dicty_cDB: VFJ403 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available onfervae strain CBS ... 304 4e-81 EU679414_1( EU679414 |pid:none) Tetranychus cinnabarinus heat shoc... 301 ...none) Pneumocystis carinii f. sp. carinii he... 301 4e-80 EU679412_1( EU679412 |pid:none) Tetranychus cinn...abarinus heat shoc... 300 5e-80 protein update 2009. 6.22 PSORT psg: 0.45 gvh: 0.33

  8. 卡泊芬净联合克林霉素治疗重症肺孢子菌肺炎的临床观察%Clinical Observation on Caspofungin and Clindamycin in the Treatment of Severe Pneumocystis Pneumonia

    Institute of Scientific and Technical Information of China (English)

    甘晓飞; 金鑫

    2016-01-01

    目的:探讨卡泊芬净联合克林霉素治疗重症肺孢子菌肺炎的临床效果。方法将82例重症肺孢子菌肺炎患者分为两组,治疗组采取卡泊芬净联合克林霉素治疗,对照组采取卡泊芬净治疗,对比2组疗效。结果治疗组治疗总有效率95.1%,高于对照组的75.6%(P<0.05)。结论卡泊芬净联合克林霉素治疗重症肺孢子菌肺炎的效果理想。%Objective To investigate clinical effect of caspofungin in combination with clindamycin in the treatment of severe Pneumocystis pneumonia.Methods 82 cases of severe Pneumocystis pneumonia patients divided into two groups. Treatment group taking caspofungin combined with clindamycin treatment, the control group was treated with caspofungin. The curative effects were compared between two groups.Results Treatment group of total rate was 95.1%,was significantly higher than that of the control group of 75.6%(P<0.05).Conclusion Combination of caspofungin and clindamycin in treatment of severe Pneumocystis pneumonia have ideal effect.

  9. Identificação de agentes infecciosos pulmonares em autópsias de pacientes com a síndrome da imunodeficiência adquirida Identification of infectious agents in the lungs in autopsies of patients with acquired immunodeficiency syndrome

    Directory of Open Access Journals (Sweden)

    Sanivia Aparecida de Lima Pereira

    2002-12-01

    Full Text Available As afecções pulmonares são freqüentes em indivíduos infectados pelo vírus da imunodeficiência humana. Neste trabalho, procurou-se identificar através de histoquímica e imunohistoquímica, agentes infecciosos nos pulmões de indivíduos portadores da síndrome da imunodeficiência adquirida (SIDA, autopsiados entre março de 1990 e julho de 2000 na FMTM. Fragmentos de pulmão de 40 indivíduos com SIDA autopsiados foram analisados histologicamente. Foram identificados agentes infecciosos em 34 (85% casos dos 40 analisados, sendo que bactérias foram encontradas em 22 (55% casos. Entre os agentes fúngicos o Pneumocystis carinii foi encontrado em oito (19,1% casos; Cryptococcus sp em quatro (9,5%, Histoplasma sp em dois (4,8% e Candida sp em um (2,4% caso. Detectou-se também associação entre Pneumocystis carinii, Citomegalovirus e Cryptococcus sp; CMV e Toxoplasma gondii. Em cinco casos, Candida sp, CMV e Pneumocystis carinii estiveram associados a bactérias. Entre as infecções não bacterianas, os fungos foram os agentes infecciosos mais isolados dos pulmões em autópsias de indivíduos com SIDA, sendo o Pneumocystis carinii o mais freqüente.Lung diseases are frequently observed in individuals infected with HIV. The aim of this study was to identify infectious agents in the lungs in the autopsied individuals with AIDS performed between march 1990 and july 2000 at the school of medicine (Uberaba- Brazil, using histochemical and immunohistochemical techniques. Analysis was made on lungs obtained from 40 individuals with AIDS. Infectious agents were observed in 34 (85% cases of the 40 analyzed. Regarding fungis, Pneumocystis carinii was found in 8 (19.1%cases; Cryptococcus sp in 4 (9.5%cases, Histoplasma sp in 2 (4.8%cases and Candida sp in 1 (2.4%case. Association of Pneumocystis carinii, Citomegalovirus and Cryptococcus sp, was observed in one case, and in another, the association of CMV, and Toxoplasma gondii. There were 5 cases

  10. XX. Animal models of pneumocystosis

    DEFF Research Database (Denmark)

    Dei-Cas, E.; Brun-Pascaud, M.; Bille-Hansen, Vivi

    1998-01-01

    As in vitro culture systems allowing to isolate Pneumocystis samples from patients or other mammal hosts are still not available, animal models have critical importance in Pneumocystis research. The parasite was reported in numerous mammals but P. carinii pneumonia (PCP) experimental models were...... a source of parasites taxonomically related to P. carinii sp. f hominis. Moreover, primates might be used as experimental hosts to human Pneumocystis. A marked variability of parasite levels among corticosteroid-treated animals and the fact that the origin of the parasite strain remains unknown......, are important drawbacks of the corticosteroid-treated models. For these reasons, inoculated animal models of PCP were developed. The intratracheal inoculation of lung homogenates containing viable parasites in corticosteroid-treated non-latently infected rats resulted in extensive, reproducible Pneumocystis...

  11. Worldwide Report Epidemiology No. 336.

    Science.gov (United States)

    2007-11-02

    Broadening research on: —the importance of the Trichomonas vaginalis infection in males and females in genitourinary pathology; —the value of treating...Pneumocystis carinii, Giardia lambia and Trichomonas intestinalis) for the last category. 1. Discussions are proposed in the use of the terms

  12. Dicty_cDB: AFH463 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available 14_1( EU679414 |pid:none) Tetranychus cinnabarinus heat shoc... 353 1e-95 U71151_1( U71151 |pid:none) Pneumo...cystis carinii heat shock protei... 352 2e-95 EU679412_1( EU679412 |pid:none) Tetranychus cinnabarinus heat

  13. Acute, rapidly progressive renal failure with simultaneous use of amphotericin B and pentamidine.

    OpenAIRE

    Antoniskis, D; Larsen, R.A.

    1990-01-01

    We report four cases of acute reversible renal failure in patients with acquired immune deficiency syndrome who received both amphotericin B (for systemic mycoses) and pentamidine isethionate (for Pneumocystis carinii pneumonia). The concurrent use of amphotericin B with either inhaled pentamidine or trimethoprim-sulfamethoxazole did not cause significant renal impairment.

  14. [Identification of infectious agents in the lungs in autopsies of patients with acquired immunodeficiency syndrome].

    Science.gov (United States)

    Pereira, Sanivia Aparecida de Lima; Rodrigues, Denise Bertulucci Rocha; Correia, Dalmo; dos Reis, Marlene Antônia; Teixeira, Vicente de Paula Antunes

    2002-01-01

    Lung diseases are frequently observed in individuals infected with HIV. The aim of this study was to identify infectious agents in the lungs in the autopsied individuals with AIDS performed between march 1990 and july 2000 at the school of medicine (Uberaba- Brazil), using histochemical and immunohistochemical techniques. Analysis was made on lungs obtained from 40 individuals with AIDS. Infectious agents were observed in 34 (85%) cases of the 40 analyzed. Regarding fungis, Pneumocystis carinii was found in 8 (19.1%)cases; Cryptococcus sp in 4 (9.5%)cases, Histoplasma sp in 2 (4.8%)cases and Candida sp in 1 (2.4%)case. Association of Pneumocystis carinii, Citomegalovirus and Cryptococcus sp, was observed in one case, and in another, the association of CMV, and Toxoplasma gondii. There were 5 cases with Candida sp, CMV and Pneumocystis carinii associated with bacteria. In conclusion, this study shows that following bacterial agents fungi were the second most common infectious agents in post mortem examination of the lungs from patients with AIDS, being Pneumocystis carinii the most prevalent.

  15. Investigation of the Role of the Cytomegalovirus as a Respiratory Pathogen in HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Rafael E de la Hoz

    1996-01-01

    Full Text Available OBJECTIVE: To investigate the occurrence of cytomegalovirus (CMV pneumonitis in the setting of human immunodeficiency virus (HIV infection and whether the presence of CMV as copathogen is associated with increased clinical severity or short term mortality in patients with Pneumocystis carinii pneumonia.

  16. Characterization of nebulized buparvaquone nanosuspensions - effect of nebulization technology

    NARCIS (Netherlands)

    Hernandez-Trejo, N; Kayser, O; Steckel, H; Muller, RH

    2005-01-01

    The poorly soluble drug buparvaquone is proposed as an alternative treatment of Pneumocystis carinii pneumonia (PCP) lung infections. Physically stable nanosuspensions were formulated in order to deliver the drug at the site of infection using nebulization. The aerosolization characteristics of two

  17. Use of real-time polymerase chain reaction for the diagnosis of Pneumocystis pneumonia in immunocompromised patients: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Hanssa Summah; ZHU Ying-gang; Matthew E Falagas; Evridiki K Vouloumanou; QU Jie-ming

    2013-01-01

    Background The diagnosis of Pneumocystis pneumonia (PCP) in immunocompromised patients is still challenging today due to the absence of an in vitro culture system and the low diagnostic accuracy of microscopic examinations.Herein,weperformed a meta-analysis to evaluate the accuracy of real-time polymerase chain reaction (PCR) in the diagnosis of PCP.Methods We searched Web of Knowledge and Medline from 1990 to May 2010 for studies reporting diagnostic accuracy data regarding the use of real-time PCR in the diagnosis of PCP in immunocompromised patients.Results Ten individual studies were included.Overall,the sensitivity of real-time PCR was 97% (95% CI:93%-99%);the specificity was 94% (95% CI:90%-96%).The area under the HSROC curve (95% CI) for real-time PCR was 0.99(0.97-0.99).In a subgroup analysis regarding studies involving HIV patients among the study population,the sensitivity and specificity were 97% (95% CI:93%-99%) and 93% (95% CI:89%-96%),respectively.Regarding studies using Bronchoalveolar lavage (BAL) samples only:sensitivity =98% (95% CI:94%-99%); specificity =93% (95% CI:89%-96%),respectively.Regarding studies using microscopy as a reference standard:sensitivity =97% (95% CI:92%-99%);specificity =93% (95% CI:88%-96%).However,high between-study statistical heterogeneity was observed in all analyses.Conclusions Real-time PCR has a good diagnostic accuracy and may provide a useful adjunctive tool for the diagnosis of PCP in immunocompromised patients.Further studies are needed in order to identify any differences in the diagnostic performance of real-time PCR in HIV and non-HIV immunocompromised patients.

  18. Discontinuation of Pneumocystis jirovecii pneumonia prophylaxis with CD4 count <200 cells/µL and virologic suppression: a systematic review.

    Directory of Open Access Journals (Sweden)

    Cecilia T Costiniuk

    Full Text Available BACKGROUND: HIV viral load (VL is currently not part of the criteria for Pneumocystis jirovecii pneumonia (PCP prophylaxis discontinuation, but suppression of plasma viremia with antiretroviral therapy may allow for discontinuation of PCP prophylaxis even with CD4 count <200 cells/µL. METHODS: A systematic review was performed to determine the incidence of PCP in HIV-infected individuals with CD4 count <200 cells/µL and fully suppressed VL on antiretroviral therapy but not receiving PCP prophylaxis. RESULTS: Four articles examined individuals who discontinued PCP prophylaxis with CD4 count <200 cells/µL in the context of fully suppressed VL on antiretroviral therapy. The overall incidence of PCP was 0.48 cases per 100 person-years (PY (95% confidence interval (CI (0.06-0.89. This was lower than the incidence of PCP in untreated HIV infection (5.30 cases/100 PY, 95% CI 4.1-6.8 and lower than the incidence in persons with CD4 count <200 cells/µL, before the availability of highly active antiretroviral therapy (HAART, who continued prophylaxis (4.85/100 PY, 95% CI 0.92-8.78. In one study in which individuals were stratified according to CD4 count <200 cells/µL, there was a greater risk of PCP with CD4 count ≤100 cells/µL compared to 101-200 cells/µL. CONCLUSION: Primary PCP prophylaxis may be safely discontinued in HIV-infected individuals with CD4 count between 101-200 cells/µL provided the VL is fully suppressed on antiretroviral therapy. However, there are inadequate data available to make this recommendation when the CD4 count is ≤100 cells/µL. A revision of guidelines on primary PCP prophylaxis to include consideration of the VL is merited.

  19. Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors.

    Science.gov (United States)

    Waks, Adrienne G; Tolaney, Sara M; Galar, Alicia; Arnaout, Amal; Porter, Julie B; Marty, Francisco M; Winer, Eric P; Hammond, Sarah P; Baden, Lindsey R

    2015-11-01

    Opportunistic infection with Pneumocystis jiroveci pneumonia (PCP) has not been recognized as a significant complication of early-stage breast cancer treatment. However, we have observed an increase in PCP incidence among patients receiving chemotherapy for early-stage breast cancer. Herein we identify risk factors for and calculate incidence of PCP in this population. We identified all cases of PCP at Dana-Farber Cancer Institute/Brigham and Women's Hospital (DFCI/BWH) from 1/1/2000 to 12/31/2013 in patients with stage I-III breast cancer treated with an adriamycin/cyclophosphamide (AC)-containing regimen. Nineteen cases of PCP in non-metastatic breast cancer patients were identified. All patients with PCP were diagnosed after receipt of either three or four cycles of AC chemotherapy on a dose-dense schedule. Patients who developed PCP were treated with median 16.4 mg prednisone equivalents/day as nausea prophylaxis for a median 64 days. The overall incidence of PCP among 2057 patients treated with neoadjuvant or adjuvant dose-dense AC for three or more cycles was 0.6 % (95 % confidence interval 0.3-1.0 %). No PCP was diagnosed in 1001 patients treated with non-dose-dense AC. There was one death from PCP. Women receiving dose-dense AC chemotherapy for early-stage breast cancer are at risk for PCP. Administering the same chemotherapy and corticosteroid dose over an 8-week versus 12-week non-dose-dense schedule appears to have created a novel infectious vulnerability. Replacing dexamethasone with alternative anti-emetics may mitigate this risk.

  20. Failure to prescribe pneumocystis prophylaxis is associated with increased mortality, even in the cART era: results from the Treat Asia HIV observational database

    Directory of Open Access Journals (Sweden)

    Lim Poh-Lian

    2012-01-01

    Full Text Available Abstract Background Pneumocystis jiroveci pneumonia (PCP prophylaxis is recommended for patients with CD4 counts of less than 200 cells/mm3. This study examines the proportion of patients in the TREAT Asia HIV Observational Database (TAHOD receiving PCP prophylaxis, and its effect on PCP and mortality. Methods TAHOD patients with prospective follow up had data extracted for prophylaxis using co-trimoxazole, dapsone or pentamidine. The proportion of patients on prophylaxis was calculated for each calendar year since 2003 among patients with CD4 counts of less than 200 cells/mm3. The effect of prophylaxis on PCP and survival were assessed using random-effect Poisson regression models. Results There were a total of 4050 patients on prospective follow up, and 90% of them were receiving combination antiretroviral therapy. Of those with CD4 counts of less than 200 cells/mm3, 58% to 72% in any given year received PCP prophylaxis, predominantly co-trimoxazole. During follow up, 62 patients developed PCP (0.5 per 100 person-years and 169 died from all causes (1.36/100 person-years. After stratifying by site and adjusting for age, CD4 count, CDC stage and antiretroviral treatment, those without prophylaxis had no higher risk of PCP, but had a significantly higher risk of death (incident rate ratio 10.8, p 3, lowering mortality rates from 33.5 to 6.3 per 100 person-years. Conclusions Approximately two-thirds of TAHOD patients with CD4 counts of less than 200 cells/mm3 received PCP prophylaxis. Patients without prophylaxis had significantly higher mortality, even in the era of combination ART. Although PCP may be under-diagnosed, these data suggest that prophylaxis is associated with important survival benefits.

  1. Correlation Between Pneumocystis jirovecii Mitochondrial Genotypes and High and Low Fungal Loads Assessed by Single Nucleotide Primer Extension Assay and Quantitative Real-Time PCR.

    Science.gov (United States)

    Alanio, Alexandre; Olivi, Martine; Cabaret, Odile; Foulet, Françoise; Bellanger, Anne-Pauline; Millon, Laurence; Berceanu, Ana; Cordonnier, Catherine; Costa, Jean-Marc; Bretagne, Stéphane

    2015-01-01

    We designed a single nucleotide primer extension (SNaPshot) assay for Pneumocystis jirovecii genotyping, targeting mt85 SNP of the mitochondrial large subunit ribosomal RNA locus, to improve minority allele detection. We then analyzed 133 consecutive bronchoalveolar lavage (BAL) fluids tested positive for P. jirovecii DNA by quantitative real-time PCR, obtained from two hospitals in different locations (Hospital 1 [n = 95] and Hospital 2 [n = 38]). We detected three different alleles, either singly (mt85C: 39.1%; mt85T: 24.1%; mt85A: 9.8%) or together (27%), and an association between P. jirovecii mt85 genotype and the patient's place of hospitalization (p = 0.011). The lowest fungal loads (median = 0.82 × 10(3) copies/μl; range: 15-11 × 10(3) ) were associated with mt85A and the highest (median = 1.4 × 10(6) copies/μl; range: 17 × 10(3) -1.3 × 10(7) ) with mt85CTA (p = 0.010). The ratios of the various alleles differed between the 36 mixed-genotype samples. In tests of serial BALs (median: 20 d; range 4-525) from six patients with mixed genotypes, allele ratio changes were observed five times and genotype replacement once. Therefore, allele ratio changes seem more frequent than genotype replacement when using a SNaPshot assay more sensitive for detecting minority alleles than Sanger sequencing. Moreover, because microscopy detects only high fungal loads, the selection of microscopy-positive samples may miss genotypes associated with low loads.

  2. Plasma IL-6/IL-10 Ratio and IL-8, LDH, and HBDH Level Predict the Severity and the Risk of Death in AIDS Patients with Pneumocystis Pneumonia.

    Science.gov (United States)

    Sun, Jia; Su, Junwei; Xie, Yirui; Yin, Michael T; Huang, Ying; Xu, Lijun; Zhou, Qihui; Zhu, Biao

    2016-01-01

    Objective. To identify blood biomarkers to predict severity and mortality in AIDS PCP patients. Methods. Biomarkers including clinical parameters and plasma inflammatory cytokines were assessed in 32 HIV-infected patients with Pneumocystis pneumonia (PCP) at time of admission. Predictive value of the biomarkers for clinical severity and in-hospital mortality was evaluated by corresponding ROC curve. Results. Levels of CRP, WBC, LDH, HBDH, and Ferritin were significantly higher in the severe and nonsurvivor AIDS PCP patients. These important biochemical indicators have inverse correlation with oxygenation index, especially levels of LDH (P = 0.008, R (2) = 0.258), HBDH (P = 0.001, R (2) = 0.335), and Ferritin (P = 0.005, R (2) = 0.237). Plasma IL-8 and IL-6 levels were significantly higher in patients with PaO2/FiO2 ≤ 200 mmHg and nonsurvivors than in those with PaO2/FiO2 > 200 mmHg and survivors. Severe and nonsurvival groups showed higher ratio of mean IL-6/IL-10 level (1.78 ± 1.56, P < 0.001; 1.11 ± 0.72, P = 0.043), larger AUC (95% CI 0.781-1.000, P < 0.001; 95% CI 0.592-0.917, P = 0.043), and more significantly inverse correlation with the oxygenation index. Conclusion. Plasma IL-8, LDH, and HBDH levels and IL-6/IL-10 ratio could be helpful for early evaluation of the severity and predicting fatal outcomes in AIDS PCP patients.

  3. Plasma IL-6/IL-10 Ratio and IL-8, LDH, and HBDH Level Predict the Severity and the Risk of Death in AIDS Patients with Pneumocystis Pneumonia

    Directory of Open Access Journals (Sweden)

    Jia Sun

    2016-01-01

    Full Text Available Objective. To identify blood biomarkers to predict severity and mortality in AIDS PCP patients. Methods. Biomarkers including clinical parameters and plasma inflammatory cytokines were assessed in 32 HIV-infected patients with Pneumocystis pneumonia (PCP at time of admission. Predictive value of the biomarkers for clinical severity and in-hospital mortality was evaluated by corresponding ROC curve. Results. Levels of CRP, WBC, LDH, HBDH, and Ferritin were significantly higher in the severe and nonsurvivor AIDS PCP patients. These important biochemical indicators have inverse correlation with oxygenation index, especially levels of LDH (P=0.008, R2=0.258, HBDH (P=0.001, R2=0.335, and Ferritin (P=0.005, R2=0.237. Plasma IL-8 and IL-6 levels were significantly higher in patients with PaO2/FiO2 ≤ 200 mmHg and nonsurvivors than in those with PaO2/FiO2 > 200 mmHg and survivors. Severe and nonsurvival groups showed higher ratio of mean IL-6/IL-10 level (1.78 ± 1.56, P<0.001; 1.11 ± 0.72, P=0.043, larger AUC (95% CI 0.781–1.000, P<0.001; 95% CI 0.592–0.917, P=0.043, and more significantly inverse correlation with the oxygenation index. Conclusion. Plasma IL-8, LDH, and HBDH levels and IL-6/IL-10 ratio could be helpful for early evaluation of the severity and predicting fatal outcomes in AIDS PCP patients.

  4. 实时荧光PCR在艾滋病合并肺孢子菌肺炎诊断中的应用%Application of real-time fluorescence PCR in the diagnosis of pneumocystis pneumonia in AIDS patients

    Institute of Scientific and Technical Information of China (English)

    田敬华; 周淳; 张伟; 华文浩; 万钢; 张亮; 陈志海

    2012-01-01

    目的 应用实时荧光PCR 技术与六甲基四胺银(GMS)染色法对艾滋病合并肺孢子菌肺炎(PCP)患者支气管肺泡灌洗液(BALF)中的肺孢子菌进行检测,比较两种检测方法的性能.方法 应用实时荧光PCR 技术与GMS染色对57例艾滋病合并肺部感染患者的BALF标本进行肺孢子菌检测,比较两种方法的检测效果.结果 收集本院18例艾滋病合并肺部感染患者的支气管灌洗液标本,采用实时荧光PCR技术检测肺孢子菌DNA,结果显示13例为阳性,阳性率为72.3%(13/18).阳性标本肺孢子菌 DNA定量为1.35 × 103~8.24 × 105 拷贝/ml,平均(1.2 ± 2.13)× 105 拷贝/ml;而GMS染色镜下检测,阳性率为72.3%(13/18),二者具有极高的一致性.收集广州市第八人民医院39例艾滋病合并肺部感染患者的支气管灌洗液标本,实时荧光PCR检测肺孢子菌DNA结果显示21例为阳性,阳性率为53.8%(21/39);而用GMS染色镜下检测,阳性率仅为2.5%(1/18).在标本量少的情况下,实时荧光肺孢子菌方法检测肺孢子菌的敏感性远高于GMS染色法.结论 对艾滋病合并肺孢子菌感染患者支气管灌洗液的肺孢子菌检测中,荧光肺孢子菌与GMS染色有极高的一致性,且敏感性明显高于后者.实时荧光肺孢子菌方法可快速、灵敏、特异性、定量地检测肺孢子菌 DNA,在PCP的诊断、治疗方案选择和疗效观察方面有重要的临床意义.%Objective To evaluate and compare real-time fluorescence PCR and Gomori ' s methenamine-silver ( GMS ) staining technique in detecting pneumocystis pneumonia ( PCP ) from bronchoaveolar lavage ( BALF ) specimens. Methods Total of 57 BALF specimens of AIDS patients with pulmonary infection were detected with Pneumocystis DNA by real-time fluorescence PCR and GMS staining. And test results of two kinds of methods were compared. Results Among 18 BALF specimens from our hospital, Pneumocystis DNA of 13 specimens were positively identified by

  5. Clinical analysis of pneumocystis pneumonia in the non-HIV-infected patients%非免疫缺陷病毒感染者肺孢子菌肺炎临床分析

    Institute of Scientific and Technical Information of China (English)

    张杜超; 方向群

    2012-01-01

    目的 提高对非免疫缺陷病毒(HIV)感染者罹患肺孢子菌肺炎的认识.方法 回顾性分析2009-2011年7例非HIV感染的免疫抑制患者发生肺孢子菌肺炎的临床资料.结果 7例均为长期服用激素及免疫抑制剂患者.首发症状均为发热、气促.血气分析5例为I型呼吸衰竭.肺CT均表现为双侧弥漫性磨玻璃样渗出影.6例于支气管镜肺泡灌洗液中、2例于痰中找到肺孢子菌,1例痰肺孢子菌PCR阳性.7例均给予复方新诺明治疗,5例呼吸衰竭患者中,3例接受机械通气治疗,2例予鼻导管或面罩吸氧.5例治愈,2例死亡.结论 非HIV感染者肺孢子菌肺炎起病急,容易并发呼吸衰竭,肺部影像学主要表现为双肺弥漫性渗出样改变.磺胺类药物治疗有一定疗效,合并呼吸衰竭的重症患者应及时给予呼吸支持.%Objective To shirty pneumocystis pneumonia ( PCP ) in the non-human immunodeficiency virus ( HIV ) infected patients. Methods The clinical data of 7 patients with PCP in non-HIV-infected immunocompromised from 2009 to 2011 in the hospital were reviewed. Results All of these patients had a long history of corticosteroid and immunosuppressive agents therapy. Fever was present in all patients combined with dyspnea. Five of them had type I respiratory failure. CT results showed that bilateral diffuse ground-glass opacification in all patients. Pneumocystis was found in bronchoalveolar lavage fluid in 6 cases, sputum pneumocystis in 2 cases and positive pneumocystis PCR in 1 case. Three cases were conducted with mechanical ventilation and two cases had oxygen inhalation through a nasal tube or face mask in these five patients with respiratory failure. Five patients were cured after treatment with SMZco, two patients were died due to respiratory failure. Conclusion Patients who have pneumocystis pneumonia without AIDS typically present with an abrupt onset of respiratory insufficiency and complicated with respiratory failure

  6. 非HIV感染肺孢子菌肺炎患者临床特点及诊治分析%Analysis of Clinical Features,Diagnosis and Treatment of Pneumocystis Pneumonia in the Non-HIV-infected Patients

    Institute of Scientific and Technical Information of China (English)

    曲丹; 马跃; 徐小嫚; 李钰

    2014-01-01

    目的:提高对非HIV感染肺孢子菌肺炎( PCP)患者的诊断和认识。方法对2011-2013年我院确诊的24例非HIV感染PCP患者的临床表现、实验室检查、CT影像特点、治疗及转归等临床资料进行总结及讨论。结果发热和呼吸困难为首发症状。病情进展迅速,所有患者存在Ⅰ型呼吸衰竭。胸部CT主要表现为弥漫性磨玻璃影。痰或支气管肺泡灌洗液姬姆萨染色肺孢子菌或肺孢子菌PCR阳性确诊。21例患者应用复方磺胺甲口恶唑( SMZco)治疗,3例患者因SMZco严重过敏或初用SMZco发生不良反应而应用卡泊芬净治疗,所有患者治愈。结论 PCP是应用免疫抑制剂患者易患的机会性感染,通过痰或支气管肺泡灌洗液PCR检测阳性或涂片姬姆萨染色查到肺孢子菌而确诊,临床应注意与其他肺炎鉴别。PCP治疗首选SMZco,当对SMZco过敏或发生不良反应时可改用卡泊芬净治疗。%Objective To improve diagnostic level and awareness of pneumocystis pneumonia( PCP)in the non-HIV-infected patients. Methods The clinical data( including manifestation,laboratory examination,CT imaging features, treatment and prognosis)of twenty-four non-HIV-infected patients with PCP who were diagnosed in our hospital from 2011 to 2013,was summarized and discussed. Results Fever and dyspnea were the first symptoms,the development of PCP was rap-id. All the patients had type Ⅰrespiratory failure. The chest CT characteristics indicated diffuse ground -glass appearance. The phlegm or bronchoalveolar lavage fluid was stained by Giemsa stain method,if pneumocystis could be found,or PCR result of phlegm or bronchoalveolar lavage fluid was positive for pneumocystis,PCP could be diagnosed. Twenty-one cases were treated with SMZco,the others were highly allergic to SMZco,or adverse reactions occurred,so they were treated with caspofungin,all the patients were cured. Conclusion PCP is a kind of common

  7. 艾滋病合并口腔念珠菌病31例临床分析%Clinical analysis of 31 cases with AIDS associated oral candidiasis

    Institute of Scientific and Technical Information of China (English)

    付茜; 肖江; 赵红心; 刘楠

    2014-01-01

    Objective:To study the clinical features and treatment outcome of AIDS associated oral candidiasis.Methods:The clinical data of 31 cases with AIDSassociated oral candidiasis from 201209 to 201303 were studied retrospectively,including general data,clinical features,oral manifestation,CD4 cell count,opportunistic infections,and antifungal therapy outcome,etc.Results:CD4cell count <200 cell/μl was found in 30 cases,AIDSrelated multiple opportunistic infection was observed in 29 cases.30 cases hadpseudomembranous candidiasis,1 cases had erythematous candidiasis and 2 cases had pseudomembranous candidiasis with angular candidiasis.After antifungal treatment,the lesion of 8 cases reduced,that of 23 cases disappeared completely,lesion relapse after drugwithdrawal happened in 3 cases.Conclusion:AIDSassociated oral candidiasis was more common in AIDS patients with CD4 <200cells/μl,the main clinical form is pseudomembranous type,and with multiple opportunistic infections.The antifungal treatment is effective for the patients.%目的:探讨艾滋病合并口腔念珠菌病的临床特点和诊治转归。方法:回顾性研究从2012-09~2013-03北京地坛医院收治的31例艾滋病合并口腔念珠菌感染者的临床资料,包括一般资料、临床特征、口腔表现、CD4细胞计数、机会性感染状况、抗真菌治疗转归等。结果:31例患者中30例 CD4细胞计数小于200个/μl,有29例合并多种机会性感染。临床表现30例为假膜型,1例为红斑型,2例假膜型合并口角炎型。抗真菌治疗后,8例病损缩小,23例病损完全消失,3例停药后复发。结论:艾滋病合并口腔念珠菌病临床上多见于 CD4细胞<200个/μl 的患者,临床表现以假膜型为主,常合并有其他部位的多种机会性感染。这类患者抗真菌治疗有效。

  8. Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania

    Directory of Open Access Journals (Sweden)

    Friis Henrik

    2010-05-01

    Full Text Available Abstract Background In tuberculosis (TB endemic parts of the world, patients with pulmonary symptoms are managed as "smear-negative TB patients" if they do not improve on a two-week presumptive, broad-spectrum course of antibiotic treatment even if they are TB microscopy smear negative. These patients are frequently HIV positive and have a higher mortality than smear-positive TB patients. Lack of access to diagnose Pneumocystis jirovecii pneumonia might be a contributing reason. We therefore assessed the prevalence of P. jirovecii by PCR in oral wash specimens among TB patients and healthy individuals in an HIV- and TB-endemic area of sub-Saharan Africa. Methods A prospective study of 384 patients initiating treatment for sputum smear-positive and smear-negative TB and 100 healthy household contacts and neighbourhood controls. DNA from oral wash specimens was examined by PCR for P. jirovecii. All patients delivered sputum for TB microscopy and culture. Healthy contacts and community controls were clinically assessed and all study subjects were HIV tested and had CD4 cell counts determined. Clinical status and mortality was assessed after a follow-up period of 5 months. Results 384 patients and 100 controls were included, 53% and 8% HIV positive respectively. A total number of 65 patients and controls (13.6% were at definitive risk for PCP based on CD4 counts 3 and no specific PCP prophylaxis. Only a single patient (0.3% of the patients was PCR positive for P. jirovecii. None of the healthy household contacts or neighbourhood controls had PCR-detectable P. jirovecii DNA in their oral wash specimens regardless of HIV-status. Conclusions The prevalence of P. jirovecii as detected by PCR on oral wash specimens was very low among TB patients with or without HIV and healthy individuals in Tanzania. Colonisation by P. jirovecii was not detected among healthy controls. The present findings may encourage diagnostic use of this non-invasive method.

  9. 实时定量PCR技术诊断PCP的研究进展%The Research Progress of Diagnosing Pneumocystis Pneumonia Using Real-Time PCR

    Institute of Scientific and Technical Information of China (English)

    孙岚; 黄敏君; 郭增柱

    2011-01-01

    肺孢子菌肺炎(PCP)是一种由耶氏肺孢子菌引起的致死性肺炎,常见于免疫功能低下人群,早期诊断有助于临床治疗.目前常用的病原学检查漏诊率较高;定性PCR检测虽然敏感,但有时难以区分隐性感染和显性感染.实时定量PCR是近年来发展的一种精确、敏感、污染少的核酸定量技术.本文综述结果表明,实时定量PCR技术能快速、敏感、特异地检测肺孢子菌,可随时跟踪监测PCP的治疗效果,指导临床用药,有助于PCP的流行病学研究及其他基础生物学研究.%Pneumocystis pneumonia ( PCP) caused by Pneurnocytsis jiroveci ( P. j) is a life-threatening infection in immunocompromised individuals. Early diagnosis of PCP is important to clinical treatment. The diagnostic technique for PCP used nowadays relies on a direct microscopic examination of respiratory specimen, the sensitivities of such examination is low. Molecular diagnosis of PCP is potentially more sensitive. Although conventional PCR has been used to detect the P. j DNA, it is sometimes difficult to distinguish the apparent and silent infection. The real-time PCR assay was developed recent years, which seemed to be accurate, sensitive and less contamination. The present paper summarized more than 20 papers conceming the studies on real-time PCR for the identification of P. j DNA. It revealed that real-time PCR is rapid,sensitive, specific diagnosis method for the detection of P. j. The quantitative results would be helpful to therapy monitoring, guide of clinical drug application and epidemiological investigation for PCP. It is also useful for other basic biological researches.

  10. 非肺孢子菌肺炎患者支气管肺泡灌洗液肺孢子菌检出情况%Detection results of Pneumocystis jirovecii from non-Pneumocystis pneumonia patients' bronchial alveolar lavage fluid samples

    Institute of Scientific and Technical Information of China (English)

    任珊珊; 田小军; 齐志群; 安亦军; 范东瀛; 王爱东; 任翊

    2015-01-01

    目的 利用常规PCR、巢式PCR(Nest PCR,nPCR)和定量PCR(Quantitative PCR,qPCR)方法,调查非肺孢子菌肺炎(Non-Pneumocystis pneumonia,non-PCP)患者支气管肺泡灌洗液(Bronchial alveolar lavage fluid,BALF)中耶氏肺孢子菌(Pneumocystis jirovecii,Pj)的检出情况.方法 入选non-PCP患者50例留取BALF,分别以线粒体大亚基rRNA(Mi-tochondrial large subunit rRNA,mtLSUrRNA)为靶基因进行常规PCR(Mt-PCR)和巢氏PCR(Mt-nPCR),以主要表面糖蛋白(Major surface glycoprotein,Msg)为靶基因进行常规PCR(Msg-PCR),检测Mt-PCR,Mt-nPCR和Msg-PCR三种方法的Pj特异性核酸片段检出率,并对PCR检出为阳性的样本分别用以mtLSU rRNA和Msg为靶基因的qPCR来检测相应Pj核酸片段拷贝数.结果 50例BALF中,Mt-nPCR、Mt-PCR及Msg-PCR的检出率分别为56%(28/50)、36%(18/50)和26%(13/50),其中三种检测方法同时阳性5例(10%),任意两种方法阳性13例(26%),任意一种方法阳性18例(36%),三种方法均为阴性14例(28%).36例PCR检测结果阳性的标本分别进行mtLSU rRNA定量PCR(Mt-qPCR)和Msg定量PCR(Msg-qPCR)检测,其中Mt-qPCR检测结果为:1000拷贝/μL~9 999拷贝/μL有36例(100%);Msg-qPCR检测结果为:100拷贝/μL~999拷贝/μL有3例(8.3%),1 000拷贝/μL~9 999拷贝/μL有16例(44.4%),10 000拷贝/μL~99 999拷贝/μL有9例(25%),105拷贝/μL以上8例(22.2%).36例配对检测qPCR样本中,Msg-qPCR拷贝数大于Mt-qPCR拷贝数样本28例(77.8%).结论 在non-PCP患者BALF中,Pj核酸扩增方法的检出率为72%,Mt-qPCR拷贝数主要位于103拷贝/μL数量级,Msg-qPCR拷贝数主要分布于103至105拷贝/μL.用核酸扩增方法在BALF中检测出Pj时,临床意义解读需要谨慎.

  11. The gene polymorphisms of drug targets in Pneumocystis jiroveci isolates%耶氏肺孢子菌的药物靶位基因多态性

    Institute of Scientific and Technical Information of China (English)

    邓西龙; 熊漫; 兰芸; 卓丽; 陈万山; 唐小平

    2016-01-01

    目的 了解耶氏肺孢子菌的药物靶位基因多态性和耐药相关基因突变的情况.方法 从148例艾滋病合并肺炎患者的呼吸道标本中扩增出51个线粒体大亚基rRNA(mtLSUrRNA)基因片段,对51例阳性样本继续进行PCR扩增,以耶氏肺孢子菌药物靶位基因二氢蝶酸合成酶(DHPS)、二氢叶酸还原酶(DHFR)、细胞色素B(CYB)为研究靶标,对扩增产物进行测序和序列分析,与GenBank中的参考序列进行比对,分析基因多态性.结果 51例样本全部扩增出DHPS基因、DHFR基因和CYB基因,序列分析显示DHPS基因中3株(5.9%)为耐药相关突变株,48株(94.1%)为野生株;DHFR基因中1株在188碱基位点有非同义突变,21株在312位点有同义突变,30株为野生株,未发现与药物耐药相关的突变株;CYB基因在5个位点有基因多态性,其中4个为同义突变,1个为非同义突变,未发现与药物耐药相关的突变.根据这5个位点的基因多态性分型可以分为6个基因型,其中2个基因型为首次检测到,51株样本中CYB1型25株、CYB2型13株、CYB5型2株、CYB8型4株,新检测到的CYB10型4株,CYB11型3株.结论 广东地区耶氏肺孢子菌药物靶位基因出现与耐药相关的基因突变较少见,CYB基因的基因多态性明显,可作为多位点序列分型研究的靶位基因.%Objective To investigate gene polymorphisms of drug targets and mutations associated with drug resistance in Pneumocystis jiroveci (P.jiroveci) isolates.Methods Among 148 samples isolated from human immunodeficiency virus (HIV)infected patients with pneumonia in Guangdong,mitochondrid larg subunit rRNA (mtLSUrRNA) gene was amplified from 51 samples.Dihydropteroate synthase (DHPS),dihydrofolate reductase (DHFR) and Cytochrome b (CYB) genes of P.jiroveci were detected by gene sequencing,and compared with the reference sequences in GenBank to evaluate gene polymorphisms.Results P.jirovecii DHPS,DHFR and CYB genes were all successfully

  12. Cutaneous ulceration: an unusual complication of intravenous pentamidine therapy.

    Science.gov (United States)

    Bolognia, J L

    1991-01-01

    Pentamidine is one of two agents currently used to treat infections with Pneumocystis carinii. The intramuscular route of administration is associated with cutaneous side effects such as dermal necrosis, sterile abscesses and ulcer formation at the injection site, while urticaria may develop near the site of intravenous drug infusion. This is a report of a renal transplant patient with Pneumocystis pneumonia who developed chemical cellulitis and ulceration following the extravasation of intravenous pentamidine into the soft tissues of the left hand and forearm. The area healed slowly over 7 weeks, but there was a residual loss of cutaneous sensation. In a review of the literature no report of a similar case was found.

  13. Pulmonary complications of AIDS: radiologic features. [AIDS

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, B.A.; Pomeranz, S.; Rabinowitz, J.G.; Rosen, M.J.; Train, J.S.; Norton, K.I.; Mendelson, D.S.

    1984-07-01

    Fifty-two patients with pulmonary complications of acquired immunodeficiency syndrome (AIDS) were studied over a 3-year period. The vast majority of the patients were homosexual; however, a significant number were intravenous drug abusers. Thirteen different organisms were noted, of which Pneumocystis carinii was by far the most common. Five patients had neoplasia. Most patients had initial abnormal chest films; however, eight patients subsequently shown to have Pneumocystis carinii pneumonia had normal chest films. A significant overlap in chest radiographic findings was noted among patients with different or multiple organisms. Lung biopsy should be an early consideration for all patients with a clinical history consistent with the pulmonary complications of AIDS. Of the 52 patients, 41 had died by the time this report was completed.

  14. Etiology and evaluation of diarrhea in AIDS: a global perspective at the millennium

    Institute of Scientific and Technical Information of China (English)

    C. Mel Wilcox

    2000-01-01

    @@INTRODUCTION It has now been almost 20 years since the initial descriptions of a heretofore unrecognized disorder afflicting homosexual men and manifesting as Pneumocystis carinii pneumonia and Kaposi′s sarcoma. With the identification of the human immunodeficiency virus (HIV) as the etiology of this syndrome, there has been exponential growth in our understanding of this devastating immune disorder. During the first decade of the acquired immunodeficiency syndrome (AIDS), there was an explosion of cases in the United States and Africa.

  15. Nurses' perspectives on problems of hospitalized PCP patients: implications for the development of a nursing taxonomy.

    OpenAIRE

    Henry, S. B.; Holzemer, W. L.; Reilly, C A

    1991-01-01

    The phenomena of interest in nursing informatics research are the data, information and knowledge related to nursing. This study presents nurses' perspectives on the problems of patients hospitalized for Pneumocystis carinii pneumonia from four data sources: nurse interview, intershift report, care plan, and nurses' notes. Even within this narrowly specified sample, patient problems showed variation across sources of data. The results of this study demonstrate the difficulties inherent in dev...

  16. Pulmonary scintigraphy by citrate of Ga67 for HIV(+) patients or AIDS. Scintigraphie pulmonaire au citrate de Ga67 chez des patients VIH(+) ou sida

    Energy Technology Data Exchange (ETDEWEB)

    Daumal, J.; Pena, C.; Mata, F.; Paternostro, C.; Penafiel, A. (Hopital Son Dureta, Palma de Mallorca (Spain))

    1993-04-01

    Pulmonary scintigraphy with citrate of gallium 67 is useful when combined with a thorax radiography to establish the presence of an infection. When the two examinations are negative we can conclude there is no infection, but if the radiography is positive with a scintiscanning negative the most possible diagnosis is tuberculosis. If the scintiscanning is positive with a diffuse model we can envisage a pneumonia by Pneumocystis Carinii and if the model is ganglionic we can think to tuberculosis. 4 tabs.

  17. Opportunistic infections and malignancies in 231 Danish AIDS patients

    DEFF Research Database (Denmark)

    Pedersen, C; Gerstoft, J; Tauris, P;

    1990-01-01

    We analysed cumulative disease frequencies in the first 231 adult Danish AIDS patients with life tables. There was a certain hierarchical pattern in the occurrence of complicating diseases. Herpes zoster, Kaposi's sarcoma and Pneumocystis carinii pneumonia were early manifestations, whereas...... diseases caused by cytomegalovirus and atypical mycobacteria tended to occur later in the course of AIDS. Compared with all other AIDS patients, homosexual men were more likely to develop Kaposi's sarcoma, cytomegalovirus chorioretinitis and mucocutaneous herpes simplex virus infection. The proportion...

  18. Mycobacterium avium complex augments macrophage HIV-1 production and increases CCR5 expression

    OpenAIRE

    1998-01-01

    Infection with HIV-1 results in pronounced immune suppression and susceptibility to opportunistic infections (OI). Reciprocally, OI augment HIV-1 replication. As we have shown for Mycobacterium avium complex (MAC) and Pneumocystis carinii, macrophages infected with opportunistic pathogens and within lymphoid tissues containing OI, exhibit striking levels of viral replication. To explore potential underlying mechanisms for increased HIV-1 replication associated with coinfection, blood monocyte...

  19. Combined caspofungin and trimethoprim treatment for severe pneumocystis caeinii pneumonia%卡泊芬净联合复方磺胺甲嗯唑治疗重症肺孢子菌肺炎

    Institute of Scientific and Technical Information of China (English)

    刘一; 刘颖; 李建; 樊再雯; 张波

    2009-01-01

    Objective To investigate the effection of combined caspofungin and trimethoprim on severe pneumocystis caeinii pneumonia (PCP). Methods The clinical feature, diagnosis and treatment procedure of six severe PCP patients were analyzed. Results All of six patients received combined therapy of caspofungin and trimethoprim. Among them, five patients acquired good effectiveness except that one patient abandoned therapy. Three non-responders to the mono-therapy of trimethoprim were all responsive to the combined drug use, and the disease condition was under control. Conclusions Combined therapy of caspofungin and trimethoprim has good effectiveness for the treatment of severe PCP and deserves to be a good regimen for the treatment of trimethoprim failure PCP patients.%目的 探讨卡泊芬净联合复方磺胺甲嗯唑治疗重症肺孢子菌肺炎的疗效.方法 分析总结6例肺孢子菌肺炎患者的临床特点和诊治经过.结果 6例患者均接受卡泊芬净联合复方磺胺甲噁唑治疗,除1例放弃治疗外,其余5例均收到满意疗效.其中3例患者初始单用复方磺胺甲噁唑治疗,病情无好转,后改为联合卡泊芬净,病情得到控制.结论 卡泊芬净联合复方磺胺甲噁唑治疗肺孢子菌肺炎取得了满意疗效,值得推荐作为单用复方磺胺甲噁唑不能控制的肺孢子菌肺炎的治疗选择.

  20. Clinical Efficacy of Integrative Medicine in Treatment of Nine HIV/AIDS-associated Non-infectious Skin Lesion Cases%中西医结合治疗9例HIV/AIDS相关性非感染性皮损患者的临床疗效观察*

    Institute of Scientific and Technical Information of China (English)

    杨舒淳; 叶建清; 王艺颖; 马秀兰; 李静茹; 马建萍

    2015-01-01

    This study was aimed to observe the clinical efficacy of Highly Active Antiretroviral Therapy (HAART) combined withPing-Ai(PA) Mixture in the treatment of Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV/AIDS) patients with non-infectious skin lesions, in order to study the advantages of integrative medicine in AIDS prevention and treatment. A total of 9 cases, who met the inclusion criteria of AIDS-associated non-infectious skin lesion with the pattern ofqi-yin deficiency and internal obstruction of phlegm-stasis, were selected. The combination of HAART and number 1 and 4 prescription of PA Mixture were used in the treatment for 3 months. The observations were made on changes of clinical symptoms, body signs, Karovsky integral and CD4+ T cells of patients before and after treatment. Stata 12.0 was used in the statistical analysis. The results showed that after integrative therapy, the single integral of clinical symptoms and body signs, such as skin spot papula, subcutaneous nodules, skin itching, fatigue was obviously reduced compared to that of the pretreatment. The total score decreased than that of the pretreatment. The patients’ quality of life (QOL) significantly increased. The Karovsky integral increased compared with that of pretreatment. The CD4+ T cells values were higher than that of the pretreatment. It was concluded that the integrative therapy had a certain effect in the treatment of AIDS-associated non-infectious skin lesions, which can improve the clinical symptoms, body signs, obviously increase the patients’ QOL and immune function.%目的:通过观察高效抗逆转录病毒治疗(Highly Active Antiretroviral Therapy,HAART)联合平艾合剂治疗人类免疫缺陷病毒/获得性免疫缺陷综合征(Human Immunodeficiency Virus /Acquired Immunodeficiency Syndrome,HIV/AIDS,简称“艾滋病”)相关性非感染性皮损患者的临床疗效,进一步研究中西医结合在艾滋病防治中的优

  1. Clinical characteristics and pathogens of 143 cases of AIDS-associated bloodstream infection%获得性免疫缺陷综合征合并血流感染143例临床及病原菌分析

    Institute of Scientific and Technical Information of China (English)

    梁欣; 柳明波; 李春玫

    2016-01-01

    ObjectiveTo understand the clinical and microbiological characteristics of AIDS-associated bloodstream infection (BSI).MethodsThe clinical and laboratory ifndings of 143 cases of BSI in AIDS patients who were hospitalized during the period from 2013 to 2014 were retrospectively analyzed.ResultsThe prevalence of BSI in AIDS patients was 22.1%. The 143 patients were divided into two groups in terms of fungal or bacterial infection. The incidence of speciifc skin rashes, anemia, hepatosplenomegaly and lymph node enlargement in fungal infection group was higher than those in bacterial infection group (allP<0.05). CD4+ cell count, WBC, neutrophils, RBC, hemoglobin, and platelet count in fungal infection group were lower than those in bacterial infection group, while AST and Cr were the opposite (allP<0.05).Penicillium marneffei(84/143, 58.7%) was the most common pathogen isolated from AIDS-associated BSI, followed byEscherichia coli (10/143, 7.0%),Cryptococcus neoformans (9/143, 6.3%),Klebsiella pneumoniae (7/143, 4.9%),Salmonella (6/143, 4.2%),Candida albicans(3/143, 2.1%), andAeromonas (3/143, 2.1%). Most strains were still susceptible to the commonly used antibiotics.ConclusionsThe prevalence of BSI is high in AIDS patients. Fungal BSI is more likely to have skin rash, anemia, hepatosplenomegaly and lymphadenopathy, hematologic abnormalities, liver and renal function impairment. Fungi, especiallyPenicillium marneffei, are the main pathogen of AIDS-associated BSI. Most strains are susceptible to the commonly used antibiotics.%目的:了解获得性免疫缺陷综合征(AIDS)合并血流感染(BSI)的临床特点、病原菌分布及其耐药性。方法回顾性分析广西钦州市第一人民医院2013—2014年住院的143例AIDS合并BSI的临床和病原学资料。结果 AIDS患者BSI患病率为22.1%。真菌性BSI的特征性皮疹、贫血貌、肝脾肿大及淋巴结肿大发生率高于细菌性BSI(P均<0.05);真菌性BSI的CD4+细胞计

  2. 儿童肾病合并肺孢子菌肺炎3例临床分析%Clinical analysis of Pneumocystis pneumonia in 3 children with nephropathy

    Institute of Scientific and Technical Information of China (English)

    周楠; 孟繁英; 沈颖; 陈植; 袁林

    2011-01-01

    Objective To further understand Pneumocystis pneumonia (PCP). Methods Clinical symptoms and laboratory data of 3 pediatrie primary or seeondary nephropathy cases with PCP were retrospectively analyzed.Results When infected with PCP, the three patients had the common characters of fever and cough at beginning with progressive hypoxia. Clinical presentations in the early stage were not special and may lead to misdiagnosis. Before PCP developed, the three patients had received immunosuppressant and high dose of oral corticosteroids for at least 8 weeks for the treatment of nephropathy. Full dose of methylprednisolone and cyclophosphamide were used in two of them. The percent of CD4+ T-lymphocyte decreased to different extent in all patients. Conclusions To monitor inmmnosuppressive therapy and improve the living environment of these high-risk patients should be addressed. To observe lymphocyte counts and administer TMP-SMZ when necessary is important for reducing the occurence of PCP.%目的 提高对肺孢子菌肺炎(PCP)的认识.方法 回顾分析3 例肾病并发PCP患儿的临床资料.结果 3例患儿的共同特点是,PCP起病急,临床以发热、咳嗽起病,伴有低氧血症,症状与体征不平行;早期临床表现无特异性,易漏诊,并发PCP前患儿均长期或大量应用免疫抑制剂、足量泼尼松口服疗程达8周及以上;免疫功能检查均有不同程度的CD4细胞比例下降.结论 提高对PCP的认识,做到早期诊断;适当控制免疫抑制剂应用、改善患儿生活环境、针对高危人群定期检测CD4细胞水平以及酌情应用复方磺胺甲基异噁唑预防均有利于降低肺孢子菌肺炎的发病率.

  3. Critical importance of long-term adherence to care in HIV infected patients in the cART era: new insights from Pneumocystis jirovecii pneumonia cases over 2004-2011 in the FHDH-ANRS CO4 cohort.

    Directory of Open Access Journals (Sweden)

    Blandine Denis

    Full Text Available OBJECTIVE: To describe characteristics and outcomes of HIV-infected patients with Pneumocystis jirovecii pneumonia (PCP over 2004-2011 in France, in particular in those previously enrolled (PE in the French Hospital Database on HIV (FHDH. METHODS: PE patients with an incident PCP were compared with patients with an inaugural PCP revealing HIV infection (reference. Adequate adherence to care was defined as a CD4 measurement at least every 6 months. Immune reconstitution (CD4≥200/mm3 and risk of death were studied using Kaplan-Meier estimates and multivariable Cox proportional hazards models. RESULTS: In a context of a decreasing incidence of PCP, 1259 HIV-infected patients had a PCP diagnosis, and 593 (47% were PE patients of whom 161 (27% have had a prior history of AIDS-defining clinical illness (prior ADI. Median time since enrolment was 8 years for PE patients; 74% had received cART. Median proportion of time with adequate adherence to care was 85% (IQR, 66-96 for all FHDH enrollees, but only 45% (IQR, 1-81 for PE patients during the 2 years before PCP. Median CD4 cell count (38/mm3 and HIV viral load (5.2 log10 copies/ml at PCP diagnosis did not differ between PE patients and the reference group. Three year mortality rate of 25% was observed for PE prior ADI group, higher than in PE non-prior ADI group (8% and the reference group (9% (p<0.0001. In the PE prior ADI group, poor prognosis remained even after adjustment for virological control and immune reconstitution (HR, 2.4 [95%CI, 1.5-3.7]. CONCLUSION: Almost 50% of PCP diagnoses in HIV-infected patients occurred presently in patients already in care, mainly with a previous cART prescription but with waning adherence to care. Having repeated ADI is contributing to the risk of death beyond its impact on immune reconstitution and viral suppression: special efforts must be undertaken to maintain those patients in care.

  4. 卡泊芬净联合克林霉素治疗重症肺孢子菌肺炎的案例分析%Analysis of caspofungin combined with clindamycin for severe pneumocystis pneumonia

    Institute of Scientific and Technical Information of China (English)

    周庆涛; 沈宁; 王蒙; 孙丽娜; 丁艳苓; 贺蓓

    2016-01-01

    Objective To investigate the therapeutic value of caspofun-gin combined with clindamycin for pneumocystis pneumonia ( PCP ).Methods The clinical data of two severe PCP patients treated by caspo-fungin combined with clindamycin regimen in department of respiratory medicine of our hospital were analyzed.Because of definitely sulfame-thoxazole/trimethoprim (SMZ/TMP) allergy history, they were both ini-tially treated with caspofungin single drug , and received mechanical ven-tilation and methylprednisolone treatment.However , clindamycin was added to both patients after 3-4 days because of poor response to caspo-fungin monotherapy.Then they got better gradually , the arterial blood gas and chest CT scan showed that the respiratory failure and lung infil-tration were much improved.Results and Conclusion The courses of caspofungin combined with clindamycin were both 3 weeks, the patients were cured without adverse drug reactions.For PCP patients with limited usage of SMZ/TMP, caspofungin combined with clindamycin may be an effective and safe regimen.%目的:探讨卡泊芬净联合克林霉素治疗肺孢子菌肺炎的价值。方法分析我院呼吸内科2例接受卡泊芬净联合克林霉素治疗的重症肺孢子菌肺炎患者的临床资料。2例患者均因明确的磺胺药过敏史而给予卡泊芬净初始单药治疗,同时给予机械通气、甲泼尼龙等治疗。3~4d后,因疗效欠佳而加用克林霉素,病情逐渐好转,复查动脉血气分析和胸部CT提示呼吸衰竭纠正、双肺渗出性病变明显吸收好转。结果与结论卡泊芬净联合克林霉素治疗3周,2例患者均治愈,且无不良反应。对于磺胺甲噁唑/甲氧苄啶不能耐受或治疗失败的肺孢子菌肺炎患者,卡泊芬净联合克林霉素方案可能是安全、有效的选择。

  5. Fungal Opportunistic Pneumonias in HIV/AIDS Patients: An Indian Tertiary Care Experience

    Science.gov (United States)

    Mehra, Bhanu; Dhakad, Megh Singh; Goyal, Ritu; Bhalla, Preena; Dewan, Richa

    2017-01-01

    Introduction Opportunistic pneumonias are a major cause of mortality and morbidity in Human Immunodeficiency Virus (HIV) reactive patients. Despite the significant role that fungi play in causation of this opportunistic mycoses, very few Indian studies have attempted to investigate the burden and aetiological spectrum of HIV/AIDS-associated fungal pneumonias. Aim To document the prevalence of fungal aetiology in HIV/AIDS-related opportunistic pneumonias in an Indian setting; and to elucidate the various fungal opportunists responsible for the same. Materials and Methods The present study was a prospective, cross-sectional analysis conducted at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi from October 2008 to September 2011. Expectorated sputa were collected from 71 HIV reactive patients with a clinical diagnosis of pneumonia and subjected to direct microscopic examination employing Gram stain, 10% KOH wet mount and India ink preparation. In addition, direct immunofluorescence of sputum samples was performed for detection of cysts and trophozoites of Pneumocystis carinii. Also, each sputum sample was inoculated in duplicate onto Sabouraud Dextrose Agar (SDA) for culture. A blood sample was drawn from each patient and a battery of serological tests was performed, including Cryptococcal Antigen Latex Agglutination System (CALASTM) for detection of cryptococcal capsular polysaccharide antigen; Platelia™ Aspergillus EIA for detection of Aspergillus galactomannan antigen; SERION ELISA antigen Candida for detection of Candida antigen and Histoplasma DxSelect™ for detecting antibodies to Histoplasma species. Descriptive statistics were employed to depict results as proportions and figures. Further, arithmetic mean and standard deviation were calculated for central tendencies and median for non-normal/skewed distributions. Results A definite fungal aetiology was established in 25 (35.2%) of 71 HIV reactive patients with pneumonic involvement

  6. Related risk factors for Pneumocystis pneumonia in AIDS patients%艾滋病患者肺孢子菌肺炎相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    邹美银; 凌勇武; 汪美华; 朱勇根; 张健荣

    2015-01-01

    OBJECTIVE To explore the risk factors for Pneumocystis pneumonia (PCP) in the AIDS patients so as to provide guidance for early identification of PCP .METHODS A total of 117 AIDS patients who were treated in the hospital from Oct 2013 to Nov 2014 were recruited as the study objects .A retrospective study was conducted , the indicators of the AIDS patients with PCP and the AIDS patients without PCP ,including the age ,gender ,in‐terval between onset of HIV infection and admission to hospital ,antifungal therapy ,oral fungal disease ,lympho‐cytes ,CD3 + T cell ,CD4 + T cell ,CD8 + T cell ,and NK cell counts ,were observed ,and the statistical analysis was performed with the use of SPSS19 .0 software .RESULTS The results of the univariate analysis showed that there was significant difference in the interval between onset of HIV infection and admission to hospital ,antifungal ther‐apy ,oral fungal disease ,or level of lymphocytes ,CD3 + T cell or CD4 + T between the AIDS patients with PCP and the AIDS patients without PCP (P0 .05) .CONCLUSION The no more than 31 .7/μl of CD4 + T counts and no more than 3 .5 months of the interval between onset of HIV infection and admission to hospital are the good indicators for the prediction of PCP in the AIDS patients with HIV infection .%目的:探讨艾滋病患者发生肺孢子菌肺炎(PC P )的危险因素,以期早期识别 PC P的发生。方法选择2013年10月-2014年11月117例艾滋病患者为研究对象,采用回顾性研究的方法,分析艾滋病发生与未发生PC P患者年龄、性别、发现 H IV感染至入院间隔时间、抗病毒治疗、口腔真菌病、淋巴细胞、CD3+ T细胞、CD4+ T细胞、CD8+ T细胞、NK细胞计数等指标,应用SPSS 19.0软件进行统计分析。结果单因素分析结果为发现HIV感染至入院间隔时间、抗病毒、口腔真菌病以及淋巴细胞、CD3+ T细胞、CD4+ T细胞表达水平在发生与未发生PCP患者中

  7. Pneumocystis Infections: MedlinePlus Health Topic

    Science.gov (United States)

    ... with bilateral ankle pain (microangiopathy) and complicated... Article: Comparison of a commercial real-time PCR assay, RealCycler® ... the sharing features on this page, please enable JavaScript. About MedlinePlus Site Map FAQs Customer Support Get ...

  8. Mycobacterial and nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus infection: A prospective, cohort study

    Directory of Open Access Journals (Sweden)

    Afessa Bekele

    2001-09-01

    Full Text Available Abstract Background A prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV infection. Methods The study included 1,225 consecutive hospital admissions of 599 HIV-infected patients treated from April 1995 through March 1998. Data included demographics, risk factors for HIV infection, Acute Physiology and Chronic Health Evaluation (APACHE II score, pulmonary complications, CD4+ lymphocyte count, hospital stay and case-fatality rate. Results Patient age (mean ± SD was 38.2 ± 8.9 years, 62% were men, and 84% were African American. The median APACHE II score was 14, and median CD4+ lymphocyte count was 60/μL. Pulmonary complications were Pneumocystis carinii pneumonia (85 in 78 patients, Mycobacterium avium complex (51 in 38, Mycobacterium tuberculosis (40 in 35, Mycobacterium gordonae (11 in 11, Mycobacterium kansasii (10 in 9, Cytomegalovirus (10 in 10, Nocardia asteroides (3 in 3, fungus ball (2 in 2, respiratory syncytial virus (1, herpes simplex virus (1, Histoplasma capsulatum (1, lymphoma (3 in 3, bronchogenic carcinoma (2 in 2, and Kaposi sarcoma (1. The case-fatality rate of patients was 11% with Pneumocystis carinii pneumonia; 5%, Mycobacterium tuberculosis; 6%, Mycobacterium avium complex; and 7%, noninfectious pulmonary complications. Conclusion Most pulmonary complications in hospitalized patients with HIV are from Pneumocystis and mycobacterial infection.

  9. 非人类免疫缺陷病毒感染患儿重症肺孢子菌肺炎的临床特点%Clinical characteristics of severe pneumocystis pneumonia in children without human immunodeficiency virus ;infection

    Institute of Scientific and Technical Information of China (English)

    刘霜; 任晓旭; 郭琳瑛; 梁金鑫; 祝益民

    2015-01-01

    目的:观察非人类免疫缺陷病毒(HIV)感染儿童重症肺孢子菌肺炎(PCP)的临床特点、感染的危险因素、治疗及预后。方法回顾性分析首都儿科研究所附属儿童医院儿科重症监护室( PICU)诊断非HIV感染重症PCP患儿的临床特点、感染危险因素、治疗及预后。结果2010年4月至2014年4月,首都儿科研究所附属儿童医院PICU诊断非HIV重症PCP共10例,其中急性白血病2例,结缔组织病3例,先天性免疫缺陷病2例,重症肺炎3例。10例患儿均出现发热、咳嗽、气促和进行性加重呼吸困难。10例PCP在诊断时均存在呼吸衰竭,小儿危重评分中位数79分,入PICU时动脉血氧分压(鼻管氧)中位数为58 mmHg(1 mmHg=0.133 kPa),氧合指数中位数为103 mmHg,肺泡-动脉氧分压差中位数为43.8 mmHg,CD4+T淋巴细胞计数中位数169×106/L。8例入PICU时为混合感染。10例均合并急性呼吸窘迫综合征(ARDS),7例有其他脏器功能不全。10例均进行机械通气,有创呼吸机使用时间中位数11 d,无创呼吸机使用时间中位数6 d。5例出现气胸或皮下、纵隔气肿。10例患儿诊断后均接受甲氧苄啶-磺胺甲唑治疗,糖皮质激素辅助治疗;7例联合卡泊芬净治疗。6例在治疗过程中出现院内感染。 PICU住院时间中位数15.5 d。存活6例,死亡4例(40%)。结论对于非HIV感染免疫功能低下患儿,PCP可能是致命性疾病,易并发ARDS,甚至多脏器功能障碍。早期进行病原学检查,积极予呼吸支持治疗,应用保护性肺通气策略,可改善预后。%Objective To investigate the clinical parameters,risk factors,treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective a-nalysis was made for the clinical features,risk factors,treatment and prognoses of the non-HIV infected severe PCP pa-tients hospitalized at Pediatric Intensive Care Unit( PICU) of Children

  10. Experimental study on the application of polymerase chain reaction in detection of pneumocystis jiroveci%聚合酶链反应检测肺孢子菌的实验研究

    Institute of Scientific and Technical Information of China (English)

    赵辉; 刘亮; 陈希胜

    2012-01-01

    目的 探讨应用改良传统三步聚合酶链反应(PCR)方法检测肺孢子菌DNA的意义.方法 选择Wistar大鼠40只,随机分成实验组和对照组各20只.实验组每周2次皮下注射地塞米松,诱导产生肺孢子菌;对照组注射等剂量的生理盐水.8周后,收集大鼠肺组织和支气管肺泡灌洗液(BALF),分别用三步法与两步法PCR技术检测肺孢子菌DNA,并与Giemsa染色法比较.结果 PCR方法检测肺泡灌洗液中肺孢子菌DNA的方法敏感性(70%)明显高于常规染色法(30%)(P<0.05),且敏感度93%、特异度100%、阳性预测值100%、阴性预测值83%.实验组中PCR检测肺组织和支气管肺泡灌洗液的肺孢子菌DNA阴性者,Giemsa病原染色法亦为阴性.实验组大鼠的肺组织与支气管肺泡灌洗液分别行传统三步法与二步法PCR检测,2种检测方法阳性率相同,分别为80%和70%,差异无统计学意义(P>0.05).对照组大鼠各种方法检测均为阴性.结论 两步法PCR可作为早期诊断肺孢子菌肺炎(PCP)的方法,可用于BALF中检测肺孢子菌DNA,其敏感度、特异度、阳性预测值和阴性预测值均很高,易于临床推广应用.%Objective To investigate the significance of the application of improved conventional three-step polymerase chain reaction (PCR) to detect pneumocystis jiroveci (PJ). Methods 40 Wistar rats were selected and randomized into experimental and control groups (n=20 each). The experimental group was subcutaneously injected dexamethasone twice a week for induction of PJ, while the control group was injected the same dose of saline. Bron-chio-alveolar lavage fluid (BALF) of the two groups was collected after 8 weeks and detected DNA of PJ using three-step PCR and two-step PCR, respectively. Thereafter, the PCR was compared with Giemsa stain. Results The sensitivity of PCR (70%) was significantly higher than that of the conventional stain method (30%) in detection of DNA of PJ in BALF (F<0

  11. Trimethoprim-sulfamethoxazole induced acute interstitial nephritis in renal allografts; clinical course and outcome.

    LENUS (Irish Health Repository)

    Garvey, J P

    2009-11-01

    Acute interstitial nephritis (AIN) secondary to trimethoprim-sulfamethoxazole (TMP-SMX) is well documented as a cause of acute renal failure in native kidneys. TMP-SMX is the standard prophylactic agent against pneumocystis carinii (PCP) used in the early post-transplant period, however, it has to date only been indirectly associated with AIN in renal allografts. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We describe eleven renal transplant patients with acute allograft dysfunction in whom a transplant biopsy demonstrated primary histopathologic features of allergic AIN, all of whom were receiving TMP-SMX in addition to other medications known to cause AIN.

  12. First national guidelines will help better control HIV/AIDS in China

    Institute of Scientific and Technical Information of China (English)

    WANG Ai-xia

    2006-01-01

    @@ A cquired immunodeficiency syndrome (AIDS)was first recognized in the United States in the Summer of 1981,1,2 when the US Centers for Disease Control and Prevention (CDC) reported the unexplained occurrence of Pneumocystis carinii pneumonia (PCP) in 5 cases and Kaposi's sarcoma in 26 cases of previouly healthy homosexual men in Los Angeles and New York. Within months, the disease became recognized in male and female intravenous drug users (IDU) and soon after in recipients of blood or IDV transfusions and in hemophiliacs.3

  13. Legionellosis in patients with HIV infection

    DEFF Research Database (Denmark)

    Bangsborg, Jette Marie; Jensen, B N; Friis-Møller, A

    1990-01-01

    During the five-year period 1984-1988 we received 192 specimens from 180 patients infected with the human immunodeficiency virus (HIV) for investigation of Legionella infection. The majority of specimens were bronchoalveolar lavage (BAL) fluids (84%), but tracheal suctions and lung tissue from...... specimens additionally for Pneumocystis carinii and mycobacteria. Legionellosis was not found to be common among HIV-infected patients, as only six specimens (3%) from six patients were found positive by DFA, and no specimens were culture-positive for Legionella species. Dual infection with Legionella and P...

  14. Sloth biology: an update on their physiological ecology, behavior and role as vectors of arthropods and arboviruses.

    Science.gov (United States)

    Gilmore, D P; Da Costa, C P; Duarte, D P

    2001-01-01

    This is a review of the research undertaken since 1971 on the behavior and physiological ecology of sloths. The animals exhibit numerous fascinating features. Sloth hair is extremely specialized for a wet tropical environment and contains symbiotic algae. Activity shows circadian and seasonal variation. Nutrients derived from the food, particularly in Bradypus, only barely match the requirements for energy expenditure. Sloths are hosts to a fascinating array of commensal and parasitic arthropods and are carriers of various arthropod-borne viruses. Sloths are known reservoirs of the flagellate protozoan which causes leishmaniasis in humans, and may also carry trypanosomes and the protozoan Pneumocystis carinii.

  15. Sloth biology: an update on their physiological ecology, behavior and role as vectors of arthropods and arboviruses

    Directory of Open Access Journals (Sweden)

    Gilmore D.P.

    2001-01-01

    Full Text Available This is a review of the research undertaken since 1971 on the behavior and physiological ecology of sloths. The animals exhibit numerous fascinating features. Sloth hair is extremely specialized for a wet tropical environment and contains symbiotic algae. Activity shows circadian and seasonal variation. Nutrients derived from the food, particularly in Bradypus, only barely match the requirements for energy expenditure. Sloths are hosts to a fascinating array of commensal and parasitic arthropods and are carriers of various arthropod-borne viruses. Sloths are known reservoirs of the flagellate protozoan which causes leishmaniasis in humans, and may also carry trypanosomes and the protozoan Pneumocystis carinii.

  16. Cutaneous gallium uptake in patients with AIDS with mycobacterium avium-intracellulare septicemia

    Energy Technology Data Exchange (ETDEWEB)

    Allwright, S.J.; Chapman, P.R.; Antico, V.F.; Gruenewald, S.M.

    1988-07-01

    Gallium imaging is increasingly being used for the early detection of complications in patients with AIDS. A 26-year-old homosexual man who was HIV antibody positive underwent gallium imaging for investigation of possible Pneumocystis carinii pneumonia. Widespread cutaneous focal uptake was seen, which was subsequently shown to be due to mycobacterium avium-intracellulare (MAI) septicemia. This case demonstrates the importance of whole body imaging rather than imaging target areas only, the utility of gallium imaging in aiding the early detection of clinically unsuspected disease, and shows a new pattern of gallium uptake in disseminated MAI infection.

  17. Fatal bilateral pneumothoraces following administration of aerosolised pentamidine.

    Science.gov (United States)

    Green, Alison; Milne, Nathan; Ong, Beng Beng

    2011-10-01

    Aerosolised pentamidine (AP) is used for prophylaxis against infection with Pneumocystis jiroveci (carinii), a significant cause of morbidity and mortality for people with human immunodeficiency virus (HIV). In this article we report a 55 year old man with HIV and a background history of asthma since childhood, who suffered respiratory arrest and died within an hour of commencing AP prophylaxis. Autopsy revealed bilateral pneumothoraces. Common side effects of AP therapy include bronchospasm and coughing. Pneumothorax has been reported in several cases. To our knowledge, this is the first reported fatality from bilateral pneumothoraces.

  18. In vitro screening of pentamidine analogs against bacterial and fungal strains.

    Science.gov (United States)

    Maciejewska, Dorota; Żabiński, Jerzy; Kaźmierczak, Paweł; Wójciuk, Karolina; Kruszewski, Marcin; Kruszewska, Hanna

    2014-07-01

    A series of linear pentamidine analogs exhibiting low cytotoxicity, active against Pneumocystis carinii, were evaluated for in vitro activities against bacterial and fungal strains. The majority of the tested bis-amidines exhibited marked activities against Gram-positive strains. In view of the fact that the highest potency was found for 1,5-bis(4-amidinophenoxy)-3-thiapentane dihydrochloride 1j with the S atom in the middle of the aliphatic linker, four new pentamidines bearing S atoms were synthesized and also evaluated against MRSA strains. N,N'-Dialkylated pentamidines with S atoms in the linker are the promising lead structures for antimicrobials development.

  19. HRCT findings of chest complications in patients with leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Nobuyuki; Matsumoto, Tsuneo; Miura, Gouji; Emoto, Takuya; Matsunaga, Naofumi [Department of Radiology, Yamaguchi University School of Medicine (Japan)

    2002-06-01

    High-resolution CT (HRCT) findings of several chest complications occurring in leukemic patients were reviewed. Although most entities show non-specific HRCT findings including ground-glass opacity and air-space consolidation, characteristic findings are observed in several pulmonary complications including Pneumocystis carinii pneumonia, fungal infections, miliary tuberculosis, leukemic infiltration, pulmonary edema, bronchiolitis obliterans, and bronchiolitis obliterans organizing pneumonia. A combination of these characteristic HRCT findings and the information obtained from the clinical setting may help in achieving a correct diagnosis of chest complications occurring in leukemic patients. (orig.)

  20. Acquired severe pneumonia in the community in seropositive HIV patients.

    Directory of Open Access Journals (Sweden)

    Héctor Cruz de los Santos

    2004-12-01

    Full Text Available Infection due to the Human Immunodeficiency Virus (HIVhas become a principal health problem worldwide mainly in underdeveloped countries. In these patients, respiratory infections constitute the greatest cause of morbimortality rate in which Pneumocystis Carinii is the most frequently found pathogen. However, this article describes the case of a woman who is seropositive to HIV and who developed a severe and rapidly fatal community acquired pneumonia dur to Sthaphylococcus aureus, a very rare and less common infection in this kind of patients.

  1. Beware the lymphopenia: a case of severe combined immunodeficiency.

    Science.gov (United States)

    Mehr, Sam; Kakakios, Alyson; Shaw, Peter; Webster, Richard; Kemp, Andrew

    2011-08-01

    We present a case of a 2-month-old boy with partially treated meningitis and suspected Pneumocystis carinii pneumonia. A full blood count revealed profound lymphopenia. The child was diagnosed with adenosine deaminase deficiency, a rare cause of severe combined immunodeficiency (SCID). SCID is an immunological emergency and must be considered in any lymphopaenic infant with opportunistic infection. We discuss adenosine deaminase-deficient SCID, which can involve multiple systems and in which other treatment options apart from bone marrow transplant are available.

  2. Detection of thoracic infections by nuclear medicine techniques in the acquired immunodeficiency syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, E.L.; Sanger, J.J. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))

    1989-11-01

    The challenge of the acquired immunodeficiency syndrome (AIDS) for nuclear medicine has been the early detection of related intrathoracic opportunistic infections, inflammatory conditions, and neoplasms. Gallium-67 citrate scanning has proved a sensitive test not only for Pneumocystis carinii pneumonia but for many of the other opportunistic infections and malignancies, including mycobacterial infections and lymphoma. Patterns and intensity of gallium uptake may suggest more specific diagnoses. Indium-111-labeled white blood cells may also be a valuable diagnostic tool in the AIDS patient.41 references.

  3. Acquired immunodeficiency syndrome associated with blood-product transfusions

    Energy Technology Data Exchange (ETDEWEB)

    Jett, J.R.; Kuritsky, J.N.; Katzmann, J.A.; Homburger, H.A.

    1983-11-01

    A 53-year-old white man had fever, malaise, and dyspnea on exertion. His chest roentgenogram was normal, but pulmonary function tests showed impaired diffusion capacity and a gallium scan showed marked uptake in the lungs. Results of an open-lung biopsy documented Pneumocystis carinii pneumonia. Immunologic test results were consistent with the acquired immunodeficiency syndrome. The patient denied having homosexual contact or using intravenous drugs. Twenty-nine months before the diagnosis of pneumocystis pneumonia was made, the patient had had 16 transfusions of whole blood, platelets, and fresh-frozen plasma during coronary artery bypass surgery at another medical center. This patient is not a member of any currently recognized high-risk group and is believed to have contracted the acquired immunodeficiency syndrome from blood and blood-product transfusions.

  4. Haemophilia, AIDS and lung epithelial permeability

    Energy Technology Data Exchange (ETDEWEB)

    O' Doherty, M.J.; Page, C.J.; Harrington, C.; Nunan, T.; Savidge, G. (Haemophilia Centre and Coagulation Research Unit, Department of Nuclear Medicine, Rayne Institute, St. Thomas' Hospital, London (United Kingdom))

    1990-01-01

    Lung {sup 99m}Tc DTPA transfer was measured in HIV antibodypositive haemophiliacs (11 smokers, 26 nonsmokers, 5 patients with Pneumocystis carinii pneumonia (PCP)). Lung {sup 99m}Tc DTPA transfer as a marker of lung epithelial permeability was measured as the half time of transfer (from airspace into blood). This half time was faster in smokers compred to nonsmokers and the transfer curve was monoexponential. In nonsmokers no difference was observed between asymptomatic HIV-positive haemophiliacs and normal subjects, with the exception of the lung bases. At the lung basis in HIV-positive haemophiliac nonsmokers the transfer was faster than in normal individuals, implying increased alveolar permeability. Pneumocystis carinii pneumonia resulted in a rapid transfer of {sup 99m}Tc DTPA (mean T50 of 2 minutes) and the transfer curve was biphasic, confirming previous observations in homosexual HIV antibody-positive patients with PCP. These changes returned to a monoexponential profile by 6 weeks following successful treatment. The DTPA lung transfer study may enable clinicians to instigate therapy for PCP without the need for initial bronchoscopy and provide a noninvasive method for the reassessment of patients should further respiratory signs or symptoms develop. This method is considered to be highly cost-effective in that it obviates the use of factor VIII concentrates required to cover bronchoscopic procedures and, with its early application and ease of use as a follow-up investigation, permits the evaluation of patients on an outpatient basis, thus reducing hospital costs. (au).

  5. AIDS-defining illnesses among patients with HIV in Singapore, 1985 to 2001: results from the Singapore HIV Observational Cohort Study (SHOCS

    Directory of Open Access Journals (Sweden)

    Bellamy Richard

    2004-11-01

    Full Text Available Abstract Background The objective was to describe the causes of initial and overall AIDS-defining disease episodes among HIV patients in Singapore. Methods A retrospective observational cohort study was performed of all adult patients seen at the national HIV referral center between 1985 and 2001. Data were extracted from the patients' records by ten trained healthcare workers. AIDS-defining conditions were established using predefined criteria. Results Among 1504 patients, 834 had experienced one or more AIDS-defining diseases. The most frequent causes of the initial AIDS-defining episode were Pneumocystis carinii pneumonia (35.7%, Mycobacterium tuberculosis (22.7% and herpes simplex (7.4%. In total 1742 AIDS-defining episodes occurred. The most frequent causes were Pneumocystis carinii pneumonia (25.1%, Mycobacterium tuberculosis (16.2% and cytomegalovirus retinitis (9.5%. Conclusions The most frequent causes of AIDS-defining illnesses in Singapore are similar to those reported in the West, prior to the introduction of anti-retroviral therapy. Opportunistic infections remain the most frequent AIDS-defining illnesses.

  6. 154 Responding to the challenge of AIDS Associated Cancers in Nigeria

    OpenAIRE

    Blattner, William; Adebamowo, Clement

    2014-01-01

    The stabilization of the HIV epidemic in Africa has uncovered new epidemic of HIV associated comorbidities including cancers which the poorly developed health care system, poor infrastructure and lack of personnel is unable to cope with. In November 2012, international leaders in Cancer Research and Policy from 15 countries met at the NIH, Bethesda and made recommendations about the interventions needed to respond to the global cancer challenge in the world. These include (1) Creation of reli...

  7. [The Balanced Scorecard: quality management in aide associations/foundations and home care services].

    Science.gov (United States)

    Charbon, J; Oyon, D

    2001-11-01

    In order to improve and defend quality of care, the foundation for help and home care in the canton de Vaud called upon modern instruments and methods of management, which proved their value in managing quality and innovation in world famous firms. The Balanced Scorecard developed by Kaplan and Norton belongs to these tools. This article summarise the setting up of this instrument by a non-profit organisation in health care, and illustrates its benefits and limits. Despite the absence of objective proofs of added value brought upon by the Balanced Scorecard, the first signs of a major mentality change can be detected, in which the client becomes the central part of the mission of the organisation.

  8. Iron regulation of the major virulence factors in the AIDS-associated pathogen Cryptococcus neoformans.

    Directory of Open Access Journals (Sweden)

    Won Hee Jung

    2006-11-01

    Full Text Available Iron overload is known to exacerbate many infectious diseases, and conversely, iron withholding is an important defense strategy for mammalian hosts. Iron is a critical cue for Cryptococcus neoformans because the fungus senses iron to regulate elaboration of the polysaccharide capsule that is the major virulence factor during infection. Excess iron exacerbates experimental cryptococcosis and the prevalence of this disease in Sub-Saharan Africa has been associated with nutritional and genetic aspects of iron loading in the background of the HIV/AIDS epidemic. We demonstrate that the iron-responsive transcription factor Cir1 in Cr. neoformans controls the regulon of genes for iron acquisition such that cir1 mutants are "blind" to changes in external iron levels. Cir1 also controls the known major virulence factors of the pathogen including the capsule, the formation of the anti-oxidant melanin in the cell wall, and the ability to grow at host body temperature. Thus, the fungus is remarkably tuned to perceive iron as part of the disease process, as confirmed by the avirulence of the cir1 mutant; this characteristic of the pathogen may provide opportunities for antifungal treatment.

  9. AIDS-associated plasmablastic lymphoma presenting as a poorly differentiated esophageal tumor: A diagnostic dilemma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Plasmablastic lymphoma (PBL) is a rare form of diffuse large B-cell lymphoma characterized by weak/absent expression of conventional B-cell markers and strong expression of plasma cell markers. It is strongly associated with human immunodeficiency virus (HIV) and Epstein Barr virus infection, and shows an unusual tropism to the oral cavity. Herein we describe a patient with AIDS who presented with weight loss and dysphagia owing to a large gastroesophageal mass. His radiographic and endoscopic findings and long history of cigarette consumption suggested carcinoma. Biopsy demonstrated a poorly differentiated tumor stained negatively to routine lymphoid markers including CD20. However, gene rearrangement studies confirmed a B-cell process and a more detailed immunohistochemical analysis revealed the cells stained positively for CD138 (plasma cell antigen). These findings were diagnostic of PBL. Our report reviews the wide differential diagnosis of PBL and underscores the importance of a broad array of viral and molecular studies needed to establish this diagnosis.

  10. Dihydropteroate synthase gene mutations in Pneumocystis and sulfa resistance

    DEFF Research Database (Denmark)

    Huang, Laurence; Crothers, Kristina; Atzori, Chiara

    2004-01-01

    in the dihydropteroate synthase (DHPS) gene. Similar mutations have been observed in P. jirovecii. Studies have consistently demonstrated a significant association between the use of sulfa drugs for PCP prophylaxis and DHPS gene mutations. Whether these mutations confer resistance to TMP-SMX or dapsone plus trimethoprim...

  11. Strain typing methods and molecular epidemiology of Pneumocystis pneumonia

    DEFF Research Database (Denmark)

    Beard, Charles Ben; Roux, Patricia; Nevez, Gilles;

    2004-01-01

    have relied on polymerase chain reaction-based approaches. Studies using these methods have improved understanding of PCP epidemiology, shedding light on sources of infection, transmission patterns, and potential emergence of antimicrobial resistance. One concern, however, is the lack of guidance...... regarding the appropriateness of different methods and standardization of these methods, which would facilitate comparing results reported by different laboratories....

  12. The practice of infectious diseases in the 1990s: the Canadian experience.

    Science.gov (United States)

    Schlech, W F

    1995-02-01

    A survey of the members of the Canadian Infectious Disease Society was carried out to determine the content of an infectious diseases consultative practice in the 1990s. Respondents were asked to identify all new inpatient, outpatient, and telephone consultations during a 1-week period in 1990. Consultations were categorized by the infectious disease syndrome of the patient and by the microorganism that was identified. Bacterial infections were the most common cause of inpatient consultations, while viral infections were more common in outpatients. Consultations for parasitic infections were primarily for Pneumocystis carinii pneumonia related to infection with the human immunodeficiency virus (HIV). "Newer" infectious disease syndromes such as chronic fatigue syndrome, toxic shock syndrome, and Lyme disease were all represented in the responses for the 1-week study period. The significant impact of HIV infection on the overall consultative load suggests that there will be a continuing need for newly trained infectious disease consultants into the 21st century.

  13. Diagnosis of pulmonary infections with HIV (+) patients. Brought of aerosol DTPA-Tc99m and of Ga67 citrate. Le diagnostic des infections pulmonaires chez les malades VIH (+). Apport de l'aerosol DTPA-Tc99m et du citrate de Ga67

    Energy Technology Data Exchange (ETDEWEB)

    Banzo, I.; Quirce, R.; Serrano, J.; Jimenez, J.; Tabuenca, O.; Carril, J.M. (Hopital Universitaire Valdecilla, Santander (Spain))

    1993-04-01

    The pulmonary clearance of aerosol DTPA-Tc99m is a technology easy to use, well support by patients with immediate results. With the pneumonia at Pneumocystis Carinii (PPC), the clearance is more sensitive and more specific than the thoracic scintigraphy with Ga67. Used with a thorax radiography, results will lead to three directions: High probability of PPC, di phasic curve and very fast T50, equal inferior to 5,10 mn. Low probability of PPC, monoexponential curve and abnormal thorax radiography or di phasic curve with a value T50 superior to 5,10 mn. With these patients other explorations will be made (Ga67, biopsy) and if possible search pulmonary tuberculosis. Extra pulmonary pathology: monoexponential curve associated with a normal thoracic radiography. 2 figs.

  14. Zidovudine treatment of AIDS and ARC in Denmark 1987

    DEFF Research Database (Denmark)

    Teglbjærg, Lars Stubbe; Mathiesen, L R; Søeberg, B;

    1989-01-01

    In 1987, a total of 138 Danish patients (94 AIDS and 44 ARC) received treatment with zidovudine, a total observation period of 572 treatment months. 15 AIDS and 1 ARC patient died after a median of 70 days (range 2-295). In the ARC group 4 patients developed AIDS (3 Pneumocystis carinii pneumonia......, 1 Kaposi's sarcoma). Among the AIDS patients 38 new opportunistic infections were reported. 24 of these opportunistic infections occurred within 6 weeks after treatment initiation. 79 patients were observed for more than 3 months, 25 of these had their daily dose zidovudine reduced, usually from 1...... on 94 occasions and 19 (14%) patients required multiple transfusions. The mortality among the AIDS patients was significantly lower compared to historical controls. In our experience zidovudine treatment is reasonably well tolerated and the side effects are manageable....

  15. Opportunistic infections and malignancies in 231 Danish AIDS patients

    DEFF Research Database (Denmark)

    Pedersen, C; Gerstoft, J; Tauris, P;

    1990-01-01

    We analysed cumulative disease frequencies in the first 231 adult Danish AIDS patients with life tables. There was a certain hierarchical pattern in the occurrence of complicating diseases. Herpes zoster, Kaposi's sarcoma and Pneumocystis carinii pneumonia were early manifestations, whereas...... diseases caused by cytomegalovirus and atypical mycobacteria tended to occur later in the course of AIDS. Compared with all other AIDS patients, homosexual men were more likely to develop Kaposi's sarcoma, cytomegalovirus chorioretinitis and mucocutaneous herpes simplex virus infection. The proportion...... of patients who developed particular diseases changed with calendar time. Most striking was a three to fourfold decrease in diseases caused by cytomegalovirus. In conclusion, the study showed that disease frequencies in patients with AIDS may vary with the patients risk behaviour and duration of AIDS...

  16. AcEST: BP914514 [AcEST

    Lifescience Database Archive (English)

    Full Text Available YMU001_000059_G04 533 Adiantum capillus-veneris mRNA. clone: YMU001_000059_G04. BP914514 - Show BP914514...is mRNA. clone: YMU001_000059_G04. Accession BP914514 Tissue type prothallium Developmental stage - Contig I...sp|P29251|FOL1_PNECA Folic acid synthesis protein fol1 OS=Pneumocystis carinii Align length 171 Score (bit) 14...es. 25:3389-3402. Query= BP914514|Adiantum capillus-veneris mRNA, clone: YMU001_000059_G04. (533 letters) Da...tabase: uniprot_sprot.fasta 412,525 sequences; 148,809,765 total letters Searching..........................

  17. Aids e miopatia relato de um caso e revisão da literatura

    Directory of Open Access Journals (Sweden)

    Káris M. de Pinho Rodrigues

    1991-09-01

    Full Text Available É relatado o caso de um paciente com miopatia de apresentação clínica incomum como manifestação inicial da infecção por HIV. O paciente apresentava aumento de volume dos membros acompanhado de sinais flogísticos e elevação dos níveis séricos de enzimas musculares. A alteração histopatológica predominante consistia em necrose segmentar de fibrocélulas musculares esqueléticas. Evoluiu com pneumonia por Pneumocystis carinii, tratada satisfatoriamente com sulfametoxazol e trimetropim. Apesar do uso sucessivo de indometacina, prednisona e dexametasona, a miopatia continuava a progredir. Após administração de methotrexate, houve regressão do quadro neurológico.

  18. Zidovudine treatment of AIDS and ARC in Denmark 1987

    DEFF Research Database (Denmark)

    Teglbjaerg, L L; Mathiesen, Lars Reinhardt; Søeberg, B;

    1989-01-01

    ,200 mg to 600 mg, 9 others were temporarily off drug. HIV antigen was analyzed in serum samples from 93 patients. Of these, 28 (52%) of 54 initially HIV antigen-positive became antigen-negative, 7 (18%) of 39 initially HIV antigen-negative became antigen-positive within the first 8 weeks of zidovudine......In 1987, a total of 138 Danish patients (94 AIDS and 44 ARC) received treatment with zidovudine, a total observation period of 572 treatment months. 15 AIDS and 1 ARC patient died after a median of 70 days (range 2-295). In the ARC group 4 patients developed AIDS (3 Pneumocystis carinii pneumonia......, 1 Kaposi's sarcoma). Among the AIDS patients 38 new opportunistic infections were reported. 24 of these opportunistic infections occurred within 6 weeks after treatment initiation. 79 patients were observed for more than 3 months, 25 of these had their daily dose zidovudine reduced, usually from 1...

  19. 肾移植术后肺部感染的诊断和治疗%Diagnosis and treatment of pulmonary infection after renal transplantation

    Institute of Scientific and Technical Information of China (English)

    何元兵; 魏妍荣

    2008-01-01

    With use of immunosuppressive drugs, incident rate of pulmonary infection in renal transplant recipients has obviously increased. This issue has caused wide public concern. There are four main pathogens which include cytomegalovirus, Pneumocystis carinii, fungus and bacteria. This review will describe epidemiology,clinical manifestations,diagnosis and treatment about these patients.%由于肾移植术后免疫抑制剂的大量使用,肺部感染的发病率明显增加,这引起广泛关注.肾移植术后肺部感染常见病原菌以巨细胞病毒、肺孢子菌、真菌、细菌为主.本文就以上4种病原菌的流行病学特点、临床表现、诊断和治疗等方面作一论述.

  20. Dectin-1 and Dectin-2 in innate immunity against fungi.

    Science.gov (United States)

    Saijo, Shinobu; Iwakura, Yoichiro

    2011-08-01

    Dectin-1 and Dectin-2 are type II transmembrane proteins of the C-type lectin family with single carbohydrate recognition domains (CRDs) in their extracellular region. They are expressed mainly in dendritic cells and macrophages. Dectin-1 recognizes β-glucans with its CRD and transduces signals through its immunoreceptor tyrosine-based activation motif (ITAM)-like motif in the cytoplasmic domain, whereas Dectin-2 recognizes α-mannans and transduces its signal through association with the ITAM-containing Fc receptor γ chain. Upon ligand binding, spleen tyrosine kinase is recruited to the ITAM and activates the caspase recruitment domain family member 9 (CARD9)-nuclear factor-κB axis, resulting in the activation of various genes including those encoding pro-inflammatory cytokines. Both β-glucans and α-mannans are major cell wall components of fungi including Candida albicans and Pneumocystis carinii. Recently, it was reported that Dectin-1 is important in protection against P. carinii by inducing reactive oxygen species, whereas both Dectin-1 and Dectin-2 play important roles in defense against C. albicans by preferentially inducing T(h)17 cell differentiation. In this review, we briefly revisit the structures, ligands, signal transduction and functional roles of Dectin-1 and Dectin-2 in host defense against fungal infection.

  1. Review of zoonotic parasites in medical and veterinary fields in the Republic of Korea.

    Science.gov (United States)

    Youn, Heejeong

    2009-10-01

    Zoonotic parasites are animal parasites that can infect humans. The major zoonotic protozoa in the Republic of Korea are Babesia bovis, Chilomastix mesnili, Cryptosporidium parvum, Endolimax nana, Entamoeba coli, Entamoeba hitolytica, Giardia lamblia, Iodamoeba bütschlii, Pneumocystis carinii, Sarcocystis cruzi, and Toxoplasma gondii. The major zoonotic helminths in Korea include trematodes, cestodes, and nematodes. Trematodes are Clonorchis sinensis, Echinostoma hortense, Echinostoma spp., Fasciola hepatica, Heterophyes nocens, Metagonimus yokogawai, and Paragonimus westermani. Cestodes are Diphyllobothrium latum, Dipylidium caninum, Echinococcus granulosus, Hymenolepis nana, Raillietina tetragona, sparganum (Spirometra spp.), Taenia saginata, T. solium, and T. asiatica. Nematodes are Ancylostoma caninum, Brugia malayi, Capillaria hepatica, Dirofilaria immitis, Gnathostoma dololesi, Gnathostoma spinigerum, Loa loa, Onchocerca gibsoni, Strongyloides stercoralis, Thelazia callipaeda, Trichinella spiralis, Trichostrongylus orientalis, Trichuris trichiura, and Trichuris vulpis. The one arthropod is Sarcoptes scabiei. Many of these parasites have disappeared or were in decline after the 1990's. Since the late 1990's, the important zoonotic protozoa have been C. parvum, E. nana, E. coli, E. hitolytica, G. lamblia, I. buetschlii, P. carinii and T. gondii. The important zoonotic helminths have been C. sinensis, H. nocens, M. yokogawai, P. westermani, D. latum, T. asiatica, sparganum, B. malayi, T. orientalis, T. callipaeda and T. spiralis. However, outbreaks of these parasites are only in a few endemic areas. The outbreaks of Enterobius vermicularis and head lice, human parasites, have recently increased in the kindergartens and primary schools in the Republic of Korea.

  2. Pharmacokinetic justification of antiprotozoal therapy. A US perspective.

    Science.gov (United States)

    Berman, J D; Fleckenstein, L

    1991-12-01

    Infections with parasitic protozoa have always been problems for the developing world and are becoming of greater importance to the developed world in this age of easy international travel. The major human protozoal diseases are summarised with an emphasis on their presentation in normal hosts and in immunocompromised individuals and current US drug treatment recommendations are discussed. Present antiprotozoal regimens are based either on a pharmacokinetic rationale or on clinical trial and error. Regimens based on trial and error include amphotericin B against leishmaniasis and arsenic against African trypanosomiasis. Regimens which are to some extent driven by pharmacokinetic or biochemical considerations include paromomycin and metronidazole against amoebiasis, sodium stibogluconate against leishmaniasis, halofantrine and mefloquine against malaria, dihydrofolate reductase (DHFR) inhibitors against Pneumocystis carinii and toxoplasmosis and aerosolised pentamidine against P. carinii pneumonia. The majority of pharmacokinetic studies have been performed only on agents which have some therapeutic activity against other diseases of the developed world. Despite the trend toward rational treatment regimens, no studies have been performed that permit optimisation of antiprotozoal treatment regimens on the basis of clinical conditions such as renal failure.

  3. Genetic characterization of Toxoplasma gondii from autopsy proven cases of AIDS associated cerebral toxoplasmosis in South India.

    Science.gov (United States)

    Vijaykumar, B R; Lekshmi, Swathi U; Sai Kant, R; Vaigundan, D; Mahadevan, Anita; Rajendran, C; Shankar, S K; Jayshree, R S

    2016-04-01

    Toxoplasma gondii (T.gondii) infection can be devastating in the immunodeficient causing high morbidity and mortality. Due to limited availability of both diagnostic facilities and Highly Active Antiretroviral Therapy (HAART), toxoplasmosis continues to be a significant problem amongst Acquired Immuno Deficiency Syndrome (AIDS) patients in India. While scanty literature is available on T. gondii isolates in animals in India, little is known about the genetic diversity of the parasite in humans. Therefore, the present study investigated the genetic diversity of T. gondii in 25 confirmed cases of cerebral toxoplasmosis developing on the background of human immunodeficiency virus (HIV) infection/AIDS. PCR DNA sequencing was performed at four important genetic loci of T. gondii: BTUB, GRA6, alternative SAG2 (alt SAG2) and SAG3 on DNA from tissues obtained at postmortem. The amplified products from all the cases were successfully sequenced except at one locus for one case. Results of the present study suggest that majority of the patients (22/25; 88%) in South India are infected with strains that are recombinants of type II/III and/or strains representing T. gondii different from the archetypal lineages I, II, and III. In addition, clonal types III, MAS, and MAS variant genotypes were encountered. No clonal type I or II was seen in the present study. In addition, variants were observed at alt SAG2 and SAG3 but BTUB and GRA6 were highly conserved. Single nucleotide polymorphisms were observed mainly at two loci which are coding for surface antigens at alt SAG2 and SAG3. In conclusion, the present study reveals genetic diversity in India amongst strains of T. gondii from clinical cases of toxoplasmosis which is in accordance with other recent studies showing a high rate of genetic diversity in this parasite across the globe. There is a need to genotype T. gondii from different forms of toxoplasmosis in humans in India.

  4. HIV- and AIDS-associated neurocognitive functioning in Zambia – a perspective based on differences between the genders

    Directory of Open Access Journals (Sweden)

    Kabuba N

    2016-08-01

    Full Text Available Norma Kabuba,1,2 J Anitha Menon,1 Donald R Franklin Jr,3 Robert K Heaton,3 Knut A Hestad2,4,5 1Department of Psychology, The University of Zambia, Lusaka, Zambia; 2Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Psychiatry, University of California, San Diego, CA, USA; 4Department of Research, Innlandet Hospital Trust, Hamar, Norway; 5Department of Public Health, Hedmark University of Applied Sciences, Elverum, Norway Abstract: Human immunodeficiency virus (HIV infection and acquired immune deficiency syndrome (AIDS are frequently associated with neurocognitive impairment (NCI. However, few studies have examined the interrelationship between gender and NCI in the HIV and AIDS population. This cross-sectional study examined the neurocognitive (NC functioning of HIV-infected male and female adults from urban Zambia. The participants included 266 HIV seropositive (HIV+ adults (males [n=107] and females [n=159]. Participants completed NC assessment by means of a comprehensive test battery using normative data from 324 HIV-seronegative (HIV- controls. The norms corrected for effects of age, education, and gender in the general population, and the test battery measures domains of attention/working memory (learning and delayed recall, executive function, verbal fluency, processing speed, verbal and visual episodic memory, and fine motor skills. An overall comparison of the HIV+ male and female participants yielded no statistically significant differences. Analysis of covariance results controlling for disease characteristics showed that HIV+ female participants had worse delayed recall scores than males, F(1,117 =9.70, P=0.002, partial ƞ2=0.077. The females also evidenced a trend toward greater impairment on learning efficiency (P=0.015. The findings suggest that there are gender-related differences in NCI after controlling for disease characteristics. It was observed that although the HIV+ females enjoyed better health compared to their HIV+ male counterparts, they still had worse performance on the neuropsychological tests. This implies that HIV may have more NC consequences for Zambian females than males. Keywords: HIV-1, neurocognitive functioning, gender, Zambia

  5. Tuberculose como doença definidora de síndrome da imunodeficiência adquirida: dez anos de evolução na Cidade do Rio de Janeiro Tuberculosis as a disease defining acquired immunodeficiency syndrome: ten years of surveillance in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Elizabeth Cristina Coelho Soares

    2006-10-01

    Full Text Available OBJETIVO: Analisar a freqüência da tuberculose e das outras principais doenças oportunistas definidoras de síndrome da imunodeficiência adquirida, no momento em que estes casos são notificados, no Município do Rio de Janeiro. MÉTODOS: Análise do banco de dados do Sistema de Vigilância Epidemiológica do Programa de Doenças Sexualmente Transmissíveis e Síndrome da Imunodeficiência Adquirida da Cidade do Rio de Janeiro, no período de 1993 a 2002. RESULTADOS: A expansão da definição de casos de síndrome da imunodeficiência adquirida ocorrida em 1998 criou um aumento substancial no número de casos notificados de síndrome da imunodeficiência adquirida, principalmente por aqueles que passaram a ser definidos pelo critério imunológico. Dentre os casos de síndrome da imunodeficiência adquirida que foram definidos apenas por doença, a candidíase em suas diversas formas manteve-se como a doença oportunista de maior freqüência no momento da notificação. Embora a pneumonia por Pneumocystis carinii se apresentasse como a segunda doença mais freqüente na maioria dos anos observados, a partir de 2001, a tuberculose ultrapassou-a em freqüência, tornando-se a segunda doença mais freqüente no momento da notificação dos casos de síndrome da imunodeficiência adquirida. CONCLUSÃO: Apesar da diminuição do número de casos de síndrome da imunodeficiência adquirida definidos por doença, a tuberculose manteve-se como um importante evento definidor dessa síndrome, sendo atualmente de ocorrência mais freqüente do que a pneumonia por Pneumocystis carinii e a toxoplasmose, provavelmente por sua alta taxa de prevalência na cidade.OBJECTIVE: To analyze the frequency of tuberculosis and of the other principal opportunistic infections defining acquired immunodeficiency syndrome at the time such cases were reported in the city of Rio de Janeiro, Brazil. METHODS: Analysis of the data compiled in the Rio de Janeiro Municipal

  6. Structure-based design of selective inhibitors of dihydrofolate reductase: synthesis and antiparasitic activity of 2, 4-diaminopteridine analogues with a bridged diarylamine side chain.

    Science.gov (United States)

    Rosowsky, A; Cody, V; Galitsky, N; Fu, H; Papoulis, A T; Queener, S F

    1999-11-18

    As part of a larger search for potent as well as selective inhibitors of dihydrofolate reductase (DHFR) enzymes from opportunistic pathogens found in patients with AIDS and other immune disorders, N-[(2,4-diaminopteridin-6-yl)methyl]dibenz[b,f]azepine (4a) and the corresponding dihydrodibenz[b,f]azepine, dihydroacridine, phenoxazine, phenothiazine, carbazole, and diphenylamine analogues were synthesized from 2, 4-diamino-6-(bromomethyl)pteridine in 50-75% yield by reaction with the sodium salts of the amines in dry tetrahydrofuran at room temperature. The products were tested for the ability to inhibit DHFR from Pneumocystis carinii (pcDHFR), Toxoplasma gondii (tgDHFR), Mycobacterium avium (maDHFR), and rat liver (rlDHFR). The member of the series with the best combination of potency and species selectivity was 4a, with IC(50) values against the four enzymes of 0. 21, 0.043, 0.012, and 4.4 microM, respectively. The dihydroacridine, phenothiazine, and carbazole analogues were also potent, but nonselective. Of the compounds tested, 4a was the only one to successfully combine the potency of trimetrexate with the selectivity of trimethoprim. Molecular docking simulations using published 3D structural coordinates for the crystalline ternary complexes of pcDHFR and hDHFR suggested a possible structural interpretation for the binding selectivity of 4a and the lack of selectivity of the other compounds. According to this model, 4a is selective because of a unique propensity of the seven-membered ring in the dibenz[b,f]azepine moiety to adopt a puckered orientation that allows it to fit more comfortably into the active site of the P. carinii enzyme than into the active site of the human enzyme. Compound 4a was also evaluated for the ability to be taken up into, and retard the growth of, P. carinii and T. gondii in culture. The IC(50) of 4a against P. carinii trophozoites after 7 days of continuous drug treatment was 1.9 microM as compared with previously observed IC(50

  7. Discussion of CT Image Features of Specific Lung Infection after Renal Transplantation%肾移植患者术后特异性肺部感染的 CT 影像特点

    Institute of Scientific and Technical Information of China (English)

    赵鹤亮; 陈昕; 洪波; 张惠英

    2014-01-01

    OBJECTIVE To observe the CT image features of specific lung infection after renal transplantation so as to provide references for clinical treatments .METHODS Totally 70 patients with specific lung infections after renal transplantation were chosen from Jan .2009 to Dec .2013 and their lungs were scanned by Light Speed 64 VCT scanner .In addition ,all patients were given blood cultures to find infectious pathogens .RESULTS Bacterial pneu‐monia accounted for 42 .86% ,cytomegalovirus pneumonia accounted for 12 .86% ,pneumocystis carinii pneumonia accounted for 5 .71% , pulmonary tuberculosis accounted for 17 .14% , and mycotic pneumonia accounted for 21 .43% .Among them ,there were 17 cases with CT manifestation as diffuse patch and grinding glassy spots or net‐shaped shadow including 18 .57% of cytomegalovirus pneumonia and 5 .71% of pneumocystis carinii pneumoni‐a .CONCLUSION Specific lung infections after renal transplantation were mainly bacterial pneumonias ,and differ‐ent infection types have distinctive CT features .Bacterial and mycotic pneumonias mainly feature with lung paren‐chyma seepage ,cytomegalovirus and pneumocystis carinii pneumonia mainly feature with pulmonary interstitial thickening ,and pulmonary tuberculosis mainly features with uneven millets .%目的:观察肾移植术后特异性肺部感染的C T影像特点,为临床治疗提供参考依据。方法临床纳入2009年1月-2013年12月70例肾移植术后发生特异性肺部感染的患者,采用飞利浦256层螺旋C T 机进行肺部扫描;此外,所有患者进行血液培养,查找感染病原体。结果细菌感染性肺炎、巨细胞病毒性肺炎、卡氏肺囊虫肺炎、肺结核、真菌性肺炎分别占42.86%、12.86%、5.71%、21.43%;其中,C T表现为弥漫性斑片与磨玻璃状斑点状或网状阴影患者17例,巨细胞病毒性肺炎18.57%、卡氏肺囊虫肺炎5.71%。结论肾移植术后特异性肺感染以

  8. Fungal recognition enhances mannose receptor shedding through dectin-1 engagement.

    Science.gov (United States)

    Gazi, Umut; Rosas, Marcela; Singh, Sonali; Heinsbroek, Sigrid; Haq, Imran; Johnson, Simon; Brown, Gordon D; Williams, David L; Taylor, Philip R; Martinez-Pomares, Luisa

    2011-03-11

    The mannose receptor (MR) is an endocytic type I membrane molecule with a broad ligand specificity that is involved in both hemostasis and pathogen recognition. Membrane-anchored MR is cleaved by a metalloproteinase into functional soluble MR (sMR) composed of the extracellular domains of intact MR. Although sMR production was initially considered a constitutive process, enhanced MR shedding has been observed in response to the fungal pathogen Pneumocystis carinii. In this work, we have investigated the mechanism mediating enhanced MR shedding in response to fungi. We show that other fungal species, including Candida albicans and Aspergillus fumigatus, together with zymosan, a preparation of the cell wall of Saccharomyces cerevisiae, mimic the effect of P. carinii on sMR production and that this effect takes place mainly through β-glucan recognition. Additionally, we demonstrate that MR cleavage in response to C. albicans and bioactive particulate β-glucan requires expression of dectin-1. Our data, obtained using specific inhibitors, are consistent with the canonical Syk-mediated pathway triggered by dectin-1 being mainly responsible for inducing MR shedding, with Raf-1 being partially involved. As in the case of steady-state conditions, MR shedding in response to C. albicans and β-glucan particles requires metalloprotease activity. The induction of MR shedding by dectin-1 has clear implications for the role of MR in fungal recognition, as sMR was previously shown to retain the ability to bind fungal pathogens and can interact with numerous host molecules, including lysosomal hydrolases. Thus, MR cleavage could also impact on the magnitude of inflammation during fungal infection.

  9. Relationship between Radiological Stages and Prognoses of Pneumocystis Pneumonia in Non-AIDS Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Xiang-Dong Mu

    2016-01-01

    Conclusions: Based on the radiological manifestations, the course of PCP in non-AIDS immunocompromised patients can be divided into three stages: early stage, mid stage, and late stage. The prognoses of patients treated at early stage are good, and those at late stage are poor. Furthermore, the CFR of patients with barotrauma is high.

  10. Relationship between Radiological Stages and Prognoses of Pneumocystis Pneumonia in Non-AIDS Immunocompromised Patients

    Institute of Scientific and Technical Information of China (English)

    Xiang-Dong Mu; Peng Jia; Li Gao; Li Su; Cheng Zhang; Ren-Gui Wang; Guang-Fa Wang

    2016-01-01

    Background:Although radiological features ofpneumocystis pneumonia (PCP) in non-Acquired Immune Deficiency Syndrome (AIDS) immunocompromised patients have been reported by other authors,there were no studies on the radiological stages of PCP previously.This study aimed to elucidate the radiological stages and prognoses of PCP in non-AIDS immunocompromised patients.Methods:Retrospective analysis ofradiological manifestations and prognoses of 105 non-AIDS PCP immunocompromised patients from August 2009 to April 2016 was conducted.Chest radiograph was divided into three stages:early stage (normal or nearly normal chest radiograph),mid stage (bilateral pulmonary infiltrates),and late stage (bilateral pulmonary consolidations);chest high-resolution computed tomography (HRCT) was also divided into three stages:early stage (bilateral diffuse ground-glass opacity [GGO]),mid stage (bilateral diffuse GGO and patchy consolidations),and late stage (bilateral diffuse consolidations).Results:The case fatality rate (CFR) of all patients was 34.3% (36/105),all of them took routine chest X-ray (CXR),and 84 underwent chest CT examinations.According to the CXR most near the beginning of anti-PCP therapy,18 cases were at early stage and CFR was 0 (0/18,P < 0.0 1),50 cases were at mid stage and CFR was 28.0% (14/50,P > 0.05),and 37 cases were at late stage and CFR was 59.5% (22/37,P < 0.01).According to the chest HRCT most near the beginning ofanti-PCP therapy,40 cases were at early stage and CFR was 20.0% (8/40,P > 0.05),34 cases were at mid stage and CFR was 47.1% (16/34,P > 0.05),and 10 cases were at late stage and CFR was 80.0% (8/10,P < 0.05);barotrauma,including pneumothorax,pneumomediastinum,and pneumohypoderma,was found in 18 cases and the C FR was 77.8% (14/18,P < 0.01).Conclusions:Based on the radiological manifestations,the course of PCP in non-AIDS immunocompromised patients can be divided into three stages:early stage,mid stage,and late stage.The prognoses of patients treated at early stage are good,and those at late stage are poor.Furthermore,the CFR of patients with barotrauma is high.

  11. Radiological diagnosis in AIDS - associated diseases: survey and differential diagnosis; AIDS-assoziierte Krankheitsbilder in der radiologischen Diagnostik: Ueberblick und Differentialdiagnose

    Energy Technology Data Exchange (ETDEWEB)

    Rademaker, J. [Beth Israel Medical Center, New York, NY (United States). Dept. of Medicine; Frahm, C. [Medizinische Univ. Luebeck (Germany). Inst. fuer Radiologische Diagnostik

    1997-03-01

    Acute manifestations of illnesses in patients with HIV-infection or AIDS will benefit from rapid diagnosis. Radiologic examinations provide substantial information to narrow the differential diagnosis. This article reviews clinically important HIV-associated diseases for the radiologist. The braod spectrum of possible manifestations is illustrated by the accompanying case reports that typify the complexity of diagnoses in this growing problem worldwide. (orig.) [Deutsch] Die oft akute Manifestation von Erkrankungen bei Patienten mit HIV-Infektion oder AIDS erfordert eine effektive Diagnostik. Radiologische Untersuchungen koennen dabei wichtige Informationen zur Einengung des diffentialdiagnostischen Spektrums geben. Die vorliegende Arbeit stellt die fuer den Radiologen wichtigsten AIDS-assoziierten Erkrankungen vor. Fallberichte demonstrieren das breite Spektrum der moeglichen Erkrankungen und illustrieren die Komplexitaet der moeglichen Befunde in diesem weltweit wachsenden Problem. (orig.)

  12. In vitro susceptibilities of the AIDS-associated microsporidian Encephalitozoon intestinalis to albendazole, its sulfoxide metabolite, and 12 additional benzimidazole derivatives.

    OpenAIRE

    Katiyar, S. K.; Edlind, T D

    1997-01-01

    Recent reports have described the successful treatment of Encephalitozoon intestinalis infection in AIDS patients with albendazole. However, this compound is rapidly metabolized in vivo to albendazole sulfoxide, and furthermore it is only 1 of about 15 commercially developed benzimidazole derivatives. To compare the activities of albendazole, albendazole sulfoxide, and other benzimidazoles, an in vitro system involving infection of green monkey kidney cell (E6) monolayers with E. intestinalis...

  13. 艾滋病恐惧症患者的自杀行为%Irrational fear of AIDS associated with suicidal behavior

    Institute of Scientific and Technical Information of China (English)

    裴迎新; 曾光

    2010-01-01

    Irrational fear of AIDS can occur when people suffer from high levels of guilt and shame arising from extramarital sex. Despite negative medical testing of anfi-HIV, the patients can come to acquire an irrational conviction that they have AIDS and fear of infection and death to others, so they maybe commit or attempt to suicide. In this paper,suicidal behavior among AIDS phobia patients and contrast between AIDS phobia and syphilis phobia are reviewed. While AIDS phobia may not be common, and suicide acts based on this symptom complex may not be common, it is helpful for physicians to learn potential suicidal risk among these patients.%艾滋病恐惧症通常是患者在婚外性行为后感到内疚及羞耻的基础上发生的.尽管HIV抗体检测阴性,患者却仍坚信自己患有艾滋病,并担心会将疾病及死亡带给家人而产生自杀企图或实施自杀.此文综述了艾滋病恐惧症患者的自杀行为,也将艾滋病恐惧症与梅毒恐惧症进行了对比.虽然这样的病例并不常见,并且在这种患者中的自杀行为也不常见,但对临床医生了解这类患者具有潜在的自杀危险还是有所助益的.

  14. New targets and delivery systems for antifungal therapy.

    Science.gov (United States)

    Walsh, T J; Viviani, M A; Arathoon, E; Chiou, C; Ghannoum, M; Groll, A H; Odds, F C

    2000-01-01

    Development of new approaches for treatment of invasive fungal infections encompasses new delivery systems for approved and investigational compounds, as well as exploiting the cell membrane, cell wall and virulence factors as putative antifungal targets. Novel delivery systems consisting of cyclodextrins, cochleates, nanoparticles/nanospheres and long circulating ('stealth') liposomes, substantially modulate the pharmacokinetics of existing compounds, and may also be useful to enhance the delivery of antifungal agents to sites of infection. Further insights into the structure-activity relationship of the antifungal triazoles that target the biosynthesis of ergosterol in the fungal cell membrane have led to the development of highly potent broad spectrum agents, including posaconazole, ravuconazole and voriconazole. Similarly, a novel generation of cell-wall active semisynthetic echinocandin 1,3 beta-glucan inhibitors (caspofungin, FK463, and VER-002) has entered clinical development. These agents have potent and broad-spectrum activity against Candida spp, and potentially useful activity against Aspergillus spp. and Pneumocystis carinii. The ongoing convergence of the fields of molecular pathogenesis, antifungal pharmacology and vaccine development will afford the opportunity to develop novel targets to complement the existing antifungal armamentarium.

  15. Pulmonary bacterial and fungal infections in human immunodeficiency virus patients: A study from India

    Directory of Open Access Journals (Sweden)

    K Shreevidya

    2012-01-01

    Full Text Available Background: Human Immunodeficiency Virus (HIV-reactive patients are more prone to infections. The morbidity and mortality in HIV-reactive patients is due to opportunistic infections. Most of the infections seen in Acquired Immunodeficiency Syndrome are endemic to that geographical region. Hence, this study was undertaken to document the occurrence of pulmonary bacterial and fungal infections in HIV patients. Materials and Methods: Expectorated and induced sputum samples were collected from 100 HIV-reactive patients and processed for bacterial and fungal pathogens including Pneumocystis carinii. Results: Of 100 samples, 66 were culture positive. Among the isolates, Mycobacterium tuberculosis constituted the highest number, 55 (83.3%, followed by other bacterial infections, 11 (16.6%, and fungi, 2 (3.03%. Tuberculosis patients had a CD4 count of less than 250 cells/μl with a mean count of 186 cells/μl and those with bacterial infections had a CD4 count of more than 300 cells/μl. The study showed that males were infected with HIV more than females and most of them belonged to the adult age group in the prime of their working life. Weight loss followed by fever and cough were the most common symptoms. Conclusion: M. tuberculosis is the most common opportunistic pathogen followed by bacterial pathogens infecting the lung in HIV. Low CD4 count is a dangerous signal of decreased immune status and higher chances of opportunistic infections and high mortality.

  16. Measles mimicking HIV seroconversion syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Brook Gary

    2010-02-01

    Full Text Available Abstract Introduction Measles is on the rise in the United Kingdom and must be considered in the differential diagnosis of any patient presenting with fever and rash. As a highly infectious disease, identified patients must be isolated in the hospital setting. Case presentation A 28-year-old Polish woman presented ill to the accident and emergency department of a district general hospital. She had painful genital ulceration, oral soreness, fever, and a facial rash. She became hypoxic within 24 hours of presentation and began to tire, thus requiring noninvasive ventilation. Her respiratory symptoms were out of proportion to the findings of her chest radiograph, which remained virtually normal. Human immunodeficiency virus seroconversion syndrome complicated by Pneumocystis carinii pneumonia was high among the differential diagnoses. She was given cotrimoxazole, high-dose steroids, broad spectrum antibiotics, and anti fungal cover. Human immunodeficiency virus polymerase chain reaction came back as negative and her symptoms resolved within 10 days of presentation. She was taken off all treatment and discharged home feeling well. Serological measles was confirmed as part of a viral screen, but its clinical suspicion was low. Conclusion The presentation of measles in this patient was unique and atypical. With its incidence rising in the United Kingdom, measles must be increasingly considered as a differential diagnosis in patients presenting with fever and rash.

  17. International NeuroAIDS: prospects of HIV-1 associated neurological complications

    Institute of Scientific and Technical Information of China (English)

    J; Roberto; TRUJILLO; Gilberto; JARAMILLO-RANGEL; Marta; ORTEGA-MARTINEZ; Augusto; C; PENALVA; de; OLIVEIRA; Jose; E; VIDAL; Joseph; BRYANT; Robert; C; GALLO

    2005-01-01

    Neurological complications associated with HIV-1/AIDS are being recognized with a high frequency that parallels the increased number of AIDS cases. The early infiltration by HIV- 1 into the nervous system can cause primary and/or secondary neurological complications. The most common neurocognitive disorder is AIDS Dementia Complex (ADC).In developing countries of Asia the three most opportunistic infections are tuberculosis (TB), cryptococcosis, and Pneumocystis carinii pneumonia. Therefore, it is expected that secondary neurological complications due to TB and cryptococcosis will be the most common cause of morbility and mortality in HIV- 1/AIDS cases in China. Research of NeuroAIDS in China is necessary to understand the impact and the biology of HIV-1 in the nervous system. Future studies would include, the molecular epidemiology and the description of opportunistic infections associated to HIV-1;the neuropathological description of primary and secondary HIV-1 complications in different groups; the HIV-1 neurotropism and immune response studies for China's unique HIV-1 strains and recombinant forms derived from the nervous system, including experimental models such as the use of transgenic rats; and the study of potential resistant virus,primarily when the anti-retroviral therapy (ART) has not full access in the brain.

  18. Acquired immunodeficiency syndrome and its ocular complications

    Directory of Open Access Journals (Sweden)

    Rao Narsing

    1994-01-01

    Full Text Available Human immunodeficiency virus infection is the first major pandemic of the 20th century. At present, almost 10 million people are known to be infected with this virus, and it is estimated that by the year 2000, approximately 40 million people will be infected. Transmission of this deadly infection is predominantly by sexual contact. Individuals infected with this virus pass through several predictable stages with progressive decrease in circulating CD4+ T cells. During the advanced stage, these patients develop various opportunistic infections or malignancies, or both. It is this advanced stage that was first recognized as AIDS, which has a 100% mortality rate. The opportunistic organisms that can involve the eye in patients with AIDS include cytomegalovirus, herpes zoster, Toxoplasma gondii, Mycobacterium tuberculosis, Cryptococcus neoformans, Mycobacterium avium-intracellulare, Pneumocystis carinii, Histoplasma capsulatum, Candida, and others. Intraocular lesions from these agents often represent disseminated infections. Visual morbidity occurs secondary to retinitis due to cytomegalovirus, herpes zoster, or Toxoplasma gondii. Anti-viral agents such as ganciclovir or foscarnet are effective against cytomegalovirus infection. The role of the ophthalmologist in the diagnosis and management of AIDS is becoming increasingly important. Not only does the eye reflect systemic disease, but ocular involvement may often precede systemic manifestations. In the AIDS patient, the ophthalmologist thus has an opportunity to make not only a slight-saving, but also life-saving diagnosis of disseminated opportunistic infections.

  19. THE CLINICAL SPECTRUM OF RESPIRATORY DISEASES IN PATIENTS WITH PRIMARY ANTIBODY DEFICIENCY

    Directory of Open Access Journals (Sweden)

    A. Aghamohammadi

    2000-08-01

    Full Text Available Primary Humoral Immunodeficiencies (PHID are currently increasingly being recognized. Patients with PHID frequently show respiratory complications.The objectives of the study is to determine the clinical spectrum of respiratory diseases in patients with PHID."We extracted data from the clinical files of patients with PHID, diagnosed according to WHO criteria. We encountered 125 patients (84 males, with the diagnosis of primary antibody deficiency including common-variable immunodeficiency (64 pts, x-linked agammaglobulinemia (29 pts, IgA deficiency (20 pts, IgG-subc!ass deficiency (8 pts, and hyper-IgM syndrome (4 pts. The mean age of the patients at the time of study was 11 years. In the evolution of their disease, 92 cases (73.6% developed upper respiratory tract infections, among which acute otitis media (68 pts, 54.4%, sinusitis (61 pts, 48.8%, and pharyngitis (12 pts, 10.4% were found to be the most frequent. Among the lower respiratory tract infections, pneumonia was the most common occurance (91 pts, 72.8%. The other lower respiratory tract complications were: bronchiectasis (22 pts, 17.6%, bronchitis (8 pts, tuberculosis (6 pts, lung abscess (4 pts, and Pneumocystis carinii pneumonia (2 pts.Respiratory infections constitute the most common presenting symptom of patients with primary humoral immunodeficiency. There may be some differences in the type and frequency of infections in each of these disorders.

  20. Long-term outcomes of liver transplant patients with human immunodeficiency virus infection and end-stage-liver-disease: single center experience

    Directory of Open Access Journals (Sweden)

    Vernadakis S

    2011-08-01

    Full Text Available Abstract Objective Orthotopic-liver-transplantation (OLT in patients with Human-Immunodeficiency-Virus infection (HIV and end-stage-liver-disease (ESDL is rarely reported. The purpose of this study is to describe our institutional experience on OLT for HIV positive patients. Material and methods This is a retrospective study of all HIV-infected patients who underwent OLT at the University Hospital of Essen, from January 1996 to December 2009. Age, sex, HIV transmission-way, CDC-stage, etiology of ESDL, concomitant liver disease, last CD4cell count and HIV-viral load prior to OLT were collected and analysed. Standard calcineurin-inhibitors-based immunosuppression was applied. All patients received anti-fungal and anti-pneumocystis carinii pneumonia prophylaxis post-OLT. Results Eight transplanted HIV-infected patients with a median age of 46 years (range 35-61 years were included. OLT indications were HCV (n = 5, HBV (n = 2, HCV/HBV/HDV-related cirrhosis (n = 1 and acute liver-failure (n = 1. At OLT, CD4 cell-counts ranged from 113-621 cells/μl, and HIV viral-loads from Conclusions OLT in HIV-infected patients and ESLD is an acceptable therapeutic option in selected patients. Long-term survival can be achieved without HIV disease-progression under antiretroviral therapy and management of the viral hepatitis co-infection.

  1. Lichenoid mucocutaneous syndrome a variant of para neoplastic pemphigus (PNP following the treatment of follicular non-Hodgkin’s lymphoma with fludarabine

    Directory of Open Access Journals (Sweden)

    Katz J

    2013-05-01

    Full Text Available Background: Paraneoplastic pemphigus (PNP is an autoimmune mucocutaneous disease associated with cancer. Since the original description of the condition, various publications have suggested the presence of a heterogeneous spectrum of paraneoplastic mucocutaneous conditions with clinical features of lichenplanus. Several cases of PNP have been reported following treatment with fludarabine. Methods: We present a case of lichenoid syndrome in a follicular B-cell non-Hodgkin lymphoma (NHL patient after treatment with fludarabine and review 8 additional published cases of fludarabine related PNP. Results: Our case is unique due to the fact that the patient presented with lichenoid features both clinically and microscopically and responded well to rituximab therapy. According to literature, both skin and mucosa (eyes and gastrointestinal tract are involved and symptoms start about 1-2 weeks after exposure to fludarabine. Various immunosuppressive treatments have been employed including high dose steroids. Many of these patients developed complications related to the immunosuppressive therapy such as cytomegalovirus, candidiasis and pneumocystis carinii infection and died from respiratory failure. On the other hand, long-term remissions have also been described. Conclusion: Our case represents an unusual case of fludarabine related to mucocutaneous lichenoid syndrome, a variant of PNP, and in view of the outcome in previously described cases, rituximab may be considered a preferred and safe first line therapy for such complication.

  2. [Nosocomial infection: clinical aspects].

    Science.gov (United States)

    Frottier, J

    1993-05-01

    Nosocomial infections develop within a hospital or are produced by microorganisms acquired during hospitalization. They may involve not only patients (2 to 10 percent) but also hospital personnel. They arise from complex interactions of multiple causal factors. Patients risk factors are these that reduce the patient's capacity for resisting the injurious effects of the microorganisms and impair natural host defense mechanisms: patients with malignant disorders or immunosuppressive therapy, poor nutritional status, extensive burn wounds ... The young and the elderly are generally more susceptible to infection. Other infections are preventable. Disease causation is often multifactorial. Nosocomial urinary tract infections had the highest rate, followed by lower respiratory tract infections, surgical infections and bacteremias. The emergence of other nosocomial infections, caused by bacteria (tuberculosis), virus (HIV, hepatitis B and C virus, cytomegalovirus...), Aspergillus species or Pneumocystis carinii appears to be recent in origin and is of importance to immunocompromised hosts, other patients and hospital personnel. Nosocomial infections and their social and economic impacts require for their prevention vigorous organized hospital-wide surveillance and control programs.

  3. International NeuroAIDS: prospects of HIV-1 associated neurological complications.

    Science.gov (United States)

    Trujillo, J Roberto; Jaramillo-Rangel, Gilberto; Ortega-Martinez, Marta; Penalva de Oliveira, Augusto C; Vidal, Jose E; Bryant, Joseph; Gallo, Robert C

    2005-01-01

    Neurological complications associated with HIV-1/AIDS are being recognized with a high frequency that parallels the increased number of AIDS cases. The early infiltration by HIV-1 into the nervous system can cause primary and/or secondary neurological complications. The most common neurocognitive disorder is AIDS Dementia Complex (ADC). In developing countries of Asia the three most opportunistic infections are tuberculosis (TB), cryptococcosis, and Pneumocystis carinii pneumonia. Therefore, it is expected that secondary neurological complications due to TB and cryptococcosis will be the most common cause of morbility and mortality in HIV-1/AIDS cases in China. Research of NeuroAIDS in China is necessary to understand the impact and the biology of HIV-1 in the nervous system. Future studies would include, the molecular epidemiology and the description of opportunistic infections associated to HIV-1; the neuropathological description of primary and secondary HIV-1 complications in different groups; the HIV-1 neurotropism and immune response studies for China's unique HIV-1 strains and recombinant forms derived from the nervous system, including experimental models such as the use of transgenic rats; and the study of potential resistant virus, primarily when the anti-retroviral therapy (ART) has not full access in the brain.

  4. Caveolae in the uptake and targeting of infectious agents and secreted toxins.

    Science.gov (United States)

    Norkin, L C

    2001-07-28

    A variety of microbial pathogens, including viruses, intracellular bacteria, and prions, as well as certain secreted bacterial toxins, can now be added to the list of ligands that enter cells via caveolae or caveolae-like membrane domains. In general, the caveolae-mediated entry pathway results in transport of these microbes and toxins to intracellular destinations that are different from that of cargo entering by other means. As a result, the caveolae-mediated entry pathway can profoundly affect the host cell-pathogen interaction long after entry has occurred. Furthermore, some microbes such as SV40 that enter via cavolae will be valuable as probes to analyze certain poorly understood intracellular trafficking pathways, such as retrograde transport to the ER. Also, viruses that enter via caveolae may have unique potential as gene and drug delivery vectors. In addition, some extracellular microbial pathogens, such as Pneumocystis carinii, may also interact with host cells via caveolae. Finally, caveolae may play a role in host immune defense mechanisms.

  5. Sputum induction - A useful tool in diagnosis of respiratory diseases

    Directory of Open Access Journals (Sweden)

    Gupta K

    2006-01-01

    Full Text Available Sputum induction by inhalation of hypertonic saline is a noninvasive, simple, cost effective and safe procedure to collect respiratory secre-tions from lung airways for diagnosis of various respiratory diseases. Sputum induction has higher yield in comparison to spontaneous sputum, BAL, bronchial washing and gastric lavage. It is widely used to assess airway inflammation in asthma and chronic obstructive pulmonary disease (COPD. It can be used as a complementary tool to BAL both in research and in clinical monitoring of patients with interstitial lung disease (ILD. The cells, recovered from spontaneous coughing can be used to study lung cancer, respiratory infections and in diagnosis of pneumocystis carinii pneumonia in patients infected with human immunodeficiency virus. In developing countries having high prevalence of pulmonary tuberculosis, sputum induction (SI can increase the diagnostic yield, resulting in better categorization of patients for treatment purposes. It increases case detection rate of smear negative pulmonary tuberculosis specially in area where facili-ties for more invasive and expensive techniques are not available.

  6. Use of recombinant cellulose-binding domains of Trichoderma reesei cellulase as a selective immunocytochemical marker for cellulose in protozoa.

    Science.gov (United States)

    Linder, Markus; Winiecka-Krusnell, Jadwiga; Linder, Ewert

    2002-05-01

    Some unicellular organisms are able to encyst as a protective response to a harmful environment. The cyst wall usually contains chitin as its main structural constituent, but in some cases, as in Acanthamoeba, it consists of cellulose instead. Specific cytochemical differentiation between cellulose and chitin by microscopy has not been possible, due to the similarity of their constituent beta-1,4-linked hexose backbones. Thus, various fluorescent brightening agents and lectins bind to both cellulose and chitin. We have used a recombinant cellulose-binding protein consisting of two cellulose-binding domains (CBDs) from Trichoderma reesei cellulases linked together in combination with monoclonal anticellulase antibodies and anti-mouse immunoglobulin fluorescein conjugate to specifically stain cellulose in the cysts of Acanthamoeba strains for fluorescence microscopy imaging. Staining was observed in ruptured cysts and frozen sections of cysts but not in intact mature cysts. No staining reaction was observed with the chitin-containing cyst walls of Giardia intestinalis, Entamoeba dispar, or Pneumocystis carinii. Thus, the recombinant CBD can be used as a marker to distinguish between cellulose and chitin. Thirteen of 25 environmental or clinical isolates of amoebae reacted in the CBD binding assay. All 13 isolates were identified as Acanthamoeba spp. Five isolates of Hartmannella and seven isolates of Naegleria tested negative in the CBD binding assay. Whether cyst wall cellulose really is a unique property of Acanthamoeba spp. among free-living amoebae, as suggested by our findings, remains to be shown in more extensive studies.

  7. Invasive pulmonary aspergillosis: A study of 39 cases at autopsy

    Directory of Open Access Journals (Sweden)

    Vaideeswar P

    2004-01-01

    Full Text Available Background: Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals. Aims: To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations. Settings and Design: Retrospective analysis of autopsy material from a tertiary care hospital. Material and Methods: All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were analysed with respect to their clinical presentation, predisposing factors, gross and histological features, complications and causes of death. Results: Among a total of 20475 autopsies performed in 12 years, 39 patients (0.19 % had invasive pulmonary aspergillosis. There were 28 males and 11 females. Their ages ranged from five months to 67 years. Dyspnoea, fever, cough with mucopurulent expectoration, chest pain and haemoptysis were commonly encountered symptoms. Forty-one per cent of the patients had no respiratory symptoms. Fungal aetiology was not entertained clinically in any of the patients. The major underlying conditions were prolonged antibiotic therapy, steroid therapy, and renal transplantation, often associated with underlying lung diseases. Pneumonia, abscesses, vascular thrombosis and infarction were common findings at autopsy. Antecedent tuberculosis, mucormycosis, Pneumocystis carinii pneumonia and Cytomegalovirus infection were also present. In most cases, death was related to extensive pulmonary involvement or fungal dissemination. Conclusion: A diagnosis of invasive pulmonary aspergillosis should always be borne in mind whenever one is dealing with recalcitrant lung infections even with subtle immunosuppression. Radiological investigations and serologic markers can be utilised for confirmation and prompt therapy.

  8. Human immunodeficiency virus infection, Part II.

    Science.gov (United States)

    Horowitz, H W; Telzak, E E; Sepkowitz, K A; Wormser, G P

    1998-12-01

    The acceptance of highly active antiretroviral therapy (HAART) among patients and health care providers has had a dramatic impact on the epidemiology and clinical characteristics of many opportunistic infections associated with human immunodeficiency virus (HIV). Previously intractable opportunistic infections and syndromes are now far less common. In addition, effective antibiotic prophylactic therapies have had a profound impact on the risk of patients developing particular infections and on the incidence of these infections overall. Most notable among these are Pneumocystis carinii, disseminated Mycobacterium avium complex, tuberculosis, and toxoplasmosis. Nevertheless, infections continue to cause significant morbidity and mortality among patients who are infected with HIV. The role of HAART in many clinical situations is unquestioned. Compelling data from clinical trials support the use of these therapies during pregnancy to prevent perinatal transmission of HIV. HAART is also recommended for health care workers who have had a "significant" exposure to the blood of an HIV-infected patient. Both of these situations are discussed in detail in this article. In addition, although more controversial, increasing evidence supports the use of HAART during the acute HIV seroconversion syndrome. An "immune reconstitution syndrome" has been newly described for patients in the early phases of treatment with HAART who develop tuberculosis, M avium complex, and cytomegalovirus disease. Accumulating data support the use of hydroxyurea, an agent with a long history in the field of myeloproliferative disorders, for the treatment of HIV. Newer agents, particularly abacavir and adefovir dipivoxil, are available through expanded access protocols, and their roles are being defined and clarified.

  9. Nuclear medicine and AIDS

    Energy Technology Data Exchange (ETDEWEB)

    O' Doherty, M.J. (Saint Thomas' Hospital, London (United Kingdom) Kent and Canterbury Hospital, Canterbury (United Kingdom). Dept. of Nuclear Medicine); Nunan, T.O. (Saint Thomas' Hospital, London (United Kingdom). Dept. of Nuclear Medicine)

    1993-10-01

    The human immunodeficiency virus (HIV) infection and its associated illnesses in a relatively young population of patients provides an expanding role for nuclear medicine. The disease enforces a review of each department's infection control procedures. It has also resulted in an increase in the number of patients presenting with diseases such as Pneumocystis carinii pneumonia, Kaposi's sarcoma etc. which prior to the HIV epidemic were extremely rare. Thus in high risk patients the interpretation of abnormalities in nuclear medicine scans needs to include the spectrum of opportunistic infections and unusual tumours. The presence of opportunistic infections in the severely immunocompromised patient has led to the development of techniques not normally used, i.e. lung [sup 99]Tc[sup m]-diethylenetriamine pentaacetate (DTPA) transfer/clearance, donor leukocyte scanning to allow rapid diagnosis of an abnormality. Radionuclide techniques are also used to monitor the effect of therapy directed at the HIV itself or against opportunistic infections. This review covers aspects of infection control as well as the use of radionuclides to investigate specific problems related to HIV infection and therapy of the associated disease processes. (author).

  10. [Infections in the child with acute leukemia].

    Science.gov (United States)

    Carrillo, J M; Jiménez, E; Jiménez, R

    1981-01-01

    One hundred and twenty-five febrile episodes in 82 children with acute leukemia were studied; 46% of the patients were from urban and 54% from rural areas. The origin of the fever was identified in 91% of the episodes, prevailing pneumonia, septicemia, chickenpox and herpes zoster. The etiological agent was identified in 46% of the cases. A viral predominance was evident, and among them varicela-zoster, following in importance gram-negative bacteria. Histoplasma capsulatum and Pneumocystis carinii were isolated in two occassions each. Sepsis was found more frequently in children with active leukemia than in those in remission (p less than 0.001). Forty-four febrile episodes occurred in patients with less than 1,000 neutrophils/ul. The daily-risk rate of infection was higher in children fom rural than in those from urban areas (p less than 0.001). After clinical and laboratory studies, methicillin and gentamicin were used, in addition to carbenicillin or trimethoprim-sulfamethoxazole is selected cases. This treatment was effective in 86% of the cases. Twelve (15%) children died, 6 of whom were in remission at that moment.

  11. Development of Novel Chitosan Microcapsules for Pulmonary Delivery of Dapsone: Characterization, Aerosol Performance, and In Vivo Toxicity Evaluation.

    Science.gov (United States)

    Ortiz, Manoel; Jornada, Denise Soledade; Pohlmann, Adriana Raffin; Guterres, Sílvia Stanisçuaski

    2015-10-01

    Pneumocystis carinii pneumonia (PCP) is a major opportunistic infection that affects patients with human immunodeficiency virus. Although orally administered dapsone leads to high hepatic metabolism, decreasing the therapeutic index and causing severe side effects, this drug is an effective alternative for the treatment of PCP. In this context, microencapsulation for pulmonary administration can offer an alternative to increase the bioavailability of dapsone, reducing its adverse effects. The aim of this work was to develop novel dapsone-loaded chitosan microcapsules intended for deep-lung aerosolized drug delivery. The geometric particle size (D 4,3) was approximately 7 μm, the calculated aerodynamic diameter (d aero) was approximately 4.5 μm, and the mass median aerodynamic diameter from an Andersen cascade impactor was 4.7 μm. The in vitro dissolution profile showed an efficient dapsone encapsulation, demonstrating the sustained release of the drug. The in vitro deposition (measured by the Andersen cascade impactor) showed an adequate distribution and a high fine particles fraction (FPF = 50%). Scanning electron microscopy of the pulmonary tissues demonstrated an adequate deposition of these particles in the deepest part of the lung. An in vivo toxicity experiment showed the low toxicity of the drug-loaded microcapsules, indicating a protective effect of the microencapsulation process when the particles are microencapsulated. In conclusion, the pulmonary administration of the novel dapsone-loaded microcapsules could be a promising alternative for PCP treatment.

  12. HIV infection in Malaysia: a report of cases seen at the University Hospital, Kuala Lumpur.

    Science.gov (United States)

    Ismail, R; Doi, S; Naganathna, N

    1995-12-01

    The spread of HIV infection into Malaysia is estimated to have occurred in the early 1980's. The first case of AIDS was reported here in 1986. As of March 31, 1994, the numbers have increased to 8049 HIV positive individuals detected in the country. The risk behaviours among those tested positive were intravenous drug use in 77.2%, sexual transmission in 4.5%, while the remainder are still under investigation. Pediatric AIDS constitutes 0.2% of positives. The high prevalence among intravenous drug users (IVDU) is likely to be due to mandatory testing for HIV upon entry to rehabilitation centres. The trend of HIV infection in this country seems to be highest amongst the intravenous drug users. The increasing number of HIV infected prostitutes and heterosexuals in our population is worrying. Since 1986, a total of 104 HIV positive individuals have been treated at the University Hospital, Kuala Lumpur, Malaysia. Of these, 25 have died and of those still alive, 5 have symptomatic disease. The most common AIDS-defining illness is Pneumocystis carinii pneumonia. Education programmes have been developed targeting the various high risk groups and the general population.

  13. [Role of bronchoalveolar lavage and transbronchial biopsy in the diagnosis of pneumonia in patients with organ transplantation].

    Science.gov (United States)

    Arnedillo Muñoz, A; Lopez Moya, M E; de Lucas Ramos, P; Puente Maestu, L; Sanchez Juanes, M J; Rodriguez Gonzalez-Moro, J M; Garcia de Pedro, J; Rodriguez de Guzman, M C

    1996-02-01

    Pneumonia in patients with organ transplantation constitutes a very frequent cause of mortality, as a result precocious aetiologic diagnosis is indispensable. The bronchoscopic techniques, bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB), constitute fundamental procedures for these diagnoses. We begin this study with the aim of evaluating the profitability obtained with these procedures. 36 bronchoscopies were performed on 29 patients with organ transplantation, in all of them we realized BAL and in 20 TBB. We confirm the presence of pneumonia in 30 (in 15 of them we had performed TBB), the BAL was diagnostic in 20 cases (66.6%) and the TBB in 7 (46.6%). With both, BAL and TBB, we obtained a sensitivity of 80% and a specificity of 75%. We isolated 10 bacteria, 8 Citomegalovirus (CMV), 6 Pneumocystis carinii and 2 Aspergillus fumigatus. The BAL and the TBB contributed significantly in the aetiologic diagnosis of pneumonia in patients with organ transplantation, consequently we consider them basic tools in the management of these infections.

  14. High-throughput Screening of New Antimitotic Compounds Based on Potential of Virtual Organization CSLabGrid

    Directory of Open Access Journals (Sweden)

    Karpov, P.A.

    2015-01-01

    Full Text Available In the frameworks of virtual organization CSLabGrid using Grid calculations the repository of 3-D models of cytoskeletal proteins (tubulins and FtsZ-proteins verified by stereochemistry, is described. The repository of structures of canonical antimicrotubular compounds (inhibitors of tubulin polymerization as well as library of ligands, suitable for high-throughput screening (HTS in Grid were created. According to the results of the library HTS 1,164 compounds that demonstrated an elevated affinity to tubulin molecules: 205 — to α-tubulin and 959 — to β-tubulin were selected. It was found that among 2,886 compounds synthesized in the Institute of Organic Chemistry of NAS of Ukraine, 6 were perspective inhibitors of α- and β-tubulin polymerization in such human pathogens as Pneumocystis carinii, Giardia intestinalis Ajellomyces capsulatus, Neosartorya fumigata and Candida albicans. Respectively, these compounds were recommended for subsequent experimental evaluation of their biological activity for use as new pharmacological agents.

  15. Síndrome de reconstitución inmune en HIV y neumonía por Pneumocystis jirovecii

    OpenAIRE

    Agustina Sosa Belaustegui; Santiago Flagel; Ana Frydman; Mariana Labato; Cristina Myburg; Jorge Risso

    2014-01-01

    El síndrome de reconstitución inmune es un conjunto de fenómenos inflamatorios agudos, que se producen como consecuencia de la recuperación de la inmunidad, generando un empeoramiento paradójico de una infección o de un proceso inflamatorio previo. En los pacientes infectados con el virus de inmunodeficiencia humana este síndrome se produce luego de iniciado el tratamiento antirretroviral. Las infecciones más frecuentes asociadas a esta entidad son las producidas por micobacterias, herpes, cr...

  16. Is Aerosolized Pentamidine for Pneumocystis Pneumonia Prophylaxis in Renal Transplant Recipients Not as Safe as We Might Think?

    Science.gov (United States)

    Macesic, N; Urbancic, K; Ierino, F; Grayson, M L

    2016-04-01

    Outbreaks ofPneumocystispneumonia have been described in renal transplant recipients. Aerosolized pentamidine is frequently used for prophylaxis in this setting. We report our experience with aerosolized pentamidine use in 56 renal transplant recipients. We found high rates of adverse reactions in patients with chronic respiratory disease.

  17. FEVER OF UNDETERMINED ORIGIN IN PATIENTS WITH THE ACQUIRED IMMUNODEFICIENCY SYNDROME IN BRAZIL: REPORT ON 55 CASES Febre de origem indeterminada em pacientes com a síndrome da imunodeficiência adquirida no Brasil: relato de 55 casos

    Directory of Open Access Journals (Sweden)

    J. Roberto LAMBERTUCCI

    1999-01-01

    Full Text Available The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4% out of 322 patients reported fever at admission to hospital and 55 (17.1% had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8%. Tuberculosis (32.7%, Pneumocystis carinii pneumonia (10.9%, and Mycobacterium avium complex (9.1% were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5%, sinusitis (3.6%, Salmonella-S. mansoni association (3.6%, disseminated histoplasmosis (3.6%, neurosyphilis (1.8%, and isosporiasis (1.8%. Four patients had non-Hodgkin's lymphoma (7.3%. We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.Revisaram-se os prontuários médicos de pacientes com AIDS e febre de origem indeterminada (FOI com o objetivo de definirem-se as causas de FOI em indivíduos HIV positivos em um país tropical e, ainda, determinar o valor dos procedimentos diagnósticos mais utilizados. Cento e oitenta e oito (58,4% de 322 pacientes apresentavam febre à internação e 55 (17,1% preencheram os critérios de FOI. A contagem média de CD4+ no grupo com FOI era de 98 células/ml. Definiu-se a causa da febre em 45 pacientes (81,8%. As

  18. Clinical and laboratory findings of disseminated Mycobacterium avium complex infection (DMAC in a pair matched case-control study Manifestações clínicas e laboratoriais da infecção disseminada pelo complexo Mycobacterium avium (DMAC em um estudo caso/controle pareado

    Directory of Open Access Journals (Sweden)

    Valeria ROLLA

    1999-09-01

    Full Text Available A pair matched case/control study was conducted from January 1991 to 30 June 1992 in order to define clinical and laboratory findings associated with DMAC infection in AIDS patients. Since DMAC infection is usually associated with advanced immunodeficiency, and therefore also with other opportunistic illnesses, in addition to the number of CD4+ lymphocytes, cases and controls were matched using the following criteria: date of AIDS diagnosis and antiretroviral therapy, number and severity of associated opportunistic infections and, whenever possible, type of Pneumocystis carinii prophylaxis, age and gender, in this order of relevance. Cases (defined as patients presenting at least one positive culture for MAC at a normally sterile site and controls presented CD4+ lymphocyte counts below 50 cel/mm3. A significantly higher prevalence of general, digestive and respiratory signs, increased LDH levels, low hemoglobin levels and CD4+ cell counts were recorded for cases when compared to controls. Increases in gGT and alkaline phosphatase levels seen in cases were also recorded for controls. In conclusion, the strategy we used for selecting controls allowed us to detect laboratory findings associated to DMAC infection not found in other advanced immunossupressed AIDS patients without DMAC.Um estudo caso/controle pareado foi realizado no período compreendido entre janeiro de 1991 e junho de 1992, a fim de determinar a associação de manifestações clínicas e laboratoriais com a DMAC em pacientes com AIDS. Como a DMAC é habitualmente associada com imunodeficiência avançada e portanto também com outras doenças oportunistas, além do número de linfócitos CD4+, casos e controles foram pareados utilizando-se os seguintes critérios: data do diagnóstico de AIDS e terapêutica anti-retroviral, número e gravidade das infecções oportunistas associadas e quando possível, tipo de profilaxia para Pneumocystis carinii, idade e sexo, nesta ordem de

  19. Clinical and epidemiological analysis of patients with HIV/AIDS admitted to a reference hospital in the northeast region of Brazil Análise clínica e epidemiológica dos pacientes com HIV/AIDS internados em um Hospital de Referência na Região Nordeste do Brasil

    Directory of Open Access Journals (Sweden)

    Vítor Yamashiro Rocha Soares

    2008-12-01

    Full Text Available The AIDS epidemic has become a worldwide phenomenon of enormous magnitude and extension, deeply transforming medical practices and public health initiatives. This retrospective survey aimed to analyze clinical and epidemiological characteristics of patients with HIV/AIDS admitted to the Institute of Tropical Diseases Natan Portella, Teresina, Piauí, Brazil, from January, 2001 through December, 2004. Of the 828 patients, 43% were from other states and 71.3% were men. Average patient age was 35.4 ± 11.5 years-old and 85.5% were illiterate or had primary education. The main form of exposure to HIV was heterosexual behavior (54.1%, while injectable drug use was confirmed by only 2.7% of registered cases. The most frequent infectious complications were candidiasis (42.4% and pneumocystosis (22.2%. Sixty-eight cases (8.2% of visceral leishmaniasis were registered. Using multivariate analysis, individuals aged over 40 years-old, patients with active tuberculosis, Pneumocystis carinii pneumonia and central nervous system cryptococcosis showed increased risk of death. In this study, young male adults with low educational levels predominated and the most frequent opportunistic infections were candidiasis and pneumocystosis.A epidemia de AIDS tornou-se um fenômeno mundial de grande magnitude e extensão, transformando profundamente a prática médica e as iniciativas em saúde pública. O estudo retrospectivo analisou as características clínicas e epidemiológicas dos pacientes com HIV/AIDS internados no Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brasil, de janeiro de 2001 a dezembro de 2004 . Dos 828 pacientes, 43% eram provenientes de outros estados e 71,3% eram do sexo masculino. A idade média foi 35,4 ± 11,5 anos. Eram analfabetos ou cursaram até o ensino fundamental 85,5%. A principal via de exposição ao HIV foi o comportamento heterossexual (54,1%, enquanto o uso de drogas injetáveis foi observado em apenas 2,7% dos

  20. Scalable Preparation and Differential Pharmacologic and Toxicologic Profiles of Primaquine Enantiomers

    Science.gov (United States)

    Tekwani, Babu L.; Herath, H. M. T. Bandara; Sahu, Rajnish; Gettayacamin, Montip; Tungtaeng, Anchalee; van Gessel, Yvonne; Baresel, Paul; Wickham, Kristina S.; Bartlett, Marilyn S.; Fronczek, Frank R.; Melendez, Victor; Ohrt, Colin; Reichard, Gregory A.; McChesney, James D.; Rochford, Rosemary; Walker, Larry A.

    2014-01-01

    Hematotoxicity in individuals genetically deficient in glucose-6-phosphate dehydrogenase (G6PD) activity is the major limitation of primaquine (PQ), the only antimalarial drug in clinical use for treatment of relapsing Plasmodium vivax malaria. PQ is currently clinically used in its racemic form. A scalable procedure was developed to resolve racemic PQ, thus providing pure enantiomers for the first time for detailed preclinical evaluation and potentially for clinical use. These enantiomers were compared for antiparasitic activity using several mouse models and also for general and hematological toxicities in mice and dogs. (+)-(S)-PQ showed better suppressive and causal prophylactic activity than (−)-(R)-PQ in mice infected with Plasmodium berghei. Similarly, (+)-(S)-PQ was a more potent suppressive agent than (−)-(R)-PQ in a mouse model of Pneumocystis carinii pneumonia. However, at higher doses, (+)-(S)-PQ also showed more systemic toxicity for mice. In beagle dogs, (+)-(S)-PQ caused more methemoglobinemia and was toxic at 5 mg/kg of body weight/day given orally for 3 days, while (−)-(R)-PQ was well tolerated. In a novel mouse model of hemolytic anemia associated with human G6PD deficiency, it was also demonstrated that (−)-(R)-PQ was less hemolytic than (+)-(S)-PQ for the G6PD-deficient human red cells engrafted in the NOD-SCID mice. All these data suggest that while (+)-(S)-PQ shows greater potency in terms of antiparasitic efficacy in rodents, it is also more hematotoxic than (−)-(R)-PQ in mice and dogs. Activity and toxicity differences of PQ enantiomers in different species can be attributed to their different pharmacokinetic and metabolic profiles. Taken together, these studies suggest that (−)-(R)-PQ may have a better safety margin than the racemate in human. PMID:24913163

  1. Identification and Characterization of Novel Rat Polyomavirus 2 in a Colony of X-SCID Rats by P-PIT assay

    Science.gov (United States)

    Rigatti, Lora H.; Toptan, Tuna; Newsome, Joseph T.

    2016-01-01

    ABSTRACT Polyomaviruses (PyVs) are known to infect a wide range of vertebrates and invertebrates and are associated with a broad spectrum of diseases, including cancers, particularly in immune-suppressed hosts. A novel polyomavirus, designated rat polyomavirus 2 (RatPyV2), was identified from a breeding colony of rats having X-linked severe combined immunodeficiency. Using a human panpolyomavirus immunohistochemistry test (P-PIT), RatPyV2 was initially detected in the parotid salivary gland of a colony member. Rolling circle amplification using DNA from harderian and parotid glands identified a novel 5.1-kb polyomavirus genome closely related to human Washington University (WU) and Karolinska Institute (KI) and vole polyomaviruses but notably divergent from Rattus norvegicus PyV1 (RnorPyV1; also designated RatPyV1). Further screening showed RatPyV2 inclusion body infection in the lung epithelium and variably in other respiratory, reproductive, and glandular tissues of 12/12 (100%) rats. IMPORTANCE Although P-PIT was developed to detect diseases associated with known human polyomaviruses, the identification of a new polyomavirus in rats suggests that it may have utility as a broad-based screen for new, as well as known polyomaviruses. Our findings suggest that RatPyV2 may be a commensal infection of laboratory rats that can lead to disseminated disease in T cell immune-deficient rats. Infection of the X-SCID rats with RatPyV2 and Pneumocystis carinii is a potential model for coinfection pathogenesis and treatment options during transplant preclinical studies. PMID:28028546

  2. [Thoracoscopic treatment of recurrent pneumothorax].

    Science.gov (United States)

    Suter, M; Berner, M; Vandoni, R; Cuttat, J F

    1994-04-01

    Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmonary disease with emphysema. A new form of secondary PNO has emerged in the recent years in AIDS patients with pneumocystis carinii pneumonia. We have shifted to a thoracoscopic therapy of PNO since May 1991. 25 PNO in 24 patients (1 bilateral) have been treated since that time up to April 1993. 19 PNO were primary, whereas 6 were secondary, included 3 iatrogenic PNO. Resection of the leaking parenchymal area was performed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrate or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO and had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its resection as well as apical parietal pleurectomy are necessary to obtain good results and a low recurrence rate.

  3. Estudo temporal das doenças associadas à AIDS no Brasil, 1980-1999

    Directory of Open Access Journals (Sweden)

    Mark Drew Crosland Guimarães

    Full Text Available Neste trabalho foram estimadas as incidências de condições associadas (CA à AIDS/100 casos de AIDS em adultos (> 12 anos, a nível nacional, de 1980 a maio de 1999. A análise incluiu qui-quadrado e regressão linear simples. As CA analisadas foram candidíase (CD, tuberculose (TB, pneumonia por Pneumocystis carinii (PCP, neurotoxoplasmose(NT, Herpes, Sarcoma de Kaposi (SK, meningite criptocócica (MC e infecções por protozoários (IP. As incidências acumuladas/100 casos de AIDS foram: CD = 59, TB = 26, PCP = 23, NT = 15, Herpes = 12, SK = 5, MC = 4 e IP = 4. A tendência anual indicou queda estatisticamente significativa em todas as CA. Entretando, houve aumento na incidência de TB (b = 0,39 e NT (b = 0,20, para as regiões Nordeste e Centro-Oeste, respectivamente. TB apresentou maior incidência entre aqueles com baixa escolaridade (< 8 anos, enquanto que PCP e SK tiveram maiores incidências entre aqueles com melhor escolaridade (8+ anos, apesar de declínios semelhantes. Acesso à terapia anti-retroviral e profilaxias para as CA explicam parcialmente estes resultados. Entretanto, a confiabilidade dos dados, o atraso na notificação, a incidência de CA pós-AIDS, bem como os critérios de notificação e diagnóstico, são fatores que devem ser avaliados.

  4. Estudo temporal das doenças associadas à AIDS no Brasil, 1980-1999

    Directory of Open Access Journals (Sweden)

    Guimarães Mark Drew Crosland

    2000-01-01

    Full Text Available Neste trabalho foram estimadas as incidências de condições associadas (CA à AIDS/100 casos de AIDS em adultos (> 12 anos, a nível nacional, de 1980 a maio de 1999. A análise incluiu qui-quadrado e regressão linear simples. As CA analisadas foram candidíase (CD, tuberculose (TB, pneumonia por Pneumocystis carinii (PCP, neurotoxoplasmose(NT, Herpes, Sarcoma de Kaposi (SK, meningite criptocócica (MC e infecções por protozoários (IP. As incidências acumuladas/100 casos de AIDS foram: CD = 59, TB = 26, PCP = 23, NT = 15, Herpes = 12, SK = 5, MC = 4 e IP = 4. A tendência anual indicou queda estatisticamente significativa em todas as CA. Entretando, houve aumento na incidência de TB (b = 0,39 e NT (b = 0,20, para as regiões Nordeste e Centro-Oeste, respectivamente. TB apresentou maior incidência entre aqueles com baixa escolaridade (< 8 anos, enquanto que PCP e SK tiveram maiores incidências entre aqueles com melhor escolaridade (8+ anos, apesar de declínios semelhantes. Acesso à terapia anti-retroviral e profilaxias para as CA explicam parcialmente estes resultados. Entretanto, a confiabilidade dos dados, o atraso na notificação, a incidência de CA pós-AIDS, bem como os critérios de notificação e diagnóstico, são fatores que devem ser avaliados.

  5. Tuberculosis in renal transplant recipients.

    Science.gov (United States)

    Lattes, R; Radisic, M; Rial, M; Argento, J; Casadei, D

    1999-06-01

    Tuberculosis (TB) has been described in kidney transplant recipients as an infection with predominantly pulmonary involvement. We report the impact of TB in kidney transplantation. Clinical records of adult kidney recipients, transplanted between 1 January 1986 and 31 December 1995 were analyzed for sex, age, graft origin, immunosuppressive therapy, TB sites, diagnostic methods and concomitant infections. Annual incidence, mean time of onset, relation to rejection treatment, tuberculin skin test (PPD) and outcome were analyzed. Patients with a history of TB or graft loss in the first month were excluded. TB was diagnosed in 14 of 384 (3.64%). Mean age at transplantation was 35 years. Twelve of these received the graft from a living donor. All had triple immunosuppression with cyclosporine. Ten had pulmonary TB, three extrapulmonary infection and one disseminated disease. In 13 cases an invasive diagnostic procedure was performed. Mycobacterium tuberculosis cultures were positive in all cases; microscopy revealed acid-fast bacilli (AFB) in 6, and adenosine deaminase was elevated in CSF and pleural effusion in 2. Annual incidence varied from 0% to 3.1%. At the time of TB presentation 8 patients had other concomitant infections (cytomegalovirus, nocardia, Pneumocystis carinii, disseminated herpes simplex virus). Median time of onset was 13 months. Diagnostic results became available post-mortem in 2 cases, and one had TB in a failing allograft. TB was treated with 4 drugs including rifampin in 10 patients. Cyclosporine was discontinued in one, lowered in one and increased in 8. During treatment 5 patients had rejection episodes. At 1 year, graft survival was 72.7% and patient survival 90.9%. TB was more prevalent when recipient and donor were both PPD positive. In summary: although TB is a growing threat in the transplant setting, early and aggressive diagnosis with meticulous monitoring of immunosuppression allows a successful outcome for both patient and graft

  6. Lipid biosynthesis pathways as chemotherapeutic targets in kinetoplastid parasites.

    Science.gov (United States)

    Urbina, J A

    1997-01-01

    Inhibitors of sterol and phospholipid biosynthesis in kinetoplastid parasites such as Trypanosoma cruzi, the causative agent of Chagas' disease, and different species of Leishmania have potent and selective activity as chemotherapeutic agents in vitro and in vivo. Recent work with the sterol C14 alpha-demethylase inhibitor D0870, a bis triazole derivative, showed that this compound is capable of inducing radical parasitological cure in murine models of both acute and chronic Chagas' disease. Other inhibitors of this type, such as SCH 56592, have also shown curative, rather than suppressive, activity against T. cruzi in these models. Leishmania species have different susceptibilities to sterol biosynthesis inhibitors, both in vitro and in vivo. Leishmania braziliensis promastigotes, naturally resistant to C14 alpha-demethylase inhibitors such as ketoconazole and D0870, were susceptible to these drugs when used in combination with the squalene epoxidase inhibitor terbinafine. Inhibitors of delta 24(25) sterol methyl transferase have been shown to act as potent antiproliferative agents against Trypanosoma cruzi, both in vitro and in vivo. New inhibitors of this type which show enhanced activity and novel mechanisms of action have been synthesized. Recent work has also demonstrated that this type of enzyme inhibitors can block sterol biosynthesis and cell proliferation in Pneumocystis carinii, a fungal pathogen which had previously been found resistant to other sterol biosynthesis inhibitors. Ajoene, an antiplatelet compound derived from garlic, was shown to have potent antiproliferative activity against epimastigotes and amastigotes of Trypanosoma cruzi in vitro; this activity was associated with a significant alteration of the phospholipid composition of the cells with no significant effects on the sterol content. In addition, alkyllsophospholipids such as ilmofosine, miltefosine and edelfosine have been shown to block the proliferation of T. cruzi and Leishmania and

  7. Estimation of CD4+ and CD8+ T-lymphocytes in human immunodeficiency virus infection and acquired immunodeficiency syndrome patients in Manipur

    Directory of Open Access Journals (Sweden)

    Singh H

    2007-01-01

    Full Text Available Purpose : To estimate and stratify CD4 + and CD8 + T-lymphocyte levels in human immunodeficiency virus (HIV infected (asymptomatic and acquired immunodeficiency syndrome (AIDS patients (symptomatic and correlate the clinical features of the patients with CD4+ and CD8+ lymphocyte level. Methods : Between April 2002 and September 2003, a total of 415 HIV seropositive adult patients (297 males and 118 females attending Regional Institute of Medical Sciences (RIMS hospitals were tested for CD4+ and CD8+ T-lymphocytes by fluorescent activated cell sorter (FACS counter (Becton Dickinson. Symptomatic patients were diagnosed as per NACO clinical case definition. Results : Ranges of 0-50, 51-100, 101-200, 201-300, 301-400, 401-500 and above 500 CD4+ T-lymphocyte per microlitre were seen in 68, 52, 101, 73, 47, 31 and 43 patients respectively whereas CD8+ T-lymphocyte ranges of 0-300, 301-600, 601-900, 901-1500, 1501-2000, 2001-3500 per microlitre were seen in 29, 84, 92, 145, 40 and 25 patients respectively. One hundred and fifty patients were asymptomatic and 265 were symptomatic. CD4/CD8 ratio in asymptomatics and symptomatics were 0.13-1.69 and 0.01-0.93 respectively. Tuberculosis and candidiasis occurred in CD4+ T-lymphocyte categories between 0-400 cells per mL in symptomatics. However, cryptosporidiosis, toxoplasmosis, herpes zoster, cryptococcal meningitis, Pneumocystis carinii pneumonia, penicilliosis and cytomegalovirus retinitis were seen in patients having CD4+ T-lymphocyte less than 200 per mL. Conclusions : CD4+ T-lymphocyte was decreased in both asymptomatic and symptomatic HIV patients, The decrease was greater in symptomatics while CD8+ T-lymphocyte was increased in both except advanced stage symptomatics. CD4:CD8 ratio was reversed in both groups. Opportunistic infections correlated with different CD4+ T-lymphocyte categories.

  8. Mycobacterium avium complex augments macrophage HIV-1 production and increases CCR5 expression.

    Science.gov (United States)

    Wahl, S M; Greenwell-Wild, T; Peng, G; Hale-Donze, H; Doherty, T M; Mizel, D; Orenstein, J M

    1998-10-13

    Infection with HIV-1 results in pronounced immune suppression and susceptibility to opportunistic infections (OI). Reciprocally, OI augment HIV-1 replication. As we have shown for Mycobacterium avium complex (MAC) and Pneumocystis carinii, macrophages infected with opportunistic pathogens and within lymphoid tissues containing OI, exhibit striking levels of viral replication. To explore potential underlying mechanisms for increased HIV-1 replication associated with coinfection, blood monocytes were exposed to MAC antigens (MAg) or viable MAC and their levels of tumor necrosis factor alpha (TNFalpha) and HIV-1 coreceptors monitored. MAC enhanced TNFalpha production in vitro, consistent with its expression in coinfected lymph nodes. Using a polyclonal antibody to the CCR5 coreceptor that mediates viral entry of macrophage tropic HIV-1, a subset of unstimulated monocytes was shown to be CCR5-positive by fluorescence-activated cell sorter analysis. After stimulation with MAg or infection with MAC, CCR5 expression was increased at both the mRNA level and on the cell surface. Up-regulation of CCR5 by MAC was not paralleled by an increase in the T cell tropic coreceptor, CXCR4. Increases in NF-kappaB, TNFalpha, and CCR5 were consistent with the enhanced production of HIV-1 in MAg-treated adherent macrophage cultures as measured by HIV-1 p24 levels. Increased CCR5 was also detected in coinfected lymph nodes as compared with tissues with only HIV-1. The increased production of TNFalpha, together with elevated expression of CCR5, provide potential mechanisms for enhanced infection and replication of HIV-1 by macrophages in OI-infected cells and tissues. Consequently, treating OI may inhibit not only the OI-induced pathology, but also limit the viral burden.

  9. Scalable preparation and differential pharmacologic and toxicologic profiles of primaquine enantiomers.

    Science.gov (United States)

    Nanayakkara, N P Dhammika; Tekwani, Babu L; Herath, H M T Bandara; Sahu, Rajnish; Gettayacamin, Montip; Tungtaeng, Anchalee; van Gessel, Yvonne; Baresel, Paul; Wickham, Kristina S; Bartlett, Marilyn S; Fronczek, Frank R; Melendez, Victor; Ohrt, Colin; Reichard, Gregory A; McChesney, James D; Rochford, Rosemary; Walker, Larry A

    2014-08-01

    Hematotoxicity in individuals genetically deficient in glucose-6-phosphate dehydrogenase (G6PD) activity is the major limitation of primaquine (PQ), the only antimalarial drug in clinical use for treatment of relapsing Plasmodium vivax malaria. PQ is currently clinically used in its racemic form. A scalable procedure was developed to resolve racemic PQ, thus providing pure enantiomers for the first time for detailed preclinical evaluation and potentially for clinical use. These enantiomers were compared for antiparasitic activity using several mouse models and also for general and hematological toxicities in mice and dogs. (+)-(S)-PQ showed better suppressive and causal prophylactic activity than (-)-(R)-PQ in mice infected with Plasmodium berghei. Similarly, (+)-(S)-PQ was a more potent suppressive agent than (-)-(R)-PQ in a mouse model of Pneumocystis carinii pneumonia. However, at higher doses, (+)-(S)-PQ also showed more systemic toxicity for mice. In beagle dogs, (+)-(S)-PQ caused more methemoglobinemia and was toxic at 5 mg/kg of body weight/day given orally for 3 days, while (-)-(R)-PQ was well tolerated. In a novel mouse model of hemolytic anemia associated with human G6PD deficiency, it was also demonstrated that (-)-(R)-PQ was less hemolytic than (+)-(S)-PQ for the G6PD-deficient human red cells engrafted in the NOD-SCID mice. All these data suggest that while (+)-(S)-PQ shows greater potency in terms of antiparasitic efficacy in rodents, it is also more hematotoxic than (-)-(R)-PQ in mice and dogs. Activity and toxicity differences of PQ enantiomers in different species can be attributed to their different pharmacokinetic and metabolic profiles. Taken together, these studies suggest that (-)-(R)-PQ may have a better safety margin than the racemate in human.

  10. Analysis of clinical pathology and immunophenotype in non-HIV/AIDS associated hodgkin lymphoma%HIV/AIDS非相关霍奇金淋巴瘤的临床病理和免疫表型分析

    Institute of Scientific and Technical Information of China (English)

    冯艳玲; 王迪; 曾东; 郑叶; 卢洪洲

    2013-01-01

    目的 探讨HIV/AIDS非相关霍奇金淋巴瘤(HL)的病理组织学形态、免疫表型特点及鉴别诊断.方法 根据WHO(2008)造血和淋巴组织肿瘤分类,应用光镜、免疫组化EnVision法染色、FISH及原位杂交,并结合临床资料和文献复习对3例HIV/AIDS合并霍奇金淋巴瘤进行综合分析.结果 3例组织学形态均符合经典型HL,亚型为混合细胞型2例,1例为淋巴细胞消减型.免疫组化染色肿瘤细胞CD30、LMP1表达阳性,肝活检1例少数肿瘤细胞EMA、CD20及C D79α弱表达,Ki67增殖指数为60%~80%,LCA、CD15、CD68、PAX5、ALK、BOB.1、OCT2、CD3、p53均阴性;背景细胞可表达CD20、CD3、CD57、bcl-6.EBER原位杂交3例均阳性.FISH示IgH基因(14q32)重排1例.结论 在HIV感染者中,HL是最常见的AIDS非定义性肿瘤之一,预后较差.组织学是诊断非HIV/AIDS相关HL的基础,结合免疫组化进行分型和鉴别诊断可以减少误诊的发生,FISH和原位杂交是辅助检测HL分子遗传学改变的技术手段.

  11. 艾滋病合并机会性感染的临床特征和诊疗分析%Analysis on Clinical Features of Acquired Immune Deficiency Syndrome Combined with Opportunistic Infections and Its Diagnosis and Treatment

    Institute of Scientific and Technical Information of China (English)

    赵贺红; 冯萍; 肖贵宝; 徐开菊; 杨志勇

    2011-01-01

    . ) of the opportunistic infections (such as tuberculosis, Pneumocystis carinii pneumonia, toxoplasmosis, etc.) were also observed and analyzed. The patients were treated according to the national standards. The clinical outcome was analyzed based on such indicators as clinical symptoms, viral load, CD4+ T cells value at the onset, and the results of various imaging. Follow-up was done for six years. Results All 53 patients had severe AIDS infection. Forty-one of them had combined infections, among whom 36 (67. 9%) had infections in two or more parts of the body, 28 (52. 8%) were infected by two or more pathogens, and 13 (24. 5%) were infected by three or more pathogens. The most common opportunistic infection was tuberculosis (35. 8%, 19/53) followed by pneumocystis carinii pneumonia (30. 2%, 16/53) and septicemia (20. 8%,11/53). Other infections included cryptococcal infection (15. 1%, 8/53), toxoplasma gondii infection (3. 8%, 2/53), herpes zoster virus infection (7. 5%, 4/53), candidiasis (17. 0%, 9/53), cytomegalovirus infection (7. 5%, 4/53), combined hepatitis B (11. 3%, 6/53), and hepatitis C (3. 8%, 2/53). Effective treatment rate for opportunistic infections was 77. 4% (41/53) with a mortality of 22. 6% (12/53). The highest fatality rate occurred to those patients with cryptococcal meningitis or mixed infections. Conclusions The occurrence of opportunistic infections rises obviously when CD4+ T cells is lower than 350/mm3, and it increases more significantly as the value of CD4+ T cells goes down. The most common opportunistic infection is tuberculosis followed by pneumocystis carinii pneumonia. The clinical outcome for the combined cases of tuberculosis is good, while combined cryptococcal encephalopathy has the highest mortality rate. High active anti-retroviral therapy should be initiated as early as possible.

  12. Acometimento pulmonar em crianças com a síndrome da imunodeficiência humana (AIDS: estudo clínico e de necrópsia de 14 casos Necroscopic study of 14 children with AIDS and pneumonia

    Directory of Open Access Journals (Sweden)

    I.T.R. YPARRAGUIRRE

    2001-06-01

    Full Text Available OBJETIVOS: Descrever os aspectos clínicos, laboratoriais, radiológicos e anatomopatológicos encontrados em tecidos pulmonares de necrópsias de crianças com Aids e acometimento pulmonar. MÉTODOS: Foram revisados, retrospectivamente, prontuários, radiografias simples de tórax e laudos de necrópsias de 14 crianças com Aids e acometimento pulmonar. RESULTADOS: Oito casos eram do sexo masculino e seis do feminino. As idades variaram de três meses a nove anos, mediana de 1,2, sendo nove deles menores de dois anos. A transmissão foi vertical em 10 pacientes, dos quais cinco mães tinham história de contaminação por relação heterossexual; três, por hemotransfusão e em duas, ignorada. Pneumonia (n=8, candidíase oral (n=8 e diarréia (n=5 foram as doenças prévias mais referidas. Os sinais e sintomas observados à internação foram febre (n=12, dispnéia (n=10, tosse (n=11, linfoadenomegalia (n=11, hepato e/ou esplenomegalia (n=10, desnutrição (n=9, palidez (n=8, cianose (n=5 e baqueteamento digital (n=2. Os achados radiológicos mais comuns foram infiltrados difusos (n=6 e condensações (n=5. As alterações histológicas pulmonares foram compatíveis com pneumonia pelo citomegalovírus (n=9, por bactérias (n=8, por Pneumocystis carinii (n=3, por Hystoplasma capsulatum (n=1, por Toxoplasma gondii (n=1 e pneumonia intersticial linfocítica (n=1. A associação CMV e bactéria foi observada em seis casos. CONCLUSÕES: Houve predomínio de menores de dois anos, de transmissão vertical, de quadro clínico inespecífico de doença pulmonar e de infiltrados e condensações à radiografia. Citomegalovírus e bactérias foram os agentes mais comuns, sendo freqüente a sua associação. Pneumonia Intersticial Linfocítica e Pneumonia pelo P. carinii não foram causas freqüentes de doenças pulmonares.BACKGROUND: To describe clinical, laboratorial, radiological, and histopathological lung findings from necroscopy of aidetic children

  13. Clinical efficacy of first- and second-line treatments for HIV-associated Pneumocystis jirovecii pneumonia: a tri-centre cohort study

    DEFF Research Database (Denmark)

    Helweg-Larsen, Jannik; Benfield, Thomas; Atzori, Chiara;

    2009-01-01

    of HIV-associated PCP from three observational cohorts in Copenhagen, London and Milan, between 1989 and 2004, was conducted. RESULTS: Trimethoprim/sulfamethoxazole (962 PCP episodes, 81%) was the most frequently used first-line therapy, followed by intravenous pentamidine (87 episodes, 7%), clindamycin....../primaquine (72 episodes, 6%) and 'other' (atovaquone, dapsone/pyrimethamine, trimetrexate or inhaled pentamidine; 67 episodes, 6%). Rates of unchanged therapy were trimethoprim/sulfamethoxazole = 79%, clindamycin/primaquine = 65% and pentamidine = 60% (P ... of failure in 82 (7%) episodes and because of toxicity in 198 (17%) episodes. Three month survival rates were trimethoprim/sulfamethoxazole = 85%, clindamycin/primaquine = 81% and pentamidine = 76% (P = 0.09). After adjustment for possible confounders, pentamidine was associated with a significantly greater...

  14. Dicty_cDB: AFG421 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available umocystis carinii f. sp. carinii he... 351 3e-95 EU679414_1( EU679414 |pid:none) Tetranychus cinnabarinus he...at shoc... 351 4e-95 EU679412_1( EU679412 |pid:none) Tetranychus cinnabarinus hea

  15. Paracoccidioides brasiliensis (Lutz, 1908 isolado por meio de hemocultura em um paciente portadora de símdrome de imunodeficiência adquirida (SIDA Paracoccidioides brasiliensis isolated by hemoculture from a patient with AIDS

    Directory of Open Access Journals (Sweden)

    David J. Hadad

    1992-12-01

    Full Text Available Relata-se o primeiro caso de isolamento de Paracoccidioides brasiliensis (P. brasiliensis em sangue de paciente HIV positivo, 28 anos, sexo masculino, natural de Nova Londrina que, ao exame físico e ultrassonográfico, apresentava esplenomegalia febril a esclarecer. Para estabelecer o diagnóstico etiológico, hemoculturas em triplicata foram realizadas para pesquisa de bactérias aeróbias, micobactérias e fungos. As hemoculturas para bactérias aeróbias e micobactérias foram negativas e P. brasiliensis foi isolado de duas hemoculturas, na fase leveduriforme em ágar BHI, 20 dias após a semeadura, a partir do meio de Negroni. O paciente classificado, segundo o "Centers for Disease Control (CDC", no grupo IV devido a uma pneumocistose pulmonar, interrompeu o tratamento por problemas particulares na segunda dose de anfotericina B, sendo tratado alternativamente com 800 mg/dia de cetoconazol. O óbito ocorreu um ano após o isolamento do P.brasiliensis em hemocultura.A case of an AIDS-patient with positive blood culture for Paracoccidioides brasiliensis is reported. The patient was a 29 years old male born in Nova Londrina (Paraná State, Brazil who presented splenomegaly and fever of unknown origin. Three blood cultures were performed, each one of them for aerobic bacteria, mycobacteria and fungi. Cultures for aerobic bacteria and mycobacteria were negative. However, the yeast phase P. brasiliensis was isolated from two cultures in BHI agar, 20 days after inoculation in Negroni medium. The patient was classified in group V according to the Centers for Disease Control (CDC criteria for AIDS, due to a Pneumocystis carinii pneumonia. Treatment was discontinued due to an individual decision of the patient on the second dose of amphotericin B. This antibiotic was replaced by ketoconazole in the daily dose of 800 mg. The patient died one year after the isolation of P. brasiliensis on blood culture.

  16. The analysis of PCP in renal transplantation recipients and HIV-infected patients%HIV阳性PCP及肾移植术后PCP患者诊治分析

    Institute of Scientific and Technical Information of China (English)

    焦洋; 董宇超; 黄怡; 李强; 周道银

    2012-01-01

    目的 探讨HIV阳性PCP及肾移植术后PCP患者的临床特点.方法 对我院呼吸科收治的4例HIV阳性PCP及4例肾移植术后PCP患者的临床症状、影像学、治疗经过进行总结分析.结果 7例患者为男性,1例为女性,发热、无痰性咳嗽及气促是常见的临床表现.影像学主要表现为两肺弥漫性磨玻璃影.肾移植术后PCP患者的确诊时间小于HIV阳性PCP患者(P<0.05)、CRP及CD+4T淋巴细胞绝对值均高于HIV阳性PCP患者(P>0.05).结论 肾移植患者在术后半年内容易发生PCP.早期诊断,及时TMP-SMZ治疗,对疾病的预防和控制有重要作用.%Objective To investigate the clinical characteristics of pneumocystis carinii pneumonia ( PCP ) alter HIV-infected and renal transplantation patients. Methods The clinical data of four HIV-infected PCP and four renal transplantal PCP were analyzed, inclu ding the clinical profiles, immunological status, and chest radiological characteristics. Results Seven of the patients were men, and one was women. The most common clinical symptoms were level', cough without sputum and breathless, and the typical imaging finding was bi lateral diffuse ground glass opacities distributing in perihilar regions. Compared with HIV-infected patients, the number of white blood cell, neumophila and CD4+ T cell were higher in renal tiansplantal patients than that of HIV-infected ones with significant difference. Con clusion More and more PCP happens in HIV-negative patients because of the use of glucocorticoid and immunosuppressive agents. Early diagnosis and timely treatment of TMP-SMZ are important in treating the disease.

  17. Postmortem Investigations Following Human Immunodeficiency Virus Infection

    Directory of Open Access Journals (Sweden)

    Andrey V. Bychkov

    2009-04-01

    Full Text Available Background: HIV/AIDS is a global disease and despite intensive research it is one of the main causes of human death. Postmortem studies have proven accurate in determining the various pathologies in these patients. Aims & Objectives: Our aim was to analyze the post mortem results of individuals who died after HIV infection in the same geographical region. We evaluated the most frequent opportunistic diseases and their clinical and morphological outcomes. Methods: We studied case reports and autopsy research data from 32 patients who died after HIV infection in Smolensk, Russian Federation, between 2003 and 2008. All patients had been diagnosed with HIV infection before death, using HIV-specific enzyme linked immunosorbent assay (ELISA and immunoblotting. Autopsy specimens of various organs were examined histologically and microbiologically. Findings: The mean survival period from the moment of detection of seropositivity in all the patients was less than five years. Twelve patients had a parenteral mode of contact, six had been infected by sexual contact, and 14 patients had unknown modes of infection. Most patients (69% had chronic hepatitis C. The main causes of death were various infectious diseases. The most common were generalized miliary tuberculosis and progressive secondary tuberculosis of the lungs. Three (9% patients had tuberculosis of the meninges and five (16% had peritoneal infections, but tuberculous peritonitis had not been diagnosed before death. Six patients had pulmonary tuberculosis and bacterial pneumonia simultaneously. Two (6% patients died from bacterial sepsis as a result of cervical lymphadenitis, and eight (12.5% from abscess-forming pneumonia. The opportunistic infections revealed were Pneumocystis carinii pneumonia (eight patients, cytomegaloviral pneumonia (three, bronchopulmonary aspergillosis (one and mucosal candidiasis (three. In three patients, the causes of death were advanced neoplastic processes: two cases

  18. THE MANY FACES OF PNEUMOMEDIASTINUM: AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Narendra Kumar Narahari

    2016-06-01

    Full Text Available Pneumomediastinum is an uncommon condition which is defined by the presence of air in the mediastinum. It may result from a number of causes, but at times the underlying aetiology remains obscure. The present study aims to review the clinical and imaging features in patients who presented with pneumomediastinum alone or in association with other findings in order to establish the aetiological diagnosis. We report here, a series of cases with pneumomediastinum of various unusual aetiologies and also the clinical profile, predisposing factors and outcome of these patients along with the associated complications. METHODS We retrospectively reviewed the records of all patients who presented to the respiratory unit of our hospital with the diagnosis of pneumomediastinum over a period of 2 years from 2013-2015. The cases of pneumomediastinum resulting from trauma and iatrogenic causes were excluded from the study. RESULTS A total of six patients (4 males and 2 females with pneumomediastinum were identified during the study period after applying the exclusion criteria. The most common presenting symptom in these cases was shortness of breath followed by dry cough, chest pain and fever. Subcutaneous emphysema and Hamman sign was identified in one patient each. Of the six cases, preexisting lung disease was identified in 3 patients and these included connective tissue disease related interstitial lung disease in two cases and combined pulmonary fibrosis and emphysema in one case. In the remaining three cases, the causes of pneumomediastinum were Pneumocystis carinii pneumonia (PCP in HIV positive patient, pulmonary tuberculosis in another and spontaneous oesophageal perforation in the third. Coexisting pneumothorax was present in 3 out of 6 cases. The mean duration of hospital stay in these six patients was 8 days. No recurrence of pneumomediastinum was seen in any of the six patients during six months of followup. CONCLUSIONS Pneumomediastinum is a

  19. Risk factors for mortality from acute lower respiratory infections (ALRI in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies.

    Directory of Open Access Journals (Sweden)

    Michela Sonego

    Full Text Available OBJECTIVE: To evaluate risk factors for death from acute lower respiratory infections (ALRI in children in low- and middle-income countries. DESIGN: Systematic review and meta-analysis. STUDY SELECTION: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. DATA SOURCES: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014. RISK OF BIAS ASSESSMENT: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. RESULTS: Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37‒13.92; age below two months (5.22, 1.70‒16.03; diagnosis of Pneumocystis Carinii (4.79, 2.67‒8.61, chronic underlying diseases (4.76, 3.27‒6.93; HIV/AIDS (4.68, 3.72‒5.90; and severe malnutrition (OR 4.27, 3.47‒5.25. Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03‒3.31; low maternal education (1.43, 1.13‒1.82; low socio-economic status (1.62, 1.32‒2.00; second-hand smoke exposure (1.52, 1.20 to 1.93; indoor air pollution (3.02, 2.11‒4.31. Immunisation (0.46, 0.36‒0.58 and good antenatal practices (0.50, 0.31‒0.81 were associated with decreased odds of death. CONCLUSIONS: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to

  20. Amphotericin B for cryptococcal meningitis in HIV positive patients: Low dose versus high dose

    Directory of Open Access Journals (Sweden)

    Rajeshwari S

    2007-01-01

    Full Text Available Aim: To compare the safety and efficacy of low dose vs high dose of amphotericin B in cryptococcal meningitis associated with HIV infection. Materials and Methods: Retrospective data of patients admitted with clinical diagnosis with or without microbiological evidence of cryptococcal meningitis was collected from Jan 2000-Mar 2006. Patients′ details were collected in a proforma which included patient′s age, weight, signs and symptoms of disease and microbiological report (blood and CSF analysis. Data also included coexisting disease; concomitant medications taken along with amphotericin B. Adverse drug reactions which occurred during the period of treatment were recorded. Patients were grouped as low dose group and high dose group depending on the dose of amphotericin B given for the treatment of cryptococcal meningitis. Patients who received amphotericin B at doses of 0.33 to 0.64 mg/kg body weight per day were categorized under low dose group and patients who received amphotericin B at doses of 0.7 to 1.1 mg/kg/day were categorized under high dose group. All data were pooled and analyzed between the groups using chi square test. Result: Total number of patients included in the study were 38, 26 in the low dose group and 12 in the high dose group. In the low dose group, 20 were males and six were females, in the high dose group eight were males and four were females. The commonest underlying diseases were tuberculosis (17 in low dose group, nine in high dose group, Pneumocystis carinii (jeroveci pneumonia (16 in low dose group, seven in high dose group and oral candidiasis (eight in low dose group, seven in high dose group, Toxoplasmosis (three in low dose group, one in high dose group, hypertension (1 in group A and diabetes mellitus (1 in group B. Concomitant medication received along with amphotericin B for coexisting diseases in both the groups were antitubercular therapy, cotrimoxazole, antiviral therapy and premedications such as

  1. Mortality among HIV-Infected Patients in Resource Limited Settings: A Case Controlled Analysis of Inpatients at a Community Care Center

    Directory of Open Access Journals (Sweden)

    Nirmala Rajagopalan

    2009-01-01

    Full Text Available Problem statement: Despite massive national efforts to scale up Antiretroviral Therapy (ART access in India since 2004, the AIDS death rate was 17.2 per 100,000 persons during 2003-2005. In the era of HAART in resource poor settings, it is imperative to understand and address the causes of AIDS related mortality. This collaborative study aimed at defining the predictors of mortality among people living with HIV/AIDS (PLHA admitted during 2003-2005 to the Freedom Foundation (FF Care and Support facility, Bangalore, India. Approach: Fifty consecutively selected HIV-infected patients who died during the study period and 50 HIV-infected patients matched by age, gender, route of transmission, nutrition status and stage of disease who survived at least 12 months post-ART were included in this study. The impact on mortality by factors such as: Hemoglobin, CD4+T lymphocyte counts, weight loss and Opportunistic Infections (OIs were studied. Statistical analyses were done by Chi-square, Fisher’s Exact Test, Kaplan-Meier and multivariate logistic regression. Results: Recurrent diarrhea was a significant risk factor for mortality (OR = 12.25, p = 0.004, followed by a diagnosis of pulmonary tuberculosis (TB at first admission (OR = 4.86 while TB in general also negatively impacted survival (p = 0.002. Though not statistically significant, Pneumocystis carinii pneumonia, Cryptococcal meningitis and Toxoplasmosis also negatively affected survival. Mortality was high among those not on HAART (81% while it was significantly reduced (28% among those on HAART (pConclusion: Interventions that facilitate early OI diagnosis and treatment especially diarrhea and TB may reduce mortality in HIV. HAART alone without proper OI management and nutrition did not prevent mortality among PLHA. In resource poor settings, it becomes imperative to focus on low cost tools and increased capacity building along with regular clinical follow-up for diagnosis and early treatment of

  2. Accelerated hyperfractionated radiotherapy combined with induction and concomitant chemotherapy for inoperable non-small-cell lung cancer. Impact of total treatment time

    Energy Technology Data Exchange (ETDEWEB)

    Nyman, J.; Mercke, C. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Oncology; Bergman, B. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Respiratory Medicine

    1998-12-31

    Tumour cell proliferation during conventionally fractionated radiotherapy (RT) can negatively influence the treatment outcome in patients with unresectable non-small-cell lung cancer (NSCLC). Accelerated and hyperfractionated RT may therefore have an advantage over conventional RT. Moreover, earlier studies have suggested improved survival with addition of cisplatin-based chemotherapy (CT). We present here the results of combined treatment with induction and concomitant CT and accelerated hyperfractionated RT in a retrospective series of patients with advanced NSCLS. Between August 1990 and August 1995, 90 consecutive patients, aged 42-77 years (median 63 years), with locally advanced unresectable or medically inoperable NSCLC and good performance status were referred for treatment: stage: I 23%, IIIa 37%, IIIb 40%. Patient histologies included: squamous cell carcinoma 52%, adenocarcinoma 34% and large cell carcinoma 13%. The treatment consisted of two courses of CT (cisplatin 100 mg/m{sup 2} day 1 and etoposide 100 mg/m{sup 2} day 1-3 i.v.), the second course given concomitantly with RT. The total RT dose was 61.2-64.6 Gy, with two daily fractions of 1.7 Gy. A one-week interval was introduced after 40.8 Gy to reduce acute toxicity, making the total treatment time 4.5 weeks. Concerning toxicity, 33 patients had febrile neutropenia, 10 patients suffered from grade III oesophagitis and 7 patients had grade III pneumonitis. There were two possible treatment-related deaths, one due to myocardial infarction and the other due to a pneumocystis carinii infection. The 1-, 2- and 3-year overall survival rates were 72%, 46% and 34%, respectively; median survival was 21.3 months. Fifty-nine patients had progressive disease: 21 failed locoregionally, 29 had distant metastases and 9 patients had a combination of these. Pretreatment weight loss was the only prognostic factor found, except for stage. However, the results for stage IIIb were no different from those for stage IIIa

  3. Glaucoma bilateral por fechamento angular induzido por sulfametoxazol-trimetoprima: relato de caso Bilateral angle-closure glaucoma induced by trimetoprim and sulfamethoxazole combination: case report

    Directory of Open Access Journals (Sweden)

    Viviane Souto Spadoni

    2007-06-01

    Full Text Available Sulfametoxazol e trimetoprima (cotrimoxazol é uma combinação de drogas amplamente usada no tratamento e profilaxia de inúmeras infecções sistêmicas. Esta droga e outras derivadas da sulfa podem causar uma síndrome ocular rara caracterizada por efusão coroidal supracililar com miopização transitória e glaucoma por fechamento angular. A maioria dos autores atribui o glaucoma ao edema do corpo ciliar que leva ao deslocamento anterior do diafragma irido-cristaliniano causando fechamento do ângulo camerular. Este trabalho descreve um caso raro no qual a síndrome ocorreu após o uso desta combinação de drogas e evoluiu para um desfecho desfavorável. Paciente de 49 anos, sexo masculino, branco com diagnóstico de síndrome da imunodeficiência adquirida iniciou tratamento profilático para Pneumocystis carinii com cotrimoxazol. Quatro dias após, apresentou quadro de dor ocular, hiperemia e quemose conjuntival, glaucoma agudo por fechamento angular com pressões intra-oculares maiores que 50 mmHg e efusão coroidal 360º, com os achados presentes nos dois olhos. Nesse mesmo dia, a medicação foi suspensa com diminuição da pressão intra-ocular após quatro dias. O paciente evoluiu com catarata total e phthisis bulbi bilateral nos dois meses subseqüentes. Os casos já descritos mencionam a melhora clínica completa do quadro ocular após a suspensão da medicação. Este seria o primeiro caso na literatura no qual a evolução foi desfavorável apesar do diagnóstico e da suspensão precoce da medicação causadora.Sulfamethoxazole-trimethoprim (cotrimoxazole is an antibiotic combination widely used for infections treatment and prophylaxis. These and others sulfonamides have been implicated in a rare syndrome of choroidal effusion with transient myopia and angle-closure glaucoma. Previous cases reported in literature evolved to complete resolution after drug withdrawal. In contrast, we describe a rare case in which a patient

  4. 中国1998年至2007年临床确诊的肺真菌病患者的多中心回顾性调查%A multicentre retrospective study of pulmonary mycosis clinically proven from 1998 to 2007

    Institute of Scientific and Technical Information of China (English)

    刘又宁; 李尔然; 陈萍; 马忠森; 施毅; 冯玉麟; 姜淑娟; 熊盛道; 胡成平; 佘丹阳; 孙铁英; 童朝晖; 贺蓓; 肖毅; 何礼贤; 瞿介明; 刘晓青

    2011-01-01

    Objective To investigate the pathogens, clinical manifestations, prognosis of and the risk factors for pulmonary mycosis in China. Methods All cases of pulmonary mycosis from 16 centers in 10 cities from Jan. 1998 to Dec. 2007 that met the diagnostic criteria were included for clinical,microbiological and radiological analysis. Results Totally 474 cases of pulmonary mycosis were retrieved.The top 5 pulmonary mycosis was pulmonary aspergillosis ( 180 cases, 37. 9% ), pulmonary candidiasis ( 162 cases, 34. 2% ), pulmonary cryptococcosis ( 74 cases, 15. 6% ), pneumocystis carinii pneumonia ( 23cases, 4. 8% ) and pulmonary mucormycosis ( 10 cases, 2. 1% ). The constituent ratio in the last 3 years was similar to that in the former 7 years. The main pathogens of pulmonary candidiasis were Candida albicans ( 308/474, 65.0% ) and Candida tropicalis ( 57/474, 12.0% ), which were sensitive to common azoles.Compared with bacterial pneumonia, pulmonary mycosis showed more symptoms of hemoptysis ( 147/474,31.0% ) and pleural effusion (95/474, 20.0% ), and less radiological specificity. Classical halo sign (4/474, 0. 8% ) and crescentic sign (17/474, 3. 6% ) were only shown in several cases of pulmonary mycosis. The most common underlying diseases were tumor ( including solid tumor and malignant hematological diseases ) ( 94/474, 19.8% ), chronic obstructive pulmonary disease ( 52/474, 11.0% ), pulmonary tuberculosis(50/474, 10. 5% ) and diabetes(48/474, 10.1% ). Compared with the other common pulmonary mycosis, pulmonary cryptococcosis affected younger patients, and more cases were community-acquired, but fewer cases with underlining diseases or compromised immune function, and had a better prognosis. Conclusion The ahead five species of pulmonary mycosis in China were orderly pulmonary aspergillomycosis,pulmonary candidosis, pulmonary cryptococcosis, pneumocystis carinii pneumonia and pulmonary mucormycosis. The main pathogens of pulmonary candidosis were Candida albicans and

  5. Papel da fibrobroncoscopia no diagnóstico de pacientes com suspeita de tuberculose pulmonar Role of the fiberoptic bronchoscopy in the diagnosis of patients with suspected pulmonary

    Directory of Open Access Journals (Sweden)

    Anna Luiza Summers Caymmi

    2004-02-01

    Full Text Available INTRODUÇÃO: A tuberculose pulmonar é uma doença infectocontagiosa de elevadas incidência e prevalência. O diagnóstico é feito de maneira rápida e segura através da baciloscopia do escarro. Entretanto, dos portadores de tuberculose pulmonar, 30% a 50% têm baciloscopia do escarro negativa ou não têm escarro, o que faz com que a fibrobroncoscopia adquira especial importância nesses casos. OBJETIVO: Avaliar a sensibilidade de espécimes colhidos, através da fibrobroncoscopia (lavado broncoalveolar e biópsia transbrônquica, para o diagnóstico de pacientes com suspeita de tuberculose pulmonar, sem confirmação diagnóstica através da baciloscopia do escarro. MÉTODO: Através da revisão dos livros de registro das fibrobroncoscopias realizadas no Hospital Universitário Professor Edgard Santos e no Hospital São Rafael, entre março de 1997 e março de 2001, foram identificados e incluídos no estudo os pacientes maiores de 18 anos, e encaminhados devido a suspeita de tuberculose com, no mínimo, três baciloscopias do escarro negativas. Foram coletados dados referentes a idade, sexo, alteração radiológica e alterações encontradas durante o exame endoscópico. RESULTADOS: Foram identificados 52 pacientes, com idade variando de 19 a 77 anos (mediana de 39, sendo 58% do sexo masculino e 37% atendidos pelo SUS. A apresentação radiológica predominante foi o infiltrado alveolar (80%. Tuberculose foi o diagnóstico final em 35 pacientes (1 com neoplasia associada, e a broncoscopia foi diagnóstica em 28 pacientes (80%. Outros diagnósticos obtidos pela broncoscopia foram: neoplasia, histoplasmose, alveolite crônica eosinofilica, pneumonia por Pneumocystis carinii e fibrose pulmonar. CONCLUSÃO: Os resultados deste estudo indicam a realização da fibrobroncoscopia em pacientes com suspeita de tuberculose não confirmada através da baciloscopia do escarro para determinação diagnóstica, não só desta doença, como de todas as

  6. Clinical value of ambroxol combined with procaterol hydrochloride on senile pneumonia%氨溴索联合盐酸丙卡特罗治疗老年肺炎的临床价值

    Institute of Scientific and Technical Information of China (English)

    廖艳琴

    2016-01-01

    Objective To study the effect of ambroxol combined with procaterol hydrochloride on Pneumocystis carinii pneumonia(PCP). Methods Thirty-two senile patients with pneumonia from June 2012 to June 2015 were selected as the research objects,and they were randomly divided into control group and observation group,with 16 cases in each group. Both groups were treated with procaterol hydrochloride 2. 0 g for intravenous drip;on this basis,the control group was given low dose of ambroxol and the observation group was treated with ambroxol. The symptoms disappear time before and after treat-ment,the oxygen partial pressure and oxygenation index were compared. Results After treatment,the related symptoms disappear time in observation group was significantly shorter than that in the control group;the oxygen partial pressure and oxygen index in observation group were significantly higher than that in control group,PO2 ,PCO2 and WBC of elderly patients after treatment of the two groups were sig-nificantly better than before treatment,and in the observation group therapy,the levels of PO2[(80. 30 ± 9. 26)mmHg,1 mmHg = 0. 133 kPa],PCO2[(45. 53 ± 4. 27)mmHg ]and WBC[(8. 85 ± 3. 62) × 109 / L]were significantly better than those of the control group[ PO2(70. 33 ± 875)mmHg,PCO2 (51. 61 ± 5. 40)mmHg and WBC(10. 81 ± 4. 00)× 109 / L],the differences were significant( P ﹤0. 05). Conclusions Compared with low dose of ambroxol hydrochloride,ambroxol combined with pro-caterol hydrochloride has good effect on Pneumocystis carinii pneumonia .%目的:对氨溴索联合盐酸丙卡特罗治疗卡氏肺孢子菌肺炎(PCP)的治疗作用进行研究。方法选取2012年6月至2015年6月32例卡氏肺孢子菌肺炎老年患者作为研究对象,将其随机分为对照组和观察组,每组16例。两组均静脉滴注盐酸丙卡特罗2.0 g,在此基础上对照组应用小剂量氨溴索,观察组应用氨溴索,比较两组症状消失时间及治疗前后的血

  7. A prospective Comparison of Porta-Sonic and Fisoneb Ultrasonic Nebulizers for Administering Aerosol Pentamidine

    Directory of Open Access Journals (Sweden)

    Andrew McIvor

    1994-01-01

    Full Text Available Objective: To report patient acceptability and overall therapeutic effectiveness of two different ultrasonic nebulizers, Fisoneb and Porta-sonic, for the administration of aerosol pentamidine for Pneumocysitis carinii prophylaxis in human immunodeficiency virus (hiv-infected individuals.

  8. Screening pharyngolaryngeal aspirate from patients undergoing surgery for a brain tumor for Pneumocystis jirovecii%脑瘤手术患者咽喉部吸取液中耶氏肺孢子菌的筛查

    Institute of Scientific and Technical Information of China (English)

    任珊珊; 宋营改; 吴赵永; 粟绍钢; 范东瀛; 王爱东; 任翊

    2015-01-01

    目的 采用常规PCR、巢式PCR(Nest PCR,nPCR)和定量PCR(Quantitative PCR,qPCR)检测耶氏肺孢子菌(Pneumoc ystisjirovecii,Pj)特异性核酸片段,调查脑瘤手术患者咽喉部吸取液中的Pj. 方法 选取无肺炎脑瘤手术患者108例,留取手术咽喉部吸取液,分别以线粒体大亚基rRNA(Mitochondrial large subunit rRNA,mtLSUrRNA)为靶基因的常规PCR(Mt-PCR)和巢氏PCR(Mt-nPCR),以及主要表面糖蛋白(Major surface glycoprotein,Msg)为靶基因的常规PCR(Msg-PCR),检查咽喉部吸取液中Pj特异性核酸片段,阳性标本进行qPCR,检测分别以mtLSUrRNA和Msg为靶基因的拷贝数. 结果 108例脑瘤手术患者咽部吸取液Mt-nPCR、Msg-PCR及MtPCR扩增阳性率率分别为41.7%(45/108)、15.7% (17/108)和4.6%(5/108),其中3种检测方法同为阳性1例(占0.9%),任意2种方法阳性11例(占10.2%),Mt-nPCR和Msg-PCR任意1种方法阳性42例(占38.9%),3种方法均阴性54例(占50.0%).54例PCR检测阳性的标本同时进行mtLSUrRNA定量PCR(Mt-qPCR)和Msg定量PCR (Msa-qPCR)检测,其中Mt-qPCR检测为100~999拷贝/μl2例(占3.7%),1 000~9 999拷贝/μl有49例(占90.7%),≥10 4拷贝/μl有3例(占5.6%);Msg-qPCR检测为1 000~9 999拷贝/μl 14例(占25.9%),10 000~99 999拷贝/μl 21例(占38.9%),100 000~999 999拷贝/μl 14例(占25.9%),≥106拷贝/μl有5例(占9.3%).54例中Msg-qPCR拷贝数>Mt-qPCR拷贝数51例(占94.4%),Msg-qPCR拷贝数<Mt-qPCR拷贝数3例(占5.6%). 结论 核酸扩增法检测脑瘤手术患者咽喉部吸取液Pj阳性率为50.0%,其中MtqPCR检测多数为103拷贝/μl,Msg qPCR检测多数为103~105拷贝/μl,解读需谨慎.

  9. Single amino-acid substitution in the N-terminal arm altered the tetramer stability of rat muscle lactate dehydrogenase A

    Institute of Scientific and Technical Information of China (English)

    YUAN; Chong; (

    2001-01-01

    [1]Price, N. C., Assembly of multi-subunit structures, in Mechanisms of Protein Folding (ed. Pain, R. H.), New York: Oxford University Press, 1994, 160-193.[2]Casal, J. I., Ahern, T. J., Davenport, R. C. et al., Subunit interface of triosephosphate isomerase: Site-directed mutagenesis and characterization of the altered enzyme, Biochemistry, 1987, 26: 1258-1264.[3]Chakerian, A. E., Matthews, K. S., Characterization of mutations in oligomerization domain of lac repressor protein, J. Biol. Chem., 1991, 266: 22206-22214.[4]Mandelman, D., Schwarz, F. P., Li, H. Y. et al., The role of quaternary interactions on the stability and activity of ascorbate peroxidase, Protein Sci., 1998, 7: 2089-2098.[5]Thomas, M. C., Ballantine, S. P., Bethell, S. S. et al., Single amino acid substitutions disrupt tetramer formation in the dihydroneopterin aldolase enzyme of Pneumocystis carinii, Biochemistry, 1998, 37: 11629-11636.[6]Holbrook, J. J., Liljas, A., Steindel, S. J. et al., Lactate dehydrogenase, in The Enzymes (ed. Boyer, P. D.), Vol. 11, 3rd ed., New York: Academic Press, 1975, 191-292.[7]Zettlmeissl, G., Rudolph, R., Jaenicke, R., Reconstitution of lactic dehydrogenase after acid dissociation, Eur. J. Biochem., 1981, 121: 169-175.[8]Zettlmeissl, G., Rudolph, R., Jaenicke, R., Rate-determining folding and association reactions on the reconstitution pathway of porcine skeletal muscle lactic dehydrogenase after denaturation by guanidine hydrochloride, Biochemistry, 1982, 21: 3946-3950.[9]Hermann, R., Jaenicke, R., Rudolph, R., Analysis of the reconstitution of oligomeric enzymes by cross-linking with glutaraldehyde: Kinetics of reassociation of lactic dehydrogenase, Biochemistry, 1981, 20: 5195-5201.[10]Jaenicke, R., Folding and association of protein, Prog. Biophys. Mol. Biol., 1987, 49: 117-237.[11]Opitz, U., Rudolph, R., Jaenicke, R. et al., Proteolytic dimeric of porcine muscle lactate dehydrogenase: Characterization, folding, and

  10. Canadian recommendations for the treatment of glioblastoma multiforme.

    Science.gov (United States)

    Mason, W P; Maestro, R Del; Eisenstat, D; Forsyth, P; Fulton, D; Laperrière, N; Macdonald, D; Perry, J; Thiessen, B

    2007-06-01

    , followed by 5 cycles if well tolerated. Additional cycles may be considered in partial responders. The dose should be increased to 200 mg/m(2) at cycle 2 if well tolerated. Weekly monitoring of blood count is advised during chemoradiation therapy in patients with a low white blood cell count. Pneumocystis carinii pneumonia has been reported, and prophylaxis should be considered. RECOMMENDATION 8: For patients with stable clinical symptoms during combined radiotherapy and temozolomide, completion of 3 cycles of adjuvant therapy is generally advised before a decision is made about whether to continue treatment, because pseudo-progression is a common phenomenon during this time. The recommended duration of therapy is 6 months. A longer duration may be considered in patients who show continuous improvement on therapy. RECOMMENDATION 9: Selected patients with recurrent gbm may be candidates for repeat resection when the situation appears favourable based on an assessment of individual patient factors such as medical history, functional status, and location of the tumour. Entry into a clinical trial is recommended for patients with recurrent disease. RECOMMENDATION 10: The optimal chemotherapeutic strategy for patients who progress following concurrent chemoradiation has not been determined. Therapeutic and clinical-molecular studies with quality of life outcomes are needed.

  11. 21 patients with HIV/AIDS complicated with tuberculosis%按结核病就诊合并HIV/AIDS患者21例临床分析

    Institute of Scientific and Technical Information of China (English)

    李志江

    2015-01-01

    Objective To explore the clinical characteristics of HIV/AIDS patients complicated with tuberculosis and to improve the clinical knowledge of HIV/AIDS complicated with tuberculosis.Methods The clinical characteristics of 21 patients seeing a doctor because oftuberculosis but complicated with HIV/AIDS at our hospital from June, 2009 to August, 2014 were analyzed.Results 21 patients with HIV/AIDS were mainly sexually transmitted.Their clinical manifestations were mainly fever, cough,sputum, fatigue, shortness of breath, chest pain, headache, diarrhea, abdominal pain, oral ulcer, weight loss, heterogeneous, voice hoarse, etc.Imaging findings of tuberculosis were atypical.The patients complicated with other opportunistic infections, such as fungal infections, thrush, cryptococcus meningitis, pneumocystis carinii pneumonia, etc.5 patients died.Conclusions The clinical characteristics of HIV/AIDS complicated with tuberculosis: ① the symptoms are not typical;② imaging findings of tuberculosis are atypical;③ easy to occur a variety of opportunistic infections, such as fungi, bacteria, virus, etc.;④ the tuberculin tests are mainly negative;⑤ blood line of disseminated tuberculosis and extrapulmonary tuberculosis are common;⑥ sputum tuberculosis detection rate is low;⑦ anti-tuberculosis effect is not satisfied and mortality is high.%目的 探讨HIV/AIDS合并结核病患者的临床特点,提高HIV/AIDS合并结核病的临床认识.方法 对我院2009年6月至2014年8月按结核病就诊合并HIV/AIDS的21例患者的临床特点进行分析.结果 21例患者HIV/AIDS传播途径以性传播为主;临床表现主要为发热、咳嗽、咳痰、乏力、气短、胸痛、头痛、腹泻、腹痛、口腔溃疡、体重下降、恶异质、声音嘶哑等;肺结核病影像学表现不典型;合并其他的机会性感染如真菌性感染、鹅口疮、隐球菌性脑膜炎、卡氏肺孢子虫肺炎等;死亡5人.结论 HIV/AIDS合并结核病的临床

  12. Anti-infective treatment for the HIV-infected patient during perioperative period%围手术期HIV感染者的抗感染治疗

    Institute of Scientific and Technical Information of China (English)

    刘保池; 张磊; 李垒; 司炎辉; 宋言峥; 赵中辛

    2012-01-01

      Objective:To investigate anti-infective treatments in HIV-infected surgical patients during the perioperative period. Methods 〓 A retrospective study of sepsis and surgical site infections (SSIs) was conducted in 266 HIV-infected patients from January 2009 to December 2011 in Shanghai Public Health Clinical Center. The patients were divided into 3 groups based on CD4 cells counts in the preoperative period: group A (<200 cell/μl), group B (200-349 cell/μl) and group C (≥350 cell/μl). Highly active anti-retrovirus therapy (HAART) was started in group B. Preoperative antibiotic medication SMZ and fluconazole against Pneumocystis carinii pneumonia (PCP) and other fungal infection was started in group A. No special treatment in group C. Results〓There were only 6 patients dead at 30 days after surgery, with the death rate of 2.3%. Sepsis appeared in 110 patients (41.3%). Patients in group A were more likely to get sepsis than patients in the other two groups (P <0.01). Conclusion〓Complete evalua- tion of surgical risk and suitable perioperative anti-infective treatment may lead to better outcome for HIV-infected surgical patients.%  〓〓[]〓目的〓探讨 HIV 感染者围手术期合理的抗感染治疗.方法〓回顾性分析上海市公共卫生临床中心外科2009年1月至2011年12月救治的266例 HIV 感染患者围手术期临床资料,根据患者术前 CD4 T 淋巴细胞水平分 A 组<200 cell/μl,B 组200~349 cell/μl 和 C 组≥350 cell/μl 三组,对 B 组给予抗 HIV 病毒治疗,对 A 组给予抗 HIV 病毒、磺胺甲唑(SMZ)和氟康唑预防肺孢子虫和真菌感染,对已经合并结核、真菌等机会性感染者给予相应的抗感染治疗.对 C组无特殊处理.结果〓经适当的抗感染治疗,266例患者手术后30 d 内死亡6例,病死率2.3%.110例发生脓毒症,脓毒症发生率41.3%.A 组脓毒症发病率明显高于 B 组和 C 组(P <0.01).结论〓精细的手术与合理的围手术

  13. Study on the anti-Pneunocystis carinii effect of arteminsin derivatives in vitro with transmission electron microscopic%青蒿素衍生物体外抗卡氏肺孢子虫不同时相透射电镜观察

    Institute of Scientific and Technical Information of China (English)

    倪小毅; 陈雅棠; 王健; 廖晓刚; 王红

    2002-01-01

    研究双氢青蒿素、青蒿琥酯体外抗卡氏肺孢子虫(Pc)不同时相的超微结构改变.将HepG-2细胞接种入若干个50ml培养瓶,待细胞长满瓶底的80%时,接种Pc.4h后分别加入双氢青蒿素5、50μmol/L,青蒿琥酯100μmol/L,喷他脒(Pentamidine)15μmol/L,空白对照和0.3%无水乙醇.前3组(青蒿素衍生物组)分别于用药后2、4、8、12、16、24h,后3组于用药后24h取样制备电镜标本.结果用喷他脒处理包膜发生改变.双氢青蒿素5tμmol/L作用8h后滋养体开始出现改变,而50μmol/L作用4h后即有变化,其超微结构改变,主要为空泡形成和膜系结构的损伤,包囊在24h出现病理改变.青蒿琥酯100μmol/L 8h有少量滋养体出现病理变化,改变的性质与双氢青蒿素相同.双氢青蒿素在小剂量时8h,大剂量时4h即可对其产生作用,主要损害卡氏肺孢子虫的膜系结构.青蒿琥酯的作用较双氢青蒿素弱.

  14. FEATURES OF PNEUMONIA IN HIV-INFECTED PATIENTS

    Directory of Open Access Journals (Sweden)

    M. T. Vatutin

    2016-01-01

    Full Text Available The article presents the clinical, diagnostic and treatment features of pneumocystis pneumonia in HIV-infected patients. The clinical case of diagnosis verification in a patient 58 years old with severe respiratory failure is described.

  15. Dicty_cDB: SFD687 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available arinii f. sp. carinii he... 353 8e-96 EU679414_1( EU679414 |pid:none) Tetranychus cinnabarinus heat shoc... ...353 1e-95 EU679412_1( EU679412 |pid:none) Tetranychus cinnabarinus heat shoc... 3

  16. 亲属活体肾移植受者术后巨细胞病毒肺炎的单中心10年诊治经验总结%Cytomegalovirus pneumonia after living-related donor kidney transplantation : the experiences of one single center within 10 years

    Institute of Scientific and Technical Information of China (English)

    刘茁; 马潞林; 侯小飞; 赵磊; 刘磊; 张洪宪; 王国良; 张树栋

    2016-01-01

    感染,发生急性呼吸窘迫综合征、呼吸衰竭而死亡.结论 CMV肺炎是亲属活体肾移植术后较常见的感染性并发症.CMV肺炎易并发其他微生物感染,并成为肾移植患者术后死亡原因之一.及早明确诊断,早期抗病毒治疗联合及时有效的抗细菌、真菌治疗可提高CMV肺炎的治愈率.%Objective To report one-center experience on diagnosis and treatment of cytomegalovirus (CMV) pneumonia in recipients after living-related donor kidney transplantation (LDKT).Methods The clinical and follow-up data of 168 recipients after LDKT from April 2005 to September 2014 were analyzed retrospectively.We analyzed the general information,clinical manifestation,treatment and outcomes of 34 recipients who were diagnosed as CMV pneumonia.Of the 34 patients,26 were male and 8 were female.The average age were 32.0 years old.Thirty-four patients developed CMV pneumonia between 12 to 402 days with an average of (91.7 ±60.8) days post-transplant.It was (6.4 ±3.7) d(range 1-14 d) from the onset of illness to seeking medical intervention.All cases presented with fever,18 cases with dyspnea,11 cases with cough and 6 cases with myalgia or fatigue.The highest temperature was (38.8 ± 0.5) ℃ (range 38.0-40.0℃).Leukocyte count was (10.5 ± 4.4) × 109/L,elevated in 18 cases,normal in 14 cases,reduced in 2 cases.Quantitative polymerase chain reaction(PCR) assay for CMV DNA was (9.3-15.8) × 103 copies/ml for active CMV infection.Chest X ray or CT of all cases demonstrated patchy shadow or interstitial pneumonia.The etiological examination showed that 12 cases were complicated with other microorganism,including 8 cases with Pneumocystis carinii,3 cases with Streptococcus A,3 cases with Neisseria,3 cases with candida albicans,2 cases with klebsiella pneumoniae,Staphylococcus aureus,enterococcus faecium,Pseudomonas aeruginosa varied 1 case.Results In antiviral therapy,patients were treated by introvenous ganciclovir 5 mg/kg every 12

  17. Relationship of levels of serum carcinoembryonic antigen and pathological imaging changes of lungs in patients with acquired immune deficiency syndrome (AIDS)%AIDS患者血清CEA水平与胸部影像学关系的临床观察

    Institute of Scientific and Technical Information of China (English)

    王家驷; 王廷杰; 王平飞; 张雪漫; 冉梅

    2013-01-01

    among clinical expressions, symptoms, CT image changes of thorax and the leves of serum CEA were analyzed comparatively. Results The results were showed over 5 ng/ml serum levers of CEA (raised serum CEA) were 44.12% in 68 cases of patients with AIDS, there were not significant difference about mean age, the cases of fever and cough between raised serum CEA group and normal serum CEA group, but mean age were the eldest 3.22 year older in higher CEA group than normal groups, there were significant difference in the cases with raised serum CEA levers of chief complaint of short breath and complicating fungal infection, which were double to normal CEA groups, the cases of raised serum CEA of other chief complaints, as anergy, night sweat and chest discomfort were about moiety (a half) (47.83%) to normal CEA group, the mean levers of normal CEA group were (2.04 ± 1.34) ng/ml, but the levers of higher CEA group were (8.28 ± 4.54) ng/ml (P < 0.001), the probability of GGO in lungs of patients suffer from AIDS with raised serum CEA were 4 times of patients with normal CEA groups. The mean CEA levers of AIDS were showed that there were homologus difference with different range and density of chest eikonic GGO in patients with AIDS, but the mean levers of lung glaebule shadow, mediastinum enlargement and fiber item shadow were 0.00-10.93 ng/ml about, there were significant deviation than lungs GGO (P < 0.001). Conclusions There are correlation in the serum heighterned CEA levels with lungs GGO range and density, it is non-tumorous charactenistics, could associate with Pneumocystis carinii pneumonia.

  18. 经支气管镜肺活检对弥漫性肺实质疾病的诊断价值%The diagnostic value of transbronchial lung biopsy in diffuse parenchymal lung diseases

    Institute of Scientific and Technical Information of China (English)

    施举红; 许文兵; 刘鸿瑞; 冯瑞娥; 朱元珏; 肖毅; 蔡柏蔷

    2008-01-01

    Objective This study was to evaluate the efficacy and limitations of transbronchial lung biopsy(TBLB)in the diagnosis of diffuse parenchymal lung diseases(DPLD). Methods TBLB was performed in 416 patients with diffuse lung diseases from January 2001 to October 2006 in Peking Union Medical College Hospital. The results of clinical data and pathologic diagnosis were retrospectively analyzed.Results Confirmed diagnosis by TBLB was obtained in 124 patients,the total positive diagnostic rate was 29.8%. The diseases included pulmonary sarcoidosis(52/124,41.9%),bronchiolitis obliterans organizing pneumonia/organizing pneumonia(BOOP/OP)(28/124,22.6%),pulmonary alveolar proteinosis(19/124,15.3%),lung cancer(12/124,9.7%),pulmonary vasculitis(5/124,4.0%),pulmonary tuberculosis(3/124, 2.4%), and pneumocystis carinii pneumonia,lung fungal infection,lymphangiomyomatosis,and pulmonary amyloidosis(each 1/124,0.8%). Open lung or thoracoscopic biopsy was performed in 104 cases in whom the diagnosis was undetermined by TBLB. Confirmed diagnosis Was obtained in 109 patients,including nonspecific interstitial pneumonia(37/104,37.7%),usual interstitial pneumonia(18/104,18.4%),pulmonary sarcoidosis(11/104,11%),BOOP/OP(6/104,6%),and lung cancer(5/104,5.1%). Conclusions Pathologic diagnosis can be obtained by TBLB in about 30% of the cases with DPLD,and therefore it should be considered to be a routine diagnostic procedure before open lung or thoracoscopic biopsy.%目的 评价经支气管镜肺活检(TBLB)在弥漫性肺实质病变诊断中的作用.方法 回顾性分析2001年1月至2006年10月在北京协和医院住院、经TBLB检查且具有完整临床资料的肺部弥漫性疾病患者416例,男157例,女259例,平均年龄(42.6±18.9)岁.结果 416例中124例(29.8%)经支气管镜肺活检确诊,其中结节病52例(41.9%),闭塞型细支气管炎伴机化性肺炎(BOOP/OP)28例(22.6%),肺泡蛋白沉积症(PAP)19例(15.3%),肺部肿瘤12例(9.7%),肺血管炎5例(4.0%),

  19. [Diabetes mellitus induced by pentamidine, without previous episodes of hypoglycemia, in patients with AIDS].

    Science.gov (United States)

    Santos, I; del Arco, C; García-Polo, I; Noguerado, A; Caso, E; Gómez-Pan, A

    1990-12-01

    The onset of a pneumonia by P. carinii in AIDS patients have force scientist to look for others therapies against this parasite. It is more necessary when the first line treatment which is cotrimoxazol produced secondary effects or not therapeutic effects. Pentamidine which is an agent usually used to treat leishmaniasis and trypanosomiasis, but it is an alternative for P. carinii infection. The problems are the frequent and severe secondary effects when administered by continuous infusions and less when it is inhaled. Between those effects are the changes in carbohydrate metabolism which are 9% of them. It is frequent observe hypoglycemia during infusion following by hyperglycemia in 5% of the cases which convert the patients in diabetic insulinodependent. A case of a patient who developed diabetes mellitus insulinodependent, 10 days after the end of pentamidine treatment, without previous episodes of hypoglycemia, is presented. The medical literature is reviewed.

  20. Helmintos parasitos de Nectomys squamipes (Brants do município de Sumidouro, RJ

    Directory of Open Access Journals (Sweden)

    Delir Corrêa Gomes

    1984-03-01

    Full Text Available Os helmintos encontrados em setenta e uma necrópsias de Nectomys squamipes, capturados no Município de Sumidouro, Estado do Rio de janeiro, São analisados qualitativamente e quantitativamente. Foram estudadas as seguintes espécies: Pseudechinostomum caballeroi, Raillietina sp., Hassalstrongylus epsilon, Syphacia venteli, Aspidodera raillieti, Physaloptera getula e Litomosoides carinii.The helminths recovered from seventy one specimens of Nectomys squamipes, from "Município de Sumidouro", Rio de Janeiro State, are analyzed in conformity to their quantitative and qualitative features. It was possible to study seven species as follows: Pseudechinostomum caballeroi, Raillietina sp., Hassalstrongylus epsilon, Syphacia venteli, Aspidodera raillieti, Physaloptera getula and Litomosoides carinii.

  1. A Quantitative Model to Estimate Drug Resistance in Pathogens

    Directory of Open Access Journals (Sweden)

    Frazier N. Baker

    2016-12-01

    Full Text Available Pneumocystis pneumonia (PCP is an opportunistic infection that occurs in humans and other mammals with debilitated immune systems. These infections are caused by fungi in the genus Pneumocystis, which are not susceptible to standard antifungal agents. Despite decades of research and drug development, the primary treatment and prophylaxis for PCP remains a combination of trimethoprim (TMP and sulfamethoxazole (SMX that targets two enzymes in folic acid biosynthesis, dihydrofolate reductase (DHFR and dihydropteroate synthase (DHPS, respectively. There is growing evidence of emerging resistance by Pneumocystis jirovecii (the species that infects humans to TMP-SMX associated with mutations in the targeted enzymes. In the present study, we report the development of an accurate quantitative model to predict changes in the binding affinity of inhibitors (Ki, IC50 to the mutated proteins. The model is based on evolutionary information and amino acid covariance analysis. Predicted changes in binding affinity upon mutations highly correlate with the experimentally measured data. While trained on Pneumocystis jirovecii DHFR/TMP data, the model shows similar or better performance when evaluated on the resistance data for a different inhibitor of PjDFHR, another drug/target pair (PjDHPS/SMX and another organism (Staphylococcus aureus DHFR/TMP. Therefore, we anticipate that the developed prediction model will be useful in the evaluation of possible resistance of the newly sequenced variants of the pathogen and can be extended to other drug targets and organisms.

  2. [Advances in research of dihydroartemisinin against parasitic diseases].

    Science.gov (United States)

    Li, Hong-Jun; Wang, Wei; Liang, You-Sheng

    2011-08-01

    Dihydroartemisinin, the main metabolite of artemisinin and two artemisinin derivatives, artemether and artesunate, is a broad-spectrum anti-parasitic drug. The present paper systematically reviews the advances in research of dihydroartemisinin against Plasmodium, Schistosoma, Pneumocystis, Toxoplasma, Trichomonas vaginalis, Leishmania, Giardia lamblia.

  3. Immunodeficiency associated with a nonsense mutation of IKBKB

    DEFF Research Database (Denmark)

    Nielsen, Christian; Jakobsen, Marianne A; Larsen, Martin Jakob;

    2014-01-01

    insufficiency and Pneumocystis jirovecii pneumonia which was successfully treated. At nine months, iatrogenic systemic infection with Mycobacterium bovis was found and eventually led to her death at age 14 months. Laboratory findings were reminiscent of hyper-IgM syndrome, but genetic testing gave...

  4. Morbidity and Mortality Weekly Report. Volume 47. Number RR-1. 1998 Guidelines for Treatment of Sexually Transmitted Diseases.

    Science.gov (United States)

    1997-01-23

    deaths annually; these deaths result from cirrhosis of the liver and primary hepatocellular carcinoma. The risk for perinatal HBV infection among...Antigen HBV Hepatitis B virus HIV Human immunodeficiency virus HPV Human papillomavirus HSV Herpes simplex virus IFA Immunofluorescence assay IG...Pneumocystis car/>7//pneumonia PCR Polymerase chain reaction PID Pelvic inflammatory disease PPD Purified protein derivative PPV Positive predictive

  5. Evolution of the HIV-1 Envelope Glycoprotein Genes and Neutralizing Antibody Response in an Individual with Broadly Cross Neutralizing Antibodies

    Science.gov (United States)

    2010-08-31

    global mY/AIDS epidemic .... .. ... ..... ...... ... ..... ........ ...... ...... .... ....... ........... . 4 my classification and genetic ...Pneumocystis carinni pneumonia (PCP) among previously healthy homosexual men in Los Angeles, CA. At the time of publication, two of the five men had...healthy homosexual men across the United States. Disturbingly, severe and aggressive cases of Kaposi’s sarcoma, normally a slowly progressive cancer

  6. Granulomatous PJP presenting as a solitary lung nodule in an immune competent female.

    Science.gov (United States)

    Lam, J; Kelly, M M; Leigh, R; Parkins, M D

    2014-01-01

    Pneumocystis jiroveci pneumonia (PJP) opportunistically targets immunosuppressed patients, most notably those with advanced HIV/AIDS. Radiologically, PJP typically appears as bilateral diffuse pulmonary infiltrates. Herein an unusual case of an immunocompetent woman developing granulomatous PJP in the absence of evident risk factors is described. PJP may be an under-recognized cause of pulmonary nodules in immune competent individuals.

  7. Granulomatous PJP presenting as a solitary lung nodule in an immune competent female

    Directory of Open Access Journals (Sweden)

    J. Lam

    2014-01-01

    Full Text Available Pneumocystis jiroveci pneumonia (PJP opportunistically targets immunosuppressed patients, most notably those with advanced HIV/AIDS. Radiologically, PJP typically appears as bilateral diffuse pulmonary infiltrates. Herein an unusual case of an immunocompetent woman developing granulomatous PJP in the absence of evident risk factors is described. PJP may be an under-recognized cause of pulmonary nodules in immune competent individuals.

  8. Study on the diagnosis and treatment of severe pneumonia following renal transplantation in the elderly%老年人肾移植术后重症肺炎的特点及诊治

    Institute of Scientific and Technical Information of China (English)

    马嵘; 王勇; 李晓北

    2009-01-01

    , including 20 cases aged <60 years (<60 years old group) and 8 cases aged ≥60 years (≥60 years old group). Results In <60 years old group, the severe pneumonia occurred during 1-13 months after the renal transplantation. All the patients had fever. 10 cases coughed and 8 cases had expectoration. 6 cases had type I respiratory failure (RF) and 3 cases experienced type 11 RF. 6 cases had lobar pneumonia and 13 cases occurred interstitial pneumonia. One case experienced lung consolidation. The pathogens of 16 cases in <60 years old group were identified, including 4 cases with bacterial pneumonia, 4 cases with cytomegalovirus (CMV) pneumonia, 2 cases with pneumocystis carinii pneumonia, Ⅰ case with mycoplasma infection, Ⅰ case with tuberculosis infection, and 4 cases with mixed infection (2 cases infected by bacteria plus CMV, 1 case by bacteria plus fungi and 1 case by bacteria plus tuberculosis). Combined drugs (broad-spectrum antibiotic, antivirus and antifungal agent) were administered on the initial stage and sensitive drugs were used later according to the pathogens. Hormone or immunoglobulin was used when other drugs were useless. 17 cases were cured and 3 cases died. In ≥60 years old group, the severe pneumonia occurred during 1-9 months after renal transplantation. All 8 patients had fever, too. 5 cases coughed and 3 cases had expectoration. 3 cases experienced type ⅠRF and 1 case experienced type Ⅱ RF. 3 cases had lobar pneumonia and 5 casesoccurred interstitial pneumonia. The pathogens of 5 eases were identified. Among them, 2 cases were affected by bacterial pneumonia, 1 case by CMV pneumonia and 2 cases by mixed pneumonia (one by bacteria plus CMV, one by bacteria plus fungi). Similar modality was applied, and 5 cases were cured and 3 cases died. Conclusions Most of severe pneumonia occur during 1-9 months after renal transplantation in the elderly. The main pathogens are bacteria and CMV. Medications for all of the most common pathogens and assisted

  9. Disease: H00370 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available imaging. Infectious disease JC polyomavirus [VGNM:NC_001699] Combination therapy AIDS-associated: Highly active antiretroviral thera...py (HAART) + Cidofovir Immunodepressed patient: Discontinuation of immunosuppressiv

  10. Blood vessel growth blocker may treat AIDS-related Kaposi’s sarcoma

    Science.gov (United States)

    Patients with an AIDS-associated cancer, Kaposi's sarcoma (KS), showed improvement after receiving the combination of bevacizumab, a cancer drug that blocks the growth of new blood vessels, and highly active antiretroviral therapy (HAART).

  11. Towards New Antifolates Targeting Eukaryotic Opportunistic Infections

    Energy Technology Data Exchange (ETDEWEB)

    Liu, J.; Bolstad, D; Bolstad, E; Wright, D; Anderson, A

    2009-01-01

    Trimethoprim, an antifolate commonly prescribed in combination with sulfamethoxazole, potently inhibits several prokaryotic species of dihydrofolate reductase (DHFR). However, several eukaryotic pathogenic organisms are resistant to trimethoprim, preventing its effective use as a therapeutic for those infections. We have been building a program to reengineer trimethoprim to more potently and selectively inhibit eukaryotic species of DHFR as a viable strategy for new drug discovery targeting several opportunistic pathogens. We have developed a series of compounds that exhibit potent and selective inhibition of DHFR from the parasitic protozoa Cryptosporidium and Toxoplasma as well as the fungus Candida glabrata. A comparison of the structures of DHFR from the fungal species Candida glabrata and Pneumocystis suggests that the compounds may also potently inhibit Pneumocystis DHFR.

  12. [Extrapulmonary pneumocystosis: a case report].

    Science.gov (United States)

    Valdebenito, Carlos; Bonacic, Macarena; Matamala, Jennifer; Wolff, Marcelo

    2015-06-01

    We report a case of a middle-age male patient, with newly HIV infection in AIDS stage diagnosis, no comorbitidies, who was hospitalized for subacute malaise, fever, self-limited unproductive cough and no bloody chronic diarrea. The diagnosis of Pneumocystis jiroveci pneumonia was performed by imagenological suspicion and stains of cysts of this pathogen with bronchoalveolar lavage samples. Treatment was initiated with oral cotrimoxazole and starting HAART with good clinical outcome. Concomitantly, an etiologic study was conducted for chronic diarrhea and through histopathological examination of colonic mucosa, numerous extracellular cystic structures Pneumocystis characteristics were observed, performing the diagnosis of extrapulmonary pneumocystosis. Extrapulmonary pneumocystosis is a rare cause of P. jiroveci infection, requires a high index of suspicion and should be approached in HIV patients with severe AIDS which is common in co-infection of various infections and is peremptory to make an etiologic diagnosis and early treatment.

  13. Effects of pentamidine isethionate on Saccharomyces cerevisiae.

    OpenAIRE

    Ludewig, G.; Williams, J M; Li, Y.; Staben, C

    1994-01-01

    We used Saccharomyces cerevisiae as a model system in which to examine the mechanism of action of the anti-Pneumocystis drug pentamidine. Pentamidine at low concentrations inhibited S. cerevisiae growth on nonfermentable carbon sources (50% inhibitory concentration [IC50] of 1.25 micrograms/ml in glycerol). Pentamidine inhibited growth on fermentable energy sources only at much higher concentrations (IC50 of 250 micrograms/ml in glucose). Inhibition at low pentamidine concentrations in glycer...

  14. Micosis pulmonares en pacientes de la Quinta Región: Período 2007-2010

    OpenAIRE

    Cruz CH,Rodrigo; Vieille O,Peggy; Fuentes H,Daniela; Ponce E,Elliete; Piontelli L,Eduardo

    2012-01-01

    Background: The frequency of pulmonary mycoses has increased in the past few years specially in immunocompromised patients. Aim: To determine the frequency of invasive fungal diseases by analyzing lung secretion samples. Material and Methods: Samples of bronchoalveolar lavage (BAL) tracheal aspiration (TA) and induced sputum (IS) were obtained from patients of five hospitals in the Valparaíso Region for the diagnosis of invasive or non-invasive fungal disease, and pneumocystis (PCP), in the p...

  15. Pneumocystepneumoni ved behandling med infliximab

    DEFF Research Database (Denmark)

    Josephson, Maria Eklund; Kristensen, Lena Hagelskjaer; Andersen, Vibeke

    2008-01-01

    The treatment of ulcerative colitis has improved since the appearance of Tumor Necrosis Factor (TNF)-alpha inhibitors. However, the use of TNF-alpha inhibitors increases the risk of opportunistic infections. We describe two cases of Pneumocystis jiroveci pneumonia during infliximab therapy...... for active ulcerative colitis. They were successfully treated with sulfametoxazole/trimetroprim. High awareness of P. jiroveci pneumonia in patients who develop pulmonary symptoms with hypoxia during TNF-alpha modulator therapy is recommended....

  16. Delayed presentation of severe combined immunodeficiency due to prolonged maternal T cell engraftment

    OpenAIRE

    Al-Muhsen, Saleh Z.

    2010-01-01

    Severe combined immunodeficiency (SCID) is a primary immunodeficiency disorder with heterogenous genetic etiologies. We describe a typical case in a 9-year-old boy that was masked by a clinically functional maternal T cell engraftment leading to late presentation with Pneumocystis jiroveci pneumonia and cytomegalovirus infection, probably following exhaustion of maternally engrafted cells. Based on immunological findings, he had a T- B+SCID phenotype. This report suggests that in rare cases, ...

  17. Cutaneous fungal infection in a renal transplantation patient due to a rare fungus belonging to order Pleosporales

    Directory of Open Access Journals (Sweden)

    S Galipothu

    2015-01-01

    Full Text Available Fungal infections are being increasingly reported from immuno-compromised as well as immuno-competent patients. Transplant patients are on long term immunosuppressive therapy which makes them highly vulnerable to opportunistic fungal infections .These infections can be cutaneous or systemic. Several fungi have been reported to be the culprits such as Candida spp., Aspergillus spp., C. neoformans, P. carinii, and zygomycetes group of fungi. Cutaneous infections are most commonly caused by Pityriasis (tinea versicolor, dermatophytes, and candida sp but these days the demtiaceous fungi are becoming more frequently reported .Here we report a case of post renal transplant cutaneous infection caused by dematiaceous fungus belonging to the order Pleosporales

  18. A new species, Litomosoides odilae n. sp (Nematoda: Onchocercidae) from Oligoryzomys nigripes (Rodentia: Muridae) in the rainforest of Misiones, Argentina.

    Science.gov (United States)

    Notarnicola, Juliana; Navone, Graciela

    2002-10-01

    A new species of Litomosoides was collected from the abdominal cavity of Oligoryzomys nigripes (Rodentia: Muridae) in a semideciduous secondary rainforest of Misiones, Argentina. Litomosoides odilae n. sp. belongs to the carinii group and is characterized by the amphids displaced dorsally; buccal capsule with an anterior segment transparent and an annular asymmetrical thickening; esophagus divided, with the posterior glandular portion slightly wider than the muscular; male cloacal aperture strongly protruded; and microfilaria sheathed with an attenuated tail. The morphology of the new species, which is similar to that of L petteri, a parasite of marsupials in Brazil, suggests that host-switching events may have occurred in the diversification of this genus.

  19. A taxonomic revision of small neotropical saurian Malarias allied to Plasmodium minasense.

    Science.gov (United States)

    Telford, S R

    1979-01-01

    Saurian malaria species which produce schizonts smaller than normal erythrocyte nuclei, with 4-8 merozoietes and gametocytes equal to or smaller than erythrocyte nuclei in size, parasitizing hosts of the lizard families Scincidae, Iguanidae and Teiidae in the Neotropics are considered to be Plasmodium minasense Carini and Rudolph, 1912. Subspecific designations are given to distinctive populations parasitizing different host species: P. minasense minasense is recognized from the type host, Mabuya mabouya of Brasil; P. minasense carinii Leger and Mouzels, 1917 from Iguana iguana of coastal South America; P. minasense anolisi subsp. nov. from Anolis limifrons of Panama; P. minasense capitoi subsp. nov. from Anolis capito of Panama; P. minasense plicae subsp. nov. from Plica umbra of Guyana; P. minasense tegui subsp. nov. from Tupinambis teguixin of Venezuela; and P. minasense diminutivum Telford, 1973, new combination, from Ameiva ameiva of Panama. Plasmodium rhadinurum Thompson and Huff, 1944 is recognized as a distinct species at present on the basis of possessing schizonts of different shape, asexual stages with filamentous projections in most portions of its range, and larger gametocytes, as well as apparent sympatry with P. minasense carinii in some areas.

  20. Dapsone and sulfapyridine.

    Science.gov (United States)

    Paniker, U; Levine, N

    2001-01-01

    Dapsone and sulfapyridine are structurally related compounds with anti-microbial and anti-inflammatory effects. Dapsone remains the most important drug for leprosy and is useful in the prophylaxis of Pneumocystis pneumonia in patients with HIV disease. The medical treatment of choice for dermatitis herpetiformis is dapsone; and sulfapyridine also can be used for those patients who are intolerant of dapsone. Other neutrophilic disorders also may respond to these drugs. Toxic side effects of both dapsone and sulfapyridine are mediated through the hydroxylamine metabolite. These include hemolysis, methemoglobinemia, and agranulocytosis. Careful monitoring for possible adverse reactions includes frequently performing complete blood counts and regular blood chemistry profile determinations.

  1. Delayed presentation of severe combined immunodeficiency due to prolonged maternal T cell engraftment

    Science.gov (United States)

    Al-Muhsen, Saleh Z.

    2010-01-01

    Severe combined immunodeficiency (SCID) is a primary immunodeficiency disorder with heterogenous genetic etiologies. We describe a typical case in a 9-year-old boy that was masked by a clinically functional maternal T cell engraftment leading to late presentation with Pneumocystis jiroveci pneumonia and cytomegalovirus infection, probably following exhaustion of maternally engrafted cells. Based on immunological findings, he had a T- B+SCID phenotype. This report suggests that in rare cases, engrafted maternal T cell might persist for long time leading to partial constitution of immune function and delayed clinical presentation of SCID. PMID:20427943

  2. Spectrum Of Opportunistic Infections In Aids Cases In A Tertiary Care Hospital In Nepal

    Directory of Open Access Journals (Sweden)

    Hari Shanker Joshi

    2006-12-01

    Full Text Available A retrospective study was carried out, 404 clinically suspected cases attending AIDS clinic at Manipal Teaching Hospital, Pokhara, Nepal to assess an occurance of opportunistic infections in AIDS cases. Study reveals that Tuberculosis (60%, Cryptospridiosis (13.33% and candidasis (11.11% are the predominant opportunistic infection in HIV/AIDS patients in the Pokharo village. Next common pathogen was found an ubiquitous yeast. Candida obtained from skin, oral cavity, oesophagus, sputum and stool. The least common documented documented infection was pneumocystis carini pneumonia (2.22%.

  3. [Corticosteroids in the treatment of infectious diseases].

    Science.gov (United States)

    Kronig, I; Schibler, M; Rougemont, M; Emonet, S

    2013-04-24

    The addition of a corticosteroid has become a common practice for the treatment of some infectious diseases, such as meningitis, septic shock, moderate to severe Pneumocystis jirovecii pneumonia. The belief that steroids may have a beneficial effect in the early stage of pro-inflammatory infections explains the renewed interest for these treatments. This review of recent literature helps determine the use of steroids in the treatment of infectious diseases as formal guidance, questionable or rather contraindicated. When there is a clear scientific indication for the use of corticosteroids regardless of the current infection, the latter is never a formal contraindication.

  4. [Use of the Heimlich Maneuver on children in the Rhône-Alpes area].

    Science.gov (United States)

    Boussuges, S; Maitrerobert, P; Bost, M

    1985-10-01

    In 27 children suffering from a foreign body in the respiratory tract with asphyxia, the Heimlich manoeuvre, previously described, was successful in saving life of this dramatic situation in all cases, without respiratory complication. While this method is better known by members of first-aid associations than by pediatricians, it may be successfully used in very young children and infants.

  5. The Use of Adjuvant Nutrition to Preserve and Increase Lean Body Mass in AIDS Patients with Muscle Wasting.

    Energy Technology Data Exchange (ETDEWEB)

    None

    2000-01-03

    The studies conducted under this CRADA were aimed at determining if nutritional supplementation with HMb, in combination with glutamine and arginine can ameliorate the AIDS-associated wasting syndrome and in turn improve the clinical course of the disease.

  6. Application of diffusion tensor imaging in AIDS patients with brain opportunistic diseases: A comparative study of tuberculosis and toxoplasmosis

    Directory of Open Access Journals (Sweden)

    Xiang-le Chu

    2015-06-01

    Conclusions: Quantitative DTI is valuable for diagnosis and differential diagnosis of patients with AIDS-associated infections, and also could provide references for clinical physicians for proper medications. The quantitative FA value could help better reveal different changes of microstructural integrity between different opportunistic infections.

  7. 78 FR 13364 - Center for Scientific Review; Notice of Closed Meetings

    Science.gov (United States)

    2013-02-27

    ... HUMAN SERVICES National Institutes of Health Center for Scientific Review; Notice of Closed Meetings...: Liver and Gastrointestinal Physiology, Pathology and Pharmacology. Date: March 21, 2013. Time: 2:00 p.m... . Name of Committee: AIDS and Related Research Integrated Review Group; AIDS-associated...

  8. Nef does not contribute to replication differences between R5 pre-AIDS and AIDS HIV-1 clones from patient ACH142

    Directory of Open Access Journals (Sweden)

    Rekosh David

    2008-05-01

    Full Text Available Abstract AIDS-associated, CCR5-tropic (R5 HIV-1 clones, isolated from a patient that never developed CXCR4-tropic HIV-1, replicate to a greater extent and cause greater cytopathic effects than R5 HIV-1 clones isolated before the onset of AIDS. Previously, we showed that HIV-1 Env substantially contributed to the enhanced replication of an AIDS clone. In order to determine if Nef makes a similar contribution, we cloned and phenotypically analyzed nef genes from a series of patient ACH142 derived R5 HIV-1 clones. The AIDS-associated Nef contains a series of residues found in Nef proteins from progressors 1. In contrast to other reports 123, this AIDS-associated Nef downmodulated MHC-I to a greater extent and CD4 less than pre-AIDS Nef proteins. Additionally, all Nef proteins enhanced infectivity similarly in a single round of replication. Combined with our previous study, these data show that evolution of the HIV-1 env gene, but not the nef gene, within patient ACH142 significantly contributed to the enhanced replication and cytopathic effects of the AIDS-associated R5 HIV-1 clone.

  9. HIV Infection and Cancer Risk

    Science.gov (United States)

    ... viral etiology of AIDS-associated malignancies. Advances in Pharmacology 2008; 56:509–557. [PubMed Abstract] Engels EA, ... AIDS-related malignancies: state of the art and therapeutic challenges. Journal of Clinical Oncology 2008; 26(29): ...

  10. La Dolorosa School, suburbs of Quito, Ecuador

    CERN Multimedia

    Collectes à long terme

    2007-01-01

    On his way to Paris, invited by the mutual aid association « Partage » to participate in a seminar, the Director of this school, Patrizio Raza, was kind enough to stop off in Geneva to visit us on 8 June.

  11. Atovaquone for Prophylaxis of Toxoplasmosis after Allogeneic Hematopoietic Stem Cell Transplantation.

    Science.gov (United States)

    Mendorf, Alexander; Klyuchnikov, Evgeny; Langebrake, Claudia; Rohde, Holger; Ayuk, Francis; Regier, Marc; Christopeit, Maximilian; Zabelina, Tatjana; Bacher, Adelbert; Stübig, Thomas; Wolschke, Christine; Bacher, Ulrike; Kröger, Nicolaus

    2015-01-01

    Toxoplasmosis and infections by other opportunistic agents such as Pneumocystis jirovecii constitute life-threatening risks for patients after allogeneic hematopoietic stem cell transplantation. Trimethoprim/sulfamethoxazole (TMP-SMX) has been well established for post-transplant toxoplasmosis and pneumocystis prophylaxis, but treatment may be limited due to toxicity. We explored atovaquone as an alternative and compared it with TMP-SMX regarding toxicity and efficacy during the first 100 days after transplantation in 155 consecutive adult stem cell recipients. Eight patients with a prior history of TMP-SMX intolerance received atovaquone as first-line prophylaxis. TMP-SMX was used for 141 patients as first-line strategy, but 13 patients (9.2%) were later switched to atovaquone due to TMP-SMX toxicity or gastrointestinal symptoms. No active toxoplasmosis or active P. jirovecii infection developed under continued prophylaxis with either TMP-SMX or atovaquone. However, for reasons of TMP-SMX and/or atovaquone toxicity, 7 patients were unable to tolerate any efficacious toxoplasmosis prophylaxis and therefore obtained inhalative pentamidine as P. jirovecii prophylaxis but no toxoplasmosis prophylaxis. Importantly, 2 of these patients developed severe toxoplasmosis. In summary, atovaquone appears as a valid alternative for at least some post-transplant patients who cannot tolerate TMP-SMX. This should be further confirmed by multicenter trials.

  12. 肺孢子虫肺炎与巨细胞病毒肺炎影像学特点

    Institute of Scientific and Technical Information of China (English)

    吴迪; 谢红浪

    2010-01-01

    @@ 免疫抑制是由各种原发性和(或)继发性病因所导致的机体免疫低反应状态,临床以后者更为常见,多表现为以感染为主的临床综合征.当机体外周血CD4~+细胞计数<200个/μl时,极易发生机会性感染~([1]),常见于HIV感染和继发于免疫抑制治疗的免疫缺陷患者.耶氏肺孢子虫(pneumocystis jiroveci)和巨细胞病毒(cytomegalovirus,CMV)是免疫抑制状态下最常见的两种机会性感染病原体,由其导致的肺孢子虫肺炎(pneumocystis pneumonia,PCP)和巨细胞病毒肺炎(cytomegalovirus pneumonia,CMP)临床表现极为相似,且均存在病原体获取困难、血清学检验阳性率偏低及病原体无法体外培养等诊断难点,如未予及时明确诊治,死亡率均较高.因此,二者的早期诊断极其重要.

  13. 肺孢子虫肺炎的发病机制和药物治疗

    Institute of Scientific and Technical Information of China (English)

    许书添; 谢红浪

    2010-01-01

    @@ 耶氏肺孢子虫(pneumocystis jiroveci,简称肺孢子虫)是常见于免疫功能低下患者的机会性感染病原体,多在人免疫缺陷病毒(HIV)感染、恶性肿瘤、器官移植、自身免疫及血液系统疾病患者中发病.一旦发生肺孢子虫肺炎(pneumocystis pneumonia,PCP),病情进展迅速,病死率极高,若不经治疗,33至4周内几乎100%患者死亡;倘若治疗,不同人群的死亡率不同,HIV感染者死亡率为5%~10%,免疫缺陷的肿瘤患者死亡率高达20%~25%,需要机械通气者死亡率则更高,达60%~90%~([1,2]).PCP的病情严重性与免疫功能和炎症反应程度密切相关,而与病原体数量无关.本文拟就PCP发病机制、临床特征和药物治疗的最新进展作一简述.

  14. A broncofibroscopia no diagnóstico etiológico de afecções pulmonares em pacientes com síndrome da imunodeficiência adquirida

    Directory of Open Access Journals (Sweden)

    Silva R.M. da

    2000-01-01

    Full Text Available OBJETIVO: Avaliar o papel da broncofibroscopia no diagnóstico etiológico de pneumopatias em pacientes positivos ao vírus da imunodeficência humana. MÉTODOS: O presente estudo analisa um grupo de 49 pacientes com diagnóstico de síndrome da imunodeficiência adquirida, admitidos no Hospital Nereu Ramos - Florianópolis -SC. Foram selecionados pacientes sintomáticos respiratórios com lesão simples ao exame radiográfico do tórax, sem diagnóstico etiológico confirmado por exame de escarro. Tais pacientes foram submetidos à broncofibroscopia com realização de lavado broncoalveolar, escovado brônquico e biópsia pulmonar transbrônquica. As amostras foram analisados com bacterioscopia pelo Gram, pesquisa de BAAR, citomegalovírus, P. carinii e outros fungos. RESULTADOS: A broncofibroscopia foi efetiva na realização do diagnóstico etiológico em 71,43% dos casos. A biópsia pulmonar transbrônquica foi a técnica com maior positividade, firmando o diagnóstico em 59,18% dos casos. A técnica com menor positividade foi o escovado brônquico, com diagnóstico em 4,08% dos casos. O agente etiológico mais freqüente foi o P. carinii (42,8%, seguido pelo M. tuberculosis (22,86%. Nenhuma complicação foi observada nos procedimentos realizados. CONCLUSÃO: Concluímos no presente estudo que neste grupo de pacientes a broncofibroscopia foi um procedimento seguro e efetivo para o diagnóstico etiológico de afecções pulmonares.

  15. Non-AIDS Kaposi's sarcoma in the head and neck area.

    Science.gov (United States)

    Patrikidou, Anna; Vahtsevanos, Kostas; Charalambidou, Martha; Valeri, Rosalia-Maria; Xirou, Persefoni; Antoniades, Kostas

    2009-02-01

    Kaposi's sarcoma is classified into 4 types: classic (sporadic), African (endemic), iatrogenic (transplant recipients), and epidemic (acquired immunodeficiency syndrome [AIDS]-associated). This article aims to feature a comprehensive review of non-AIDS Kaposi's sarcoma, including literature review and report of 3 cases. Case material was from our hospital's archive. Literature review was conducted via electronic and manual medical database searches. Biological aspects, diagnostic difficulties, investigation protocols, and management modalities are discussed.

  16. Magnetic nanotherapeutics for dysregulated synaptic plasticity during neuroAIDS and drug abuse

    OpenAIRE

    Sagar, Vidya; Atluri, Venkata Subba Rao; Pilakka-Kanthikeel, Sudheesh; Nair, Madhavan

    2016-01-01

    The human immunodeficiency virus (HIV) is a neurotropic virus. It induces neurotoxicity and subsequent brain pathologies in different brain cells. Addiction to recreational drugs remarkably affects the initiation of HIV infections and expedites the progression of acquired immunodeficiency syndrome (AIDS) associated neuropathogenesis. Symptoms of HIV-associated neurocognitive disorders (HAND) are noticed in many AIDS patients. At least 50 % of HIV diagnosed cases show one or other kind of neur...

  17. Chylothorax in a patient with metastatic Kaposi sarcoma: Differential diagnostic considerations

    OpenAIRE

    Ryan Alexander, DO; Magda Rizer, DO; William Burke, MD; Lawrence Ciment, MD

    2015-01-01

    Kaposi sarcoma (KS) is a low-grade mesenchymal tumor involving blood and lymphatic vessels. There are four types, based on clinical presentation: classic, endemic (Africana), iatrogenic (typically, involving renal allograft recipients), and AIDS-associated (epidemic). Kaposi's sarcoma-associated herpes virus infection has been linked along with other factors to the development of KS. The Kaposi's sarcoma-associated herpes virus interacts and encodes for numerous molecular proteins that play a...

  18. Cryptosporidium, Enterocytozoon, and Cyclospora Infections in Pediatric and Adult Patients with Diarrhea in Tanzania.

    OpenAIRE

    Cegielski, J P; Ortega, Y. R.; McKee, S; Madden, J F; Gaido, L; Schwartz, D. A.; Manji, K; Jorgensen, A F; Miller, S E; Pulipaka, U P; Msengi, A E; Mwakyusa, D H; Sterling, C R; Reller, L B

    1999-01-01

    Cryptosporidiosis, microsporidiosis, and cyclosporiasis were studied in four groups of Tanzanian inpatients: adults with AIDS-associated diarrhea, children with chronic diarrhea (of whom 23 of 59 were positive [+] for human immunodeficiency virus [HIV]), children with acute diarrhea (of whom 15 of 55 were HIV+), and HIV control children without diarrhea. Cryptosporidium was identified in specimens from 6/86 adults, 5/59 children with chronic diarrhea (3/5, HIV+), 7/55 children with acute diar...

  19. Typing of Human Mycobacterium avium Isolates in Italy by IS1245-Based Restriction Fragment Length Polymorphism Analysis

    Science.gov (United States)

    Lari, Nicoletta; Cavallini, Michela; Rindi, Laura; Iona, Elisabetta; Fattorini, Lanfranco; Garzelli, Carlo

    1998-01-01

    All but 2 of 63 Mycobacterium avium isolates from distinct geographic areas of Italy exhibited markedly polymorphic, multibanded IS1245 restriction fragment length polymorphism (RFLP) patterns; 2 isolates showed the low-number banding pattern typical of bird isolates. By computer analysis, 41 distinct IS1245 patterns and 10 clusters of essentially identical strains were detected; 40% of the 63 isolates showed genetic relatedness, suggesting the existence of a predominant AIDS-associated IS1245 RFLP pattern. PMID:9817900

  20. [Disseminated infection due to Penicillium marneffei related to HIV infection: first observation in Argentina].

    Science.gov (United States)

    Santiso, Gabriela; Chediak, Viviana; Maiolo, Elena; Mujica, María T; San Juan, Jorge; Arechavala, Alicia; Negroni, Ricardo

    2011-01-01

    The first case observed in Argentina of AIDS-related human penicillosis is herein presented. The patient was a six- teen year-old young man coming from a rural area of southern China. He was admitted at the F. J. Muñiz Hospital of Buenos Aires city with severe pneumonia and adult respiratory distress. Penicillium marneffei was isolated from bronchoalveolar lavage fuid and was microscopically observed in a skin cytodiagnosis. P. marneffei identification was confirmed by rRNA amplification and its phenotypic characteristics. The patient suffered an advanced HIV infection and also presented several AIDS-related diseases due to CMV, nosocomial bacterial infections and Pneumocystis jirovecii which led to a fatal outcome.

  1. Consensus definitions of 14 severe acute toxic effects for childhood lymphoblastic leukaemia treatment

    DEFF Research Database (Denmark)

    Schmiegelow, Kjeld; Attarbaschi, Andishe; Barzilai, Shlomit

    2016-01-01

    Although there are high survival rates for children with acute lymphoblastic leukaemia, their outcome is often counterbalanced by the burden of toxic effects. This is because reported frequencies vary widely across studies, partly because of diverse definitions of toxic effects. Using the Delphi...... method, 15 international childhood acute lymphoblastic leukaemia study groups assessed acute lymphoblastic leukaemia protocols to address toxic effects that were to be considered by the Ponte di Legno working group. 14 acute toxic effects (hypersensitivity to asparaginase, hyperlipidaemia, osteonecrosis......, thromboembolism, and Pneumocystis jirovecii pneumonia) that are serious but too rare to be addressed comprehensively within any single group, or are deemed to need consensus definitions for reliable incidence comparisons, were selected for assessment. Our results showed that none of the protocols addressed all 14...

  2. Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Fungal Diagnostic Capabilities

    Science.gov (United States)

    Perlin, David S.; Muldoon, Eavan G.; Colombo, Arnaldo Lopes; Chakrabarti, Arunaloke; Richardson, Malcolm D.; Sorrell, Tania C.

    2017-01-01

    Antimicrobial resistance, a major public health concern, largely arises from excess use of antibiotic and antifungal drugs. Lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. In support of this contention, we cite 4 common clinical situations that illustrate this problem: 1) inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis; 2) failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis; 3) misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease; and 4) overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients. All communities should have access to nonculture fungal diagnostics, which can substantially benefit clinical outcome, antimicrobial stewardship, and control of antimicrobial resistance. PMID:27997332

  3. Care of Patients With HIV Infection: Medical Complications and Comorbidities.

    Science.gov (United States)

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    Care of patients with HIV infection starts with diagnosis as soon as possible, preferably at or near the time of acute infection. Opportunistic infections, malignancies, and other conditions develop progressively over time, particularly in untreated patients. The AIDS-defining opportunistic infections most common in the United States include Pneumocystis jirovecii pneumonia, Candida esophagitis, toxoplasmic encephalitis, tuberculosis, disseminated Mycobacterium avium complex, cryptococcal meningitis, and cytomegalovirus retinitis. Specific prophylaxis regimens exist for several opportunistic infections, and effective antiretroviral therapy reduces the risk of most others. Other AIDS-defining conditions include wasting syndrome and HIV encephalopathy. AIDS-defining malignancies include Kaposi sarcoma, systemic non-Hodgkin lymphoma, primary central nervous system lymphoma, and invasive cervical cancer. Although not an AIDS-defining condition, anal cancer is common in patients with HIV infection. Other HIV-related conditions include thrombocytopenia, recurrent bacterial respiratory infections, HIV-associated nephropathy, and HIV-associated neurocognitive disorder.

  4. The respiratory presentation of severe combined immunodeficiency in two Mennonite children at a tertiary centre highlighting the importance of recognizing this pediatric emergency

    Science.gov (United States)

    Lam, Simon; Kavadas, Fotini D; Haider, Seemab; Noseworthy, Mary E

    2014-01-01

    Severe combined immunodeficiency (SCID) is considered to be a pediatric emergency, with respiratory distress being the most common presenting symptom. The authors present two cases of SCID in children <4 months of age with respiratory distress at a tertiary care centre due to a recently described homozygous CD3 delta mutation found only in the Mexican Mennonite population. Failure to respond to broad-spectrum antibiotics prompted investigation for possible SCID. Bronchial alveolar lavage fluid from both patients grew Pneumocystis jiroveci, and flow cytometry revealed absent T cells. The CD3 delta gene is believed to be important in T cell differentiation and maturation. The present article reminds pediatricians and pediatric respirologists that the key to diagnosing SCID is to have a high index of suspicion if there is poor response to conventional therapies. PMID:24288697

  5. Impact of folate therapy on combined immunodeficiency secondary to hereditary folate malabsorption.

    Science.gov (United States)

    Kishimoto, Kenji; Kobayashi, Ryoji; Sano, Hirozumi; Suzuki, Daisuke; Maruoka, Hayato; Yasuda, Kazue; Chida, Natsuko; Yamada, Masafumi; Kobayashi, Kunihiko

    2014-07-01

    Hereditary folate malabsorption (HFM) is a rare autosomal recessive disorder. Severe folate deficiency in HFM can result in immunodeficiency. We describe a female infant with HFM who acquired severe Pneumocystis pneumonia. The objective of the present study was to elucidate her immunological phenotype and to examine the time course of immune recovery following parenteral folate therapy. The patient demonstrated a combined immunodeficiency with an impaired T cell proliferation response, pan-hypogammaglobulinemia, and an imbalanced pro-inflammatory cytokine profile. She had normal white blood cell count, normal lymphocyte subsets, and normal complement levels. Two novel mutations were identified within the SLC46A1 gene to produce a compound heterozygote. We confirmed full recovery of her immunological and neurophysiological status with parenteral folate replacement. The time course of recovery of her immunological profile varied widely, however. HFM should be recognized as a unique form of immunodeficiency.

  6. The Respiratory Presentation of Severe Combined Immunodeficiency in Two Mennonite Children at a Tertiary Centre Highlighting the Importance of Recognizing This Pediatric Emergency

    Directory of Open Access Journals (Sweden)

    Simon Lam

    2014-01-01

    Full Text Available Severe combined immunodeficiency (SCID is considered to be a pediatric emergency, with respiratory distress being the most common presenting symptom. The authors present two cases of SCID in children <4 months of age with respiratory distress at a tertiary care centre due to a recently described homozygous CD3 delta mutation found only in the Mexican Mennonite population. Failure to respond to broad-spectrum antibiotics prompted investigation for possible SCID. Bronchial alveolar lavage fluid from both patients grew Pneumocystis jiroveci, and flow cytometry revealed absent T cells. The CD3 delta gene is believed to be important in T cell differentiation and maturation. The present article reminds pediatricians and pediatric respirologists that the key to diagnosing SCID is to have a high index of suspicion if there is poor response to conventional therapies.

  7. Nebulized Pentamidine-Induced Acute Renal Allograft Dysfunction

    Directory of Open Access Journals (Sweden)

    Siddhesh Prabhavalkar

    2013-01-01

    Full Text Available Acute kidney injury (AKI is a recognised complication of intravenous pentamidine therapy. A direct nephrotoxic effect leading to acute tubular necrosis has been postulated. We report a case of severe renal allograft dysfunction due to nebulised pentamidine. The patient presented with repeated episodes of AKI without obvious cause and acute tubular necrosis only on renal histology. Nebulised pentamidine was used monthly as prophylaxis for Pneumocystis jirovecii pneumonia, and administration preceded the creatinine rise on each occasion. Graft function stabilised following discontinuation of the drug. This is the first report of nebulized pentamidine-induced reversible nephrotoxicity in a kidney allograft. This diagnosis should be considered in a case of unexplained acute renal allograft dysfunction.

  8. Inhibitory effects on cytochrome p450 enzymes of pentamidine and its amidoxime pro-drug.

    Science.gov (United States)

    Bürenheide, Anja; Kunze, Thomas; Clement, Bernd

    2008-07-01

    Pentamidine is an antimicrobial drug, intravenously used in the treatment of trypanosomiasis, leishmaniasis or pneumocystis pneumonia. To elucidate potential drug interactions with pentamidine and N,N'-dihydroxypentamidine, respectively, the cytochrome P450 (CYP450) inhibitory properties of these compounds were determined. The study was performed in vitro by using human liver microsomes and marker substrates of several CYP450 isoenzymes. Marker activities were investigated by high-performance liquid chromatography in presence of known selective inhibitors or at different concentrations of pentamidine and N,N'-dihydroxypentamidine, respectively. No or only minor influence on CYP1A2, 2A6, 2C9, 2C19, 2D6, 2E1 and 3A4 marker activities could be observed, suggesting that neither of the tested substances would exert a significant effect on hepatic CYP450 isoenzymes responsible for the metabolism of co-administrated drugs in vivo. However, in vivo studies are needed before final conclusions can be drawn.

  9. The RAM network in pathogenic fungi.

    Science.gov (United States)

    Saputo, Sarah; Chabrier-Rosello, Yeissa; Luca, Francis C; Kumar, Anuj; Krysan, Damian J

    2012-06-01

    The regulation of Ace2 and morphogenesis (RAM) network is a protein kinase signaling pathway conserved among eukaryotes from yeasts to humans. Among fungi, the RAM network has been most extensively studied in the model yeast Saccharomyces cerevisiae and has been shown to regulate a range of cellular processes, including daughter cell-specific gene expression, cell cycle regulation, cell separation, mating, polarized growth, maintenance of cell wall integrity, and stress signaling. Increasing numbers of recent studies on the role of the RAM network in pathogenic fungal species have revealed that this network also plays an important role in the biology and pathogenesis of these organisms. In addition to providing a brief overview of the RAM network in S. cerevisiae, we summarize recent developments in the understanding of RAM network function in the human fungal pathogens Candida albicans, Candida glabrata, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis spp.

  10. Aspergillosis in a Patient Receiving Temozolomide for the Treatment of Glioblastoma

    Directory of Open Access Journals (Sweden)

    Rodrigo Ramella Munhoz

    2013-08-01

    Full Text Available Leukopenia and selective CD4+ lymphopenia represent major adverse events associated with the use of temozolomide (TMZ, an oral alkylating agent incorporated in the treatment of glioblastoma (GBM. The increased risk of opportunistic infections, including those caused by Pneumocystis jiroveci and cytomegalovirus, has been previously described in the literature. Here we report the case, the first to our knowledge, of a patient with pulmonary invasive aspergillosis immediately after the completion of chemoradiation with TMZ for GBM. Diagnosis was confirmed through a CT-guided lung biopsy, and the patient had excellent response to systemic voriconazole. This case illustrates that TMZ can be associated with severe opportunistic infections, presumably associated with T lymphocyte immune dysfunction, and patients exposed to this agent should be carefully monitored.

  11. [General epidemiology of invasive fungal disease].

    Science.gov (United States)

    Pemán, Javier; Salavert, Miguel

    2012-02-01

    Invasive mycoses associated with high morbidity and mortality rates are increasing among immunocompromised or severely ill patients. Candida, Cryptococcus, Pneumocystis and Aspergillus are most prevalent agents with varying distribution as regards geography, patient condition and hospital units. The latest multicentre candidaemia survey conducted in Spain, showed C. albicans as the most frequently isolated species followed by C. parapsilosis, C. glabrata, C. tropicalis and C. krusei in contrast with other European or American studies where C. glabrata was second in rank. Aspergillus spp. is the leading agent causing invasive mycoses among filamentous fungi followed by Fusarium spp., Scedosporium spp. and zygomycetes. Aspergillus fumigatus is the most common agent in invasive aspergillosis (and azole-resistant isolates have been reported) but in the last few years Aspergillus flavus, Aspergillus nidulans and Aspergillus terreus have been isolated with increasing frequency variable with geographical factors, patients' underlying conditions or previous antifungal treatments.

  12. Cotrimoxazole-Induced Hypoglycaemia in a Patient with Churg-Strauss Syndrome

    Directory of Open Access Journals (Sweden)

    Russell Senanayake

    2013-01-01

    Full Text Available Cotrimoxazole is a commonly used antimicrobial agent which is traditionally indicated in the management of pneumocystis infection of which HIV and immunosuppressed individuals are at high risk. Furthermore, it can be used on the long term for prophylactic indications. Hypoglycaemia following commencement of cotrimaoxazole is a rare adverse effect which was first described in 1988. We describe a case of hypoglycaemia shortly following initiation of cotrimoxazole indicated as long-term prophylaxis on a background of Churg-Strauss syndrome. The patient was symptomatic for hypoglycaemia despite simultaneous use of high-dose prednisolone; however, the hypoglycaemia did not require a hospital admission. We will explore the risk factors, monitoring requirements, and the mechanism by which co-trimoxazole induces hypoglycaemia.

  13. Hospitalization for Pneumonia among Individuals With and Without HIV Infection, 1995-2007: A Danish Population-Based, Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Sogaard, Ole S; Lohse, Nicolai; Gerstoft, Jan;

    2008-01-01

    discharge diagnoses from 1977 onward were obtained from nationwide administrative databases. Individuals without previous hospitalization for pneumonia were observed from the date of HIV diagnosis until the first hospitalization to treat pneumonia (excluding pneumonia attributable to Pneumocystis jiroveci......Background. @nbsp; Human immunodeficiency virus (HIV)-infected individuals with high CD4(+) cell counts may have increased susceptibility to other infections. We compared incidence rates of pneumonia among individuals with and without HIV infection and explored risk factors for pneumonia in the HIV......-infected population. Methods. @nbsp; This was an observational cohort study conducted during 1995-2007. Each member of a Danish population-based nationwide cohort of HIV-infected individuals was matched with up to 99 control individuals from the general population. Data on age, mortality, emigration, and hospital...

  14. Imaging of community-acquired pneumonia: Roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases

    Institute of Scientific and Technical Information of China (English)

    Atsushi; Nambu; Katsura; Ozawa; Noriko; Kobayashi; Masao; Tago

    2014-01-01

    This article reviews roles of imaging examinations in the management of community-acquired pneumonia(CAP), imaging diagnosis of specific CAP and discrimination between CAP and noninfectious diseases. Chest radiography is usually enough to confirm the diagnosis of CAP, whereas computed tomography is required to suggest specific pathogens and to discriminate from noninfectious diseases. Mycoplasma pneumoniae pneumonia, tuberculosis, Pneumocystis jirovecii pneumonia and some cases of viral pneumonia sometimes show specific imaging findings. Peribronchial nodules, especially tree-in-bud appearance, are fairly specific for infection. Evidences of organization, such as concavity of the opacities, traction bronchiectasis, visualization of air bronchograms over the entire length of the bronchi, or mild parenchymal distortion are suggestive of organizing pneumonia. We will introduce tips to effectively make use of imaging examinations in the management of CAP.

  15. 双氢青蒿素抗寄生虫作用研究进展%Advances in research of dihydroartemisinin against parasitic diseases

    Institute of Scientific and Technical Information of China (English)

    李洪军; 汪伟; 梁幼生

    2011-01-01

    Dihydroartemisinin, the main metabolite of artemisinin and two artemisinin derivatives, artemether and artesunate, is a broad-spectrum anti-parasitic drug. The present paper systematically reviews the advances in research of dihydroartemisinin against Plasmodium, Schistosoma, Pneumocystis, Toxoplasma, Trichomonas vaginalis, Leishmania, Giardia lamblia.%双氢青蒿素是青蒿素及其衍生物蒿甲醚和青蒿琥酯在体内的有效活性代谢产物,为广谱抗寄生虫药物.本文系统综述其抗疟原虫、血吸虫、肺孢子虫、弓形虫、阴道毛滴虫、利什曼原虫、蓝氏贾第鞭毛虫作用.

  16. [Pulmonary complications in children with human immunodeficiency virus infection].

    Science.gov (United States)

    Brockmann V, Pablo; Viviani S, Támara; Peña D, Anamaría

    2007-08-01

    Pulmonary complications in children infected by human immunodeficiency virus (HIV) are common and may be the first manifestation of acquired immunodeficiency syndrome (AIDS). The aim of our study was to review pulmonary diseases and complications in pediatric patients with HIV infection in a large tertiary hospital in Santiago, Chile. We performed a retrospective, descriptive analysis of 17 patients with HIV infection controlled at the Hospital Dr. Sótero del Rio. Respiratory complications/diseases were: overall pneumonia (n: 14), recurrent pneumonia (n: 10), citomegalovirus associated pneumonia (n: 4), Pneumocystis jiroveci associated pneumonia (n: 1) pulmonary tuberculosis (n: 1), lymphoid interstitial pneumonia (n: 3) and chronic pulmonary disease (n: 7). Microorganisms isolated were mostly atypical and frequently associated with severe and chronic pulmonary damage. A high degree of suspicion is required to detect atypical microorganisms promptly, in order to rapidly implement pathogen targeted therapy that could potentially decrease the possibility of sequelae.

  17. The respiratory presentation of severe combined immunodeficiency in two Mennonite children at a tertiary centre highlighting the importance of recognizing this pediatric emergency.

    Science.gov (United States)

    Lam, Simon; Kavadas, Fotini Dimitriou; Haider, Seemab; Noseworthy, Mary Elizabeth

    2014-01-01

    Severe combined immunodeficiency (SCID) is considered to be a pediatric emergency, with respiratory distress being the most common presenting symptom. The authors present two cases of SCID in children <4 months of age with respiratory distress at a tertiary care centre due to a recently described homozygous CD3 delta mutation found only in the Mexican Mennonite population. Failure to respond to broad-spectrum antibiotics prompted investigation for possible SCID. Bronchial alveolar lavage fluid from both patients grew Pneumocystis jiroveci, and flow cytometry revealed absent T cells. The CD3 delta gene is believed to be important in T cell differentiation and maturation. The present article reminds pediatricians and pediatric respirologists that the key to diagnosing SCID is to have a high index of suspicion if there is poor response to conventional therapies.

  18. Examination of type material of two species of Litomosoides (Filarioidea : Onchocercidae, parasites from bats ; taxonomic consequences

    Directory of Open Access Journals (Sweden)

    Bain O.

    2003-09-01

    Full Text Available Type material of Litomosoides hamletti Sandground, 1934 from Glossophaga soricina soricina in Brazil and L. penai Jiménez- Quirós & Arroyo, 1 960 from Carollia perspicillata azteca in Costa Rica, was examined. The morphology of the spicules shows that these species belong to the carinii group. Their synonymy with L. guiterasi Pérez Vigueras, 1934, from Artibeus jamaicensis yucatanicus in Cuba, does not appear justified because they are distinct in several characters (body length, width of female, size and shape of buccal cavity and capsule, shape of right spicule. L. hamletti is a valid species; L. penai is closely related to it and is considered to be a sub-species, L. hamletti penai Jiménez-Quirós & Arroyo, 1960: The material recovered from Glossophaga spp., previously assigned to L guiterasi by several authors, is identified as L. h. hamletti. L. guiterasi appears to be closely related to L chandleri Esslinger, 1973; L. chitwoodi n. sp. (= Litomosoides sp. Chitwood, 1938 seems close to these species; all three are parasites of Artibeus spp.

  19. [Emergence of new pneumonia: besides severe acute respiratory syndrome].

    Science.gov (United States)

    Mangiarotti, P; Pozzi, E

    2006-10-01

    Important epidemiological modifications have been registered in respiratory infections, both in immunocompetent and immunocompromised hosts. Pathogens with modified antibiotic susceptibility patterns have emerged, which display an increased antibiotic resistance, such as S. pneumoniae, S. aureus, H. influenzae. This trait has a strong impact on the therapeutic choices, particularly when an empiric antibiotic treatment is selected. The prevalence of bacterial species showing non-susceptibility to the most common prescribed antibiotics (betalactams, macrolides etc.) follows a different geographic distribution. Some pathogens have acquired a new epidemiological role in patients affected with immune deficiencies: among them P. carinii and other bacterial, fungal and viral pathogens. The emergence of new, previously unknown, species, has been registered, both bacteria (C. pneumoniae) and viruses (Metapneumovirus, Hantavirus etc.). Such aspects must be considered in the diagnosis of respiratory infections, which should include diagnostic tests for the identification of such pathogens. Among the new respiratory infections severe acute respiratory syndrome (SARS) has quickly become a health care emergency, so that efforts have been made to identify the aetiological agent as well as the main epidemiological and clinical characteristics of the disease. Avian influenza has raised great interest immediately after the first cases of human infection caused by the avian virus, especially after the outbreaks in Asian countries and in the Netherlands. A crucial step in containing infection is the prevention of the disease; efforts are directed toward this endpoint.

  20. Síndrome da imunodeficiência adquirida: descrição anátomo-patológica de dois casos de necropsia Acquired immunodeficiency syndrome: pathologic description of two autopsy cases

    Directory of Open Access Journals (Sweden)

    Vera L. C. Delmonte

    1984-08-01

    Full Text Available Os Autores apresentam dois casos de Síndrome de Imunodeficiência Adquirida com ênfase aos achados de necropsia. A criptococose generalizada de padrão miliar, infreqüente, e a pneumocistose foram infecções oportunísticas de curso fatal pela destruição parenquimatosa de órgãos vitais que acarretaram. É destacado o papel etiopatogênico do citomegalovírus, pela concomitância de infecção em ambos os casos e associação aos órgãos mais afetados. Extensa necrose de supra-renal foi constatada, possivelmente secundária à destruição celular viral pelo CMV.Two autopsy cases of acquired immunodeficiency disease syndrome are reported. One case showed widespread miliar cryptococcosis, with scarce inflammatory response. The other developed respiratory failure due to pulmonary infection by P. carinii. In both cases we could observe generalized cytomegalic infection, with striking adrenal involvement. Special emphasis is given to the pathologic changes and the possible etiopathogenic role of cytomegaloviroses in the acquired immunodeficiency cases.

  1. Ivermectin-induced killing of microfilariae in vitro by neutrophils mediated by NO.

    Science.gov (United States)

    Zahner, H; Schmidtchen, D; Mutasa, J A

    1997-06-01

    Rat neutrophil granulocytes isolated after intraperitoneal casein injection of the donors exhibit high cytotoxic efficacy in vitro against microfilariae of Litomosoides carinii in the presence of ivermectin. Optimum effects of 80-90% killing of microfilariae were obtained with 100 ng ivermectin per milliliter and a microfilariae: cell ratio of 1:100. Spleen cells killed approximately 30% of the microfilariae under these conditions. Cytotoxic effects were independent of any adherence of the cell to the larvae. In contrast to the effects of spleen cells, cytotoxicity of neutrophils completely abrogated when cells and targets were separated by a membrane impermeable for the cells, suggesting a very short-living mediator in the latter case. Correspondingly, cytotoxic effects of neutrophils were completely inhibited by the addition of the arginine analogues NG-monomethyl-L-arginine and L-canavanine, indicating the involvement of reactive nitrogen intermediates. The nitric oxide scavenger hemoglobin also protected the microfilariae. Several compounds which are known to interfere with reactive oxygen intermediates were ineffective. An excess of ferrous ions in the medium in the presence of a reducing agent significantly reduced the cytotoxic efficacy of neutrophils.

  2. Respiratory complications in Brazilian patients infected with human immunodeficiency virus Complicações respiratórias em pacientes brasileiros infectados pelo vírus da imunodeficiência humana

    Directory of Open Access Journals (Sweden)

    Adriana Weinberg

    1993-04-01

    Full Text Available PURPOSE: To determine how often and by what means an indentifiable pulmonary pathogen can be recognized in human immunodeficiency virus (HIV infected patients with respiratory disorders in Brazil, which are the most frequently observed microorganisms and what impact specific therapy has on these agents. PATIENTS AND METHODS: Thirty-five HIV seroposiüve subjects with respiratory complaints were studied. All patients had a complete history, physical examination and blood counts. The pulmonary assessment included chest radiograms; sputum examination for bacterial and fungal pathogens; bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Patients with treatable complications received standard antimicrobial therapy. RESULTS: One or more microorganisms were found in 24 subjects and another 3 individuals showed nonspecific interstitial pneumonitis. The sputum examination identified the pulmonary pathogens in 7 cases. The bronchoalveolar lavage and the histopathologic examination were diagnostic in 14% and 83%, respectively, of the 28 individuals that were submitted to bronchoscopy. The most frequently identified microorganism was P. carinii (55%, followed by M. tuberculosis (41% and cytomegalovirus (8%. The clinical, laboratory and radiographic findings failed to distinguish the specific pulmonary pathogens. Twenty-three individuals with P. carinii pneumonitis and/or tuberculosis received specific therapy; among the evaluable patients the therapeutic response rates were 79% for PCP and 100% for TB. CONCLUSIONS: We have determined that tuberculosis, P. carinii and cytomegalovirus pneumonitis are the most common respiratory opportunistic diseases in Brazilian patients infected with HIV. The histologic evaluation was crucial in order to identify the pulmonary pathogens. Tuberculosis in AIDS individuals displayed clinical and radiographic findings atypical for reactivation disease. However, most of the features observed in HIV infected

  3. Nematode parasites of marsupials and small rodents from the Brazilian Atlantic Forest in the State of Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Delir Corrêa Gomes

    2003-12-01

    Full Text Available Nematodes from opossums and rodents captured in the Brazilian Atlantic Forest in the State of Rio de Janeiro, Brazil were studied. From the opossums Didelphis aurita Weid-Neuweid, 1826 and Philander opossum (Linnaeus, 1758 the following nematode species were recovered: Viannaia hamata Travassos, 1914, Aspidodera raillieti Travassos, 1913, Cruzia tentaculata (Rudolphi, 1819, Travassos, 1917, Turgida turgida (Rudolphi, 1819 Travassos, 1919, Gongylonemoides marsupialis (Vaz & Pereira, 1934 Freitas & Lent, 1937, Viannaia viannai Travassos, 1914, Spirura guianensis (Ortlepp, 1924 Chitwood, 1938 and from the rodents Akodon cursor (Winger, 1887, Nectomys squamipes (Brants, 1827, Oligoryzomys eliurus (Wagner, 1845 and Oryzomys intermedius (Leche, 1886: Hassalstrongylus epsilon (Travassos, 1937 Durette-Desset, 1971, Syphacia obvelata (Rudolphi, 1802 Seurat, 1916, S. venteli Travassos, 1937, Physaloptera bispiculata Vaz & Pereira, 1935, Litomosoides carinii (Travassos, 1919 Vaz, 1934, Viannaia viannai, Hassalstrongylus epsilon, H. zeta (Travassos, 1937 Durette-Desset, 1971, Stilestrongylus aculeata (Travassos, 1918 Durette-Desset, 1971 S. eta (Travassos, 1937 Durette-Desset, 1971. Highest worm burdens and prevalences were those related to Cruzia tentaculata in marsupials. Stilestrongylus aculeata was referred for the first time in Akodon cursor.

  4. Epidemiology and clinical characteristics of HIV-infected patients in Kuala Lumpur.

    Science.gov (United States)

    Cheong, I; Lim, A; Lee, C; Ibrahim, Z; Sarvanathan, K

    1997-12-01

    Between 1987 to 1995, a total of 334 patients infected with HIV were treated at the Hospital Kuala Lumpur. There were 159 Malays, 108 Chinese, 64 Indians, and 3 from other ethnic groups. Three hundred and twenty-one (96.1%) of these individuals were males and 262 (65.9%) were between the ages of 26-45 years. Intravenous drug users made up 77% (256) of the attributable risk behaviour from the group although many of them also had added risk behaviours like heterosexual activity with multiple partners (50 patients), tattoos (7 patients), homosexual practice (4 patients) and previous transfusions (3 patients). The others acquired their infection through heterosexual promiscuity (59 patients), homo/bisexual activity (7 patients), previous transfusion (5 patients) and tattoos (1 patient). Sixty-six patients (all males) had since progressed to full blown AIDS and 10 have died. The two commonest AIDS-defining events were tuberculosis infection and Pneumocystic carinii pneumonia occurring in 37 (56%) and 15 (22.7%) of patients respectively. Forty-one patients with AIDS presented for the first time with their AIDS-defining infections. The mean CD4 count of the patients when they progressed to AIDS was 130/mm3. The mean time for progression from "known" seropositivity to AIDS was 2.42 years. These results suggest that Malaysians infected with HIV are not coming forward for treatment until they are in the advanced stage of the disease.

  5. Kaposi's sarcoma-associated herpesvirus infection and Kaposi's sarcoma in Brazil

    Directory of Open Access Journals (Sweden)

    S. Ramos-da-Silva

    2006-05-01

    Full Text Available Kaposi's sarcoma (KS became a critical health issue with the emergence of acquired immunodeficiency syndrome (AIDS in the 1980s. Four clinical-epidemiological forms of KS have been described: classical KS, endemic KS, iatrogenic KS, and AIDS-associated KS. In 1994, Kaposi's sarcoma-associated herpesvirus (KSHV or human herpesvirus type 8 was identified by Chang and colleagues, and has been detected worldwide at frequencies ranging from 80 to 100%. The aim of the present study was to evaluate the frequency of KSHV infection in KS lesions from HIV-positive and HIV-negative patients in Brazil, as well as to review the current knowledge about KS transmission and detection. For these purposes, DNA from 51 cases of KS was assessed by PCR: 20 (39.2% cases of classical KS, 29 (56.9% of AIDS-associated KS and 2 (3.9% of iatrogenic KS. Most patients were males (7.5:1, M/F, and mean age was 47.9 years (SD = ± 18.7 years. As expected, HIV-positive KS patients were younger than patients with classical KS. On the other hand, patients with AIDS-associated KS have early lesions (patch and plaque compared to classical KS patients (predominantly nodular lesions. This is assumed to be the result of the early diagnose of KS in the HIV-positive setting. KSHV infection was detected by PCR in almost all cases (48/51; 94.1%, irrespectively of the clinical-epidemiological form of KS. These results show that KSHV is associated with all forms of KS in Brazilian patients, a fact that supports the role of this virus in KS pathogenesis.

  6. Spectrum of Opportunistic Infections and Risk Factors for In-Hospital Mortality of Admitted AIDS Patients in Shanghai.

    Science.gov (United States)

    Luo, Bin; Sun, Jianjun; Cai, Rentian; Shen, Yinzhong; Liu, Li; Wang, Jiangrong; Zhang, Renfang; Shen, Jiayin; Lu, Hongzhou

    2016-05-01

    To investigate the frequency and the spectrum of major opportunistic infections (OIs), evaluate the major clinical factors associated with each specific OI, and identify the risk factors for in-hospital death among HIV patients in East China.A retrospective cohort study was made including all the HIV-infected patients who were admitted for the first time to the Shanghai Public Health Clinical Center during June 1, 2013 to June 1, 2015. The demographic and clinical data were collected. Comparison of continuous variables was analyzed by one-way ANOVA and rank sum test. Person χ test and Fisher exact test were applied to analyze the categorical variables. A Cox proportional hazards regression model was used to determine the risk for the occurrence of in-hospital death.In total, 920 patients were enrolled with age of 41.59 ± 13.36 years and 91% male. Median CD4 was 34 (IQR, 13-94) cells/μL. Among these patients, 94.7% acquired OIs while the rest developed malignancies. Pneumocystis pneumonia and bacterial coinfection (42.1%) was found to be the most common OIs, followed by tuberculosis (31.4%), CMV (20.9%), Cryptococcosis (9.0%), and MAC infection (5.2%). Of the above 5 major OIs, CMV-infected patients had the lowest median CD4 cell count 22.50 (IQR, 7.50-82.00) while the patients with tuberculosis infection had the highest count 61.00 (IQR, 27.00-176.00). In-hospital death rate was 4.2 per 100 person-years among these patients. Of note, admitted patients with 2 types of OIs (2.20, 95% CI 1.39-3.48) and those patients who were 40-year old or older (1.75, 95% CI 1.10-2.78) had a higher risk of such death.Pneumocystis pneumonia and tuberculosis were still the leading causes for the admission of HIV-infected patients in East China, and these patients tended to have very low CD4 cell counts. It is believed that expanding the HIV screening test and pushing the infected ones get ART earlier is required for generating a more successful HIV management strategy.

  7. Pentosan polysulfate as an inhibitor of extracellular HIV-1 Tat.

    Science.gov (United States)

    Rusnati, M; Urbinati, C; Caputo, A; Possati, L; Lortat-Jacob, H; Giacca, M; Ribatti, D; Presta, M

    2001-06-22

    HIV-1 Tat protein, released from HIV-infected cells, may act as a pleiotropic heparin-binding growth factor. From this observation, extracellular Tat has been implicated in the pathogenesis of AIDS and of AIDS-associated pathologies. Here we demonstrate that the heparin analog pentosan polysulfate (PPS) inhibits the interaction of glutathione S-transferase (GST)-Tat protein with heparin immobilized to a BIAcore sensor chip. Competition experiments showed that Tat-PPS interaction occurs with high affinity (K(d) = 9.0 nm). Also, GST.Tat prevents the binding of [(3)H]heparin to GST.Tat immobilized to glutathione-agarose beads. In vitro, PPS inhibits GST.Tat internalization and, consequently, HIV-1 long terminal repeat transactivation in HL3T1 cells. Also, PPS inhibits cell surface interaction and mitogenic activity of GST.Tat in murine adenocarcinoma T53 Tat-less cells. In all assays, PPS exerts its Tat antagonist activity with an ID(50) equal to approximately 1.0 nm. In vivo, PPS inhibits the neovascularization induced by GST.Tat or by Tat-overexpressing T53 cells in the chick embryo chorioallantoic membrane. In conclusion, PPS binds Tat protein and inhibits its cell surface interaction, internalization, and biological activity in vitro and in vivo. PPS may represent a prototypic molecule for the development of novel Tat antagonists with therapeutic implications in AIDS and AIDS-associated pathologies, including Kaposi's sarcoma.

  8. Comparative imaging of HIV-associated diseases of the hepatobiliary system in CT and cholangiography; Vergleichende Darstellung HIV-assoziierter Erkrankungen des hepatobiliaeren Systems in Computertomographie und Cholangiographie

    Energy Technology Data Exchange (ETDEWEB)

    Knollmann, F.D. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Adler, A. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Maeurer, J. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Gruenewald, T. [2. Innere Abteilung, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Hintze, R.E. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Schedel, H. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Veltzke, W. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany)

    1995-07-01

    With the incidence of AIDS being on the rise, diagnostic work-up of hepatobiliary disease in these patients is of increasing interest. 57 X-ray cholangiograms and computed tomographic studies of 13 AIDS-patients with clinical signs of cholangitis were reviewed. Nine patients had abnormal cholangiographic findings. Computed tomography of 8 patients revealed hepatobiliary disease in six cases. Of three patients with cholangiograms reflecting bile duct dilatation of neoplastic aetiology, CT was required in two for definite diagnosis. Cholangiography is the method of choice for diagnosing AIDS-associated cholangitis, whereas computed tomography compres favourably in depicting neoplastic disease of the hepatobiliary system. Follow-up of AIDS-associated cholangitis usually delineates unchanged radiologic findings. (orig.) [Deutsch] Die Beteiligung des hepatobiliaeren Systems bei AIDS wurde in 57 roentgencholangiographischen und computertomographischen Untersuchungen an 13 Patienten retrospektiv analysiert. Bei 9 Patienten wurden im Cholangiogramm pathologische Gallengangveraenderungen gefunden. 6 von 8 durch CT untersuchte Patienten hatten Zeichen einer hepatobiliaeren Erkrankung. Bei 3 Patienten mit gallenstaubdingenden Tumoren war die definitive Diagnose in 2 Faellen erst durch CT zu stellen. Waehrend die Cholangiographie zur Sicherung einer AIDS-assoziierten Cholangitis das Verfahren der Wahl darstellt, ist zur Tumordiagnositk die Computertomographie ueberlegen. Cholangitische Gallengangsveraenderungen bleiben im Verlauf haeufig konstant. (orig.)

  9. AIDS Cholangiopathy in an Asymptomatic, Previously Undiagnosed Late-Stage HIV-Positive Patient from Kenya

    Directory of Open Access Journals (Sweden)

    Yiming Gao

    2011-01-01

    Full Text Available AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbuminemia. Liver enzymes were all elevated. Deep venous thrombosis was confirmed, and a CT scan of the chest disclosed no pulmonary emboli. However, the visualized portion of the abdomen showed dilatation of the common bile and pancreatic ducts. This was confirmed on ultrasonography and MRCP, and no obstructive lesions were noted. An ERCP revealed a dilated common bile duct without filling defects or strictures. A balloon occlusion cholangiogram showed strictures and beading of the intrahepatic ducts. Shortly thereafter, serology for HIV returned positive along with a depressed CD4 cell count, and the patient was diagnosed with AIDS-associated cholangiography.

  10. Kaposi’s sarcoma in Brazilian AIDS patients: a study of 144 cases Sarcoma de Kaposi em pacientes com AIDS: estudo de 144 casos

    Directory of Open Access Journals (Sweden)

    Esther G. BIRMAN

    2000-12-01

    Full Text Available One hundred and forty-four Brazilian AIDS patients presenting with Kaposi’s sarcoma (KS were evaluated with respect to the frequency of oral neoplasms and their clinical features. The majority of the patients were young male adults (age range: 21-40 years old, from which 11.1 % presented with oral KS (OKS exclusively. Oral and skin lesions were associated in 25% of the cases, while only four patients showed association between oral and visceral KS; 49.3% of the cases were exclusively dermatological. The hard palate was the main site affected, followed by the oropharynx. The localization of KS was found to be similarly frequent in the tongue, gingiva and other sites of the oral mucosa. Candidosis was the prevailing fungal disease; in 20% of the cases it was restricted to the oral mucosa and in 80% it was systemic. No high frequency of paracoccidioidomicosis and cryptococcosis was detected. The prevailing bacterial disease was Tuberculosis and there was only one case of syphilis. Among the viral diseases, the most frequently detected was herpes simplex, followed by molusco contagiosum, condiloma acuminatum and cytomegaloviroses at lower frequencies. Pneumonia caused by Pneumocystes carinii and toxoplasmosis were also identified. The authors emphasise the importance of oral examination in HIV-infected patients bearing in mind several aspects related especially to KS, and stress the need for an interdisciplinary team in the management of these patients, in order to provide better quality of life as well as rapid diagnosis and treatment.Foram estudados pacientes brasileiros portadores de SIDA apresentando sarcoma de Kaposi (SK. O perfil de idade mostrou um grupo com média de idade entre 21 e 40 anos, sendo que 11,1% da amostra apresentava SK exclusivamente na cavidade bucal, observando-se em 25% da amostra uma associação de lesões bucais e na pele. Somente quatro pacientes apresentaram associação de lesões bucais e viscerais, enquanto 49

  11. Diagnostic imaging, preautopsy imaging and autopsy findings of 8 AIDS cases: a comparative study

    Institute of Scientific and Technical Information of China (English)

    LI Hong-jun; GAO Yan-qing; CHENG Jing-liang; ZHANG Yu-zhong

    2009-01-01

    Background Aquired immune deficiency syndrome (AIDS) presents a challenge to medical researchers because of its unique pathological and clinical picture. The clinical data, particularly autopsy evidence, from China have failed to provide enough pathological and etiological evidence for AIDS diagnosis, which impairs the reliability of the diagnosis and our full understanding of the occurrence and development of AIDS complications. The purpose of this study was to investigate the imaging and pathologic characteristics of AIDS.Methods Autopsy, imaging and pathological data from 8 cases of AIDS were retrospectively analyzed. Routine CT scanning of different body parts was performed during their periods of hospitalization. Transverse CT scanning was conducted from the skull to the pelvis immediately after the occurrence of death. After routine formalin fixing, 7 cardevers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each section and organs for pathological examinations.Results The autopsy data indicated the presence of parasitic infections, bacterial infections, fungal infections, and virus infections in AIDS patients. Pneumocystis pneumonia, pulmonary tuberculosis, coccobacteria pneumonia, Aspergillus pneumonia, cytomegalovirus pneumonia, toxoplasma encephalitis, lymphoma and cerebrovascular diseases were found in these patients.Conclusions During the course of AIDS progression, the concurrent multiple infections as well as tumor development may result in multiple organ pathological changes and clinically complex symptoms that further complicate the imaging and pathological manifestations, thus resulting in difficult differential diagnosis. A combination of imaging data and autopsy data can help to clarify the diagnosis.

  12. A case of Goodpasture syndrome positive for anti-GBM antibody and MPO-ANCA complicated by a variety of serious infections.

    Science.gov (United States)

    Sakoda, C; Kusaba, T; Adachi, T; Sonomura, K; Kimura, T; Nakayama, M; Kishimoto, N; Nakagawa, H; Okigaki, M; Hatta, T; Matsubara, H; Mori, Y

    2011-04-01

    A 62-year-old female was admitted to our hospital for investigation of acute progressive renal insufficiency and a systemic inflammatory reaction, despite treatment with several antibiotics. Laboratory data revealed severe renal insufficiency and positive titers for the myeloperoxidase anti-neutrophil cytoplasmic and anti-glomerular basement membrane antibodies. The deterioration of her general status did not allow us to perform the renal biopsy. Although corticosteroid therapy, hemodialysis, and plasma exchange were concomitantly initiated, pulmonary hemorrhage occurred several days after admission. Mechanical ventilation support was provided and continuous hemodiafiltration was carried out, following which the respiratory failure improved immediately. However, she developed clinical depression and suicidal behavior under the intensive therapy. Therefore, plasma exchange was discontinued and corticosteroid was tapered as quickly as possible. Four months after admission, platelet transfusion and short-term mechanical ventilation support improved the pulmonary hemorrhage; however, her mental status deteriorated despite psychiatric consultation and treatment with a tranquilizer. Thereafter, severe and serious systemic infection due to various pathogens including Staphylococcus aureus, Cytomegalovirus, Pneumocystis jiroveci, Pseudomonas aeruginosa, and Bacteroides recurred, and she died from systemic invasive aspergillosis (IA). We suspected severe immunosuppression caused by various factors, such as predonisolone administration, chronic renal failure on maintenance hemodialysis, depression, and malnutrition due to chronic inflammation and granulocytopenia as a side effect of ganciclovir. When treating rapidly progressive glomerulonephritis, immunosuppressive status should be carefully monitored regarding not only the dosage of therapeutic regimen but also the mental health status and nutrition of the patient.

  13. Assessment of the Usefulness of Multiplex Real-Time PCR Tests in the Diagnostic and Therapeutic Process of Pneumonia in Hospitalized Children: A Single-Center Experience.

    Science.gov (United States)

    Gowin, Ewelina; Bartkowska-Śniatkowska, Alicja; Jończyk-Potoczna, Katarzyna; Wysocka-Leszczyńska, Joanna; Bobkowski, Waldemar; Fichna, Piotr; Sobkowiak, Paulina; Mazur-Melewska, Katarzyna; Bręborowicz, Anna; Wysocki, Jacek; Januszkiewicz-Lewandowska, Danuta

    2017-01-01

    The aim of the study was assessment of the usefulness of multiplex real-time PCR tests in the diagnostic and therapeutic process in children hospitalized due to pneumonia and burdened with comorbidities. Methods. The study group included 97 children hospitalized due to pneumonia at the Karol Jonscher Teaching Hospital in Poznań, in whom multiplex real-time PCR tests (FTD respiratory pathogens 33; fast-track diagnostics) were used. Results. Positive test results of the test were achieved in 74 patients (76.3%). The average age in the group was 56 months. Viruses were detected in 61 samples (82% of all positive results); bacterial factors were found in 29 samples (39% of all positive results). The presence of comorbidities was established in 90 children (92.78%). On the basis of the obtained results, 5 groups of patients were established: viral etiology of infection, 34 patients; bacterial etiology, 7 patients; mixed etiology, 23 patients; pneumocystis, 9 patients; and no etiology diagnosed, 24 patients. Conclusions. Our analysis demonstrated that the participation of viruses in causing severe lung infections is significant in children with comorbidities. Multiplex real-time PCR tests proved to be more useful in establishing the etiology of pneumonia in hospitalized children than the traditional microbiological examinations.

  14. A Systematic Review and Meta-Analysis of the Data Behind Current Recommendations for Corticosteroids in Non–HIV-Related PCP: Knowing When You Are on Shaky Foundations

    Science.gov (United States)

    Injean, Patil; Eells, Samantha J.; Wu, Hoover; McElroy, Imani; Gregson, Aric L.; McKinnell, James A.

    2017-01-01

    Background Randomized trials show a mortality benefit to adjunctive corticosteroids for human immunodeficiency virus (HIV)-related Pneumocystis jiroveci pneumonia (HIV-PCP). Guidelines for non-HIV PCP (NH-PCP) recommend adjunctive corticosteroids based on expert opinion. We conducted a systematic review and meta-analysis characterizing adjunctive corticosteroids for NH-PCP. Methods We searched MEDLINE from 1966 through 2015. Data on clinical outcomes from NH-PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I2 index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. Results Our search yielded 5044 abstracts, 277 articles were chosen for full review, and 6 articles described outcomes in moderate to severe NH-PCP. Studies were limited by variable definitions, treatment selection bias, concomitant infections and small sample size. Individual studies reported shorter intensive care unit stay and duration of mechanical ventilation of patients given adjunctive corticosteroids. There was no association between corticosteroids and survival in NH-PCP (odds ratio, 0.66; 95% confidence interval, 0.38-1.15; P = 0.14). Conclusions The literature does not support an association between adjunctive corticosteroids and survival from NH-PCP but data are limited and findings should not be considered conclusive. Further research with improved methodology is needed to better understand the role of adjunctive corticosteroids for NH-PCP. PMID:28361121

  15. Prospective etiological investigation of community-acquired pulmonary infections in hospitalized people living with HIV

    Science.gov (United States)

    Figueiredo-Mello, Claudia; Naucler, Pontus; Negra, Marinella D.; Levin, Anna S.

    2017-01-01

    Abstract The study of the etiological agents of community-acquired pulmonary infections is important to guide empirical therapy, requires constant updating, and has a substantial impact on the prognosis of patients. The objective of this study is to determine prospectively the etiology of community-acquired pulmonary infections in hospitalized adults living with HIV. Patients were submitted to an extended microbiological investigation that included molecular methods. The microbiological findings were evaluated according to severity of the disease and pneumococcal vaccine status. Two hundred twenty-four patients underwent the extended microbiological investigation of whom 143 (64%) had an etiology determined. Among the 143 patients with a determined etiology, Pneumocystis jirovecii was the main agent, detected in 52 (36%) cases and followed by Mycobacterium tuberculosis accounting for 28 (20%) cases. Streptococcus pneumoniae and Rhinovirus were diagnosed in 22 (15%) cases each and influenza in 15 (10%) cases. Among atypical bacteria, Mycoplasma pneumoniae was responsible for 12 (8%) and Chlamydophila pneumoniae for 7 (5%) cases. Mixed infections occurred in 48 cases (34%). S pneumoniae was associated with higher severity scores and not associated with vaccine status. By using extended diagnostics, a microbiological agent could be determined in the majority of patients living with HIV affected by community-acquired pulmonary infections. Our findings can guide clinicians in the choice of empirical therapy for hospitalized pulmonary disease. PMID:28121925

  16. The Spectrum of Infectious Diseases in Kidney Transplantation: A Review of the Classification, Pathogens and Clinical Manifestations.

    Science.gov (United States)

    Anastasopoulos, Nikolaos-Andreas; Duni, Anila; Peschos, Dimitrios; Agnantis, Niki; Dounousi, Evangelia

    2015-01-01

    Kidney transplantation is the treatment-of-choice for a significant number of patients with end-stage renal disease. Renal transplant recipients (RTRs) benefit from a longer life expectancy, with a better quality of life. Despite, recent accomplishments in the field of kidney transplantation, both short- and long-term, surgical and medical complications still exist. Among these complications, cardiovascular disease, carcinogenesis and infections are the most important. Infectious diseases constitute the most common complications after renal transplantation and the second most common cause of death among RTRs with a functioning graft. Theoretically, all infectious pathogens could cause disease in immunocompromised RTRs, yet among these, one could identify more important ones, such as the Enterobacteriaceae, causing urinary tract infections; pneumonia due to Pneumocystis jirovecii; Candida species which cause invasive fungal infections; herpes viruses; hepatitis viruses and parasites. Early diagnosis and effective treatment are key elements in salvaging both the allograft and the patient. However, clinical manifestations and diagnosis of such infectious diseases are not easily identified due to the altered state of immune response of the RTR. Thus, apart from possessing a deep knowledge of the etiology and the treatment options in each case, transplant physicians should also always remain alert when dealing with RTRs.

  17. Severe manifestation of psoriasis in a HIV infected patient: a case report

    Directory of Open Access Journals (Sweden)

    Alper Gunduz

    2015-12-01

    Full Text Available The human immunodeficiency virus (HIV epidemic in Turkey reveals a slow progression and at the end of November 2015, the total official number was reported to be 11,109 cases. Approximately 90% of HIV patients develop some type of skin disease. Especially patients with psoriasis and HIV infection often present with more severe and treatment-refractory cutaneous disease. Herein, we describe a case of a patient with previously known psoriasis worsened by HIV infection. A 37-year-old housewife was admitted to our clinic with previously known psoriasis worsened during the last two years with conversion to erythrodermic psoriasis which was not controlled even by PUVA, methotrexate and systemic cyclosporine. The patient had positive HIV antibody test. HIV RNA viral load was 120.000 copy/ml and CD4 count 88/ mm3 . She also had oral candidiasis and Pneumocystis jirovecii pneumonia. The patient received antiretroviral treatment including tenofovir/emtricitabine and lopinavir/ritonavir. Symptoms resolved gradually within one month with almost complete impovement of her erythrodermic psoriasis. . Four years later the patient was still on tenofovir/emtricitabine and lopinavir/ritonavir without concomitant spesific psoriasis treatment. Psoriasis manifestations can be severe in AIDS patients. Clinicians face diagnostic and therapeutic difficulties when psoriasis coexists with HIV infection. The HIV test should be considered in patients affected by severe erythrodermic psoriasis and resistant to conventional and biological treatments. [Dis Mol Med 2015; 3(4.000: 43-45

  18. Assessment of the Usefulness of Multiplex Real-Time PCR Tests in the Diagnostic and Therapeutic Process of Pneumonia in Hospitalized Children: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Ewelina Gowin

    2017-01-01

    Full Text Available The aim of the study was assessment of the usefulness of multiplex real-time PCR tests in the diagnostic and therapeutic process in children hospitalized due to pneumonia and burdened with comorbidities. Methods. The study group included 97 children hospitalized due to pneumonia at the Karol Jonscher Teaching Hospital in Poznań, in whom multiplex real-time PCR tests (FTD respiratory pathogens 33; fast-track diagnostics were used. Results. Positive test results of the test were achieved in 74 patients (76.3%. The average age in the group was 56 months. Viruses were detected in 61 samples (82% of all positive results; bacterial factors were found in 29 samples (39% of all positive results. The presence of comorbidities was established in 90 children (92.78%. On the basis of the obtained results, 5 groups of patients were established: viral etiology of infection, 34 patients; bacterial etiology, 7 patients; mixed etiology, 23 patients; pneumocystis, 9 patients; and no etiology diagnosed, 24 patients. Conclusions. Our analysis demonstrated that the participation of viruses in causing severe lung infections is significant in children with comorbidities. Multiplex real-time PCR tests proved to be more useful in establishing the etiology of pneumonia in hospitalized children than the traditional microbiological examinations.

  19. ABO-Incompatible Kidney Transplantation

    Science.gov (United States)

    Morath, Christian; Zeier, Martin; Döhler, Bernd; Opelz, Gerhard; Süsal, Caner

    2017-01-01

    ABO-incompatible (ABOi) kidney transplantation has long been considered a contraindication to successful kidney transplantation. During the last 25 years, increasing organ shortage enforced the development of strategies to overcome the ABO antibody barrier. In the meantime, ABOi kidney transplantation has become a routine procedure with death-censored graft survival rates comparable to the rates in compatible transplantations. Desensitization is usually achieved by apheresis and B cell-depleting therapies that are accompanied by powerful immunosuppression. Anti-A/B antibodies are aimed to be below a certain threshold at the time of ABOi kidney transplantation and during the first 2 weeks after surgery. Thereafter, even a rebound of anti-A/B antibodies does not appear to harm the kidney transplant, a phenomenon that is called accommodation, but is poorly understood. There is still concern, however, that infectious complications such as viral disease, Pneumocystis jirovecii pneumonia, and severe urinary tract infections are increased after ABOi transplantations. Recent data from the Collaborative Transplant Study show that during the first year after kidney transplantation, one additional patient death from an infectious complication occurs in 100 ABOi kidney transplant recipients. Herein, we review the recent evidence on ABOi kidney transplantation with a focus on desensitization strategies and respective outcomes. PMID:28321223

  20. The burden of serious human fungal infections in Brazil.

    Science.gov (United States)

    Giacomazzi, Juliana; Baethgen, Ludmila; Carneiro, Lilian C; Millington, Maria Adelaide; Denning, David W; Colombo, Arnaldo L; Pasqualotto, Alessandro C

    2016-03-01

    In Brazil, human fungal infections are prevalent, however, these conditions are not officially reportable diseases. To estimate the burden of serious fungal diseases in 1 year in Brazil, based on available data and published literature. Historical official data from fungal diseases were collected from Brazilian Unified Health System Informatics Department (DATASUS). For fungal diseases for which no official data were available, assumptions of frequencies were made by estimating based on published literature. The incidence (/1000) of hospital admissions for coccidioidomycosis was 7.12; for histoplasmosis, 2.19; and for paracoccidioidomycosis, 7.99. The estimated number of cryptococcal meningoencephalitis cases was 6832. Also, there were 4115 cases of Pneumocystis pneumonia in AIDS patients per year, 1 010 465 aspergillosis and 2 981 416 cases of serious Candida infections, including invasive and non-invasive diseases. In this study, we demonstrate that more than 3.8 million individuals in Brazil may be suffering from serious fungal infections, mostly patients with malignant cancers, transplant recipients, asthma, previous tuberculosis, HIV infection and those living in endemic areas for truly pathogenic fungi. The scientific community and the governmental agencies should work in close collaboration in order to reduce the burden of such complex, difficult-to-diagnose and hard to treat diseases.