WorldWideScience

Sample records for human pneumocystis carinii

  1. 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...

  2. 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

    The opportunistic pathogen Pneumocystis carinii causes pneumonia (P. carinii pneumonia, or PCP) in immunocompromised individuals such as AIDS patients. Rat-derived P. carinii carinii organisms have distinct sterols which are not synthesized by mammals and not found in other microbes infecting...... mammalian lungs. The dominant sterol present in the organism is cholesterol (which is believed to be scavenged from the host), but other sterols in P. carinii carinii have an alkyl group at C-24 of the sterol side chain (C(28) and C(29) 24-alkylsterols) and a double bond at C-7 of the nucleus. Recently...... 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...

  3. Sterols of Pneumocystis carinii hominis Organisms Isolated from Human Lungs

    Science.gov (United States)

    Kaneshiro, Edna S.; Amit, Zunika; Chandra, Jyotsna; Baughman, Robert P.; Contini, Carlo; Lundgren, Bettina

    1999-01-01

    The opportunistic pathogen Pneumocystis carinii causes pneumonia (P. carinii pneumonia, or PCP) in immunocompromised individuals such as AIDS patients. Rat-derived P. carinii carinii organisms have distinct sterols which are not synthesized by mammals and not found in other microbes infecting mammalian lungs. The dominant sterol present in the organism is cholesterol (which is believed to be scavenged from the host), but other sterols in P. carinii carinii have an alkyl group at C-24 of the sterol side chain (C28 and C29 24-alkylsterols) and a double bond at C-7 of the nucleus. Recently, pneumocysterol (C32), which is essentially lanosterol with a C-24 ethylidene group, was detected in lipids extracted from a formalin-fixed human P. carinii-infected lung, and its structures were elucidated by gas-liquid chromatography, mass spectrometry, and nuclear magnetic resonance spectrometry 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 performed. Several of the same distinct sterols (e.g., fungisterol and methylcholest-7-ene-3β-ol) previously identified in P. carinii carinii were also present in organisms isolated from human specimens. Pneumocysterol was detected in only some of the samples. PMID:10548595

  4. 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...

  5. 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...

  6. 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.

  7. Antibody responses to a major Pneumocystis carinii antigen in human immunodeficiency virus-infected patients with and without P. carinii pneumonia

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Lundgren, Jens Dilling; Nielsen, T

    1992-01-01

    Antibody responses to a major purified human Pneumocystis carinii surface antigen (gp95) were determined by ELISA in human immunodeficiency virus (HIV)-infected patients. Serum IgG directed against gp95 was measured in 129 consecutive HIV-infected patients who underwent bronchoscopy for evaluation...

  8. 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...

  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. 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

  11. 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

    BACKGROUND: The major surface glycoprotein (MSG) is an abundant, immunogenic glycoprotein located on the surface of Pneumocystis carinii. Little is known about the proinflammatory effects of MSG. DESIGN: We have investigated the effect of human MSG on the secretion of the chemokines interleukin 8...

  12. 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

    IgG and IgM antibodies to a purified human Pneumocystis carinii surface antigen (gp95) were measured in 694 serum specimens from two different population groups using an EIA technique. In a population of 441 patients with no evidence of immunosuppression, the percentage of persons positive for Ig...

  13. 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

  14. 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

  15. Clusters of Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

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

    1998-01-01

    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...

  16. Pneumocystis carinii pneumonia in AIDS patients

    DEFF Research Database (Denmark)

    Orholm, Marianne; Nielsen, T L; Holten-Andersen, W

    1992-01-01

    The aim of this study was to evaluate whether the amount of Pneumocystis carinii organisms found at fiberoptic bronchoscopy (FB) performed on HIV-positive patients correlated to the character of the P. carinii pneumonia (PCP). A consecutive series of 105 patients presented with 131 episodes...... of pulmonary symptoms requiring FB, and in 75 of these episodes a diagnosis of PCP was made. Specimens were stained with Giemsa and methenamine silver nitrate and the number of parasites found was given as: numerous, many, few or none. The following signs and symptoms were registered: cough, dyspnoea, fever......, loss of weight, chest radiograph, haemoglobin, WBC, CD4 cell count, PO2 and HIV p24 antigen. The PCP was characterized by the clinical course: mild, moderate, severe, and by the outcome: pulmonary healthy, pulmonary insufficiency and death. No correlations between the number of P. carinii organisms...

  17. Pneumocystis carinii glycoprotein A binds macrophage mannose receptors.

    OpenAIRE

    O'Riordan, D.M.; Standing, J E; Limper, A H

    1995-01-01

    Pneumocystis carinii causes life-threatening pneumonia in patients with impaired immunity. Recent studies suggest that alveolar macrophages interact with P. carinii through macrophage mannose receptors. However, the ligand(s) on P. carinii that is recognized by these receptors has not been fully defined. P. carinii contains a major mannose-rich surface antigen complex termed glycoprotein A (gpA). It was therefore hypothesized that gpA binds directly to macrophage mannose receptors and mediate...

  18. 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...

  19. 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...

  20. 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....

  1. 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.

  2. 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.

  3. 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....

  4. Radiographic and HRCT findings of pneumocystis carinii pneumonia

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    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

  5. 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...

  6. Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelines.

    Science.gov (United States)

    Goldie, Sue J; Kaplan, Jonathan E; Losina, Elena; Weinstein, Milton C; Paltiel, A David; Seage, George R; Craven, Donald E; Kimmel, April D; Zhang, Hong; Cohen, Calvin J; Freedberg, Kenneth A

    2002-04-22

    Human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) have experienced a dramatic decrease in Pneumocystis carinii pneumonia (PCP), necessitating reassessment of clinical guidelines for prophylaxis. A simulation model of HIV infection was used to estimate the lifetime costs and quality-adjusted life expectancy (QALE) for alternative CD4 cell count criteria for stopping primary PCP prophylaxis in patients with CD4 cell count increases receiving HAART and alternative agents for second-line PCP prophylaxis in those intolerant of trimethoprim-sulfamethoxazole (TMP/SMX). The target population was a cohort of HIV-infected patients in the United States with initial CD4 cell counts of 350/microL who began PCP prophylaxis after their first measured CD4 lymphocyte count less than 200/microL. Data were from randomized controlled trials and other published literature. For patients with CD4 cell count increases during HAART, waiting to stop prophylaxis until the first observed CD4 cell count was greater than 300/microL prevented 9 additional cases per 1000 patients and cost $9400 per quality-adjusted life year (QALY) gained compared with stopping prophylaxis at 200/microL. For patients intolerant of TMP/SMX, using dapsone increased QALE by 2.7 months and cost $4500 per QALY compared with no prophylaxis. Using atovaquone rather than dapsone provided only 3 days of additional QALE and cost more than $1.5 million per QALY. Delaying discontinuation of PCP prophylaxis until the first observed CD4 cell count greater than 300/microL is cost-effective and provides an explicit "PCP prophylaxis stopping criterion." In TMP/SMX-intolerant patients, dapsone is more cost-effective than atovaquone.

  7. IgM response to a human Pneumocystis carinii surface antigen in HIV-infected patients with pulmonary symptoms

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Kovacs, J A; Mathiesen, Lars Reinhardt

    1993-01-01

    95. Four of the 5 patients with IgM antibodies also had IgG antibodies to gp95 and microbiologically proven P. carinii pneumonia (PCP). In 76/128 patients for whom serial samples were available, changes in antibody response were determined. In 3 patients we demonstrated an increase in IgM antibody...... response to gp95. These patients also showed an increase in IgG antibodies to gp95 and had microbiologically proven PCP. Prior to the development of the IgM response, IgG antibodies to gp95 were detectable in all 3 patients. Thus, HIV-infected patients with PCP seldom produce IgM antibodies to the major...... human P. carinii surface antigen. The increase in IgM response during the course of PCP observed in 3 patients suggests either reinfection with a new strain, or antigenic drift of an already acquired strain of P. carinii....

  8. 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.

  9. 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...

  10. 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...

  11. 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

  12. HIV in pregnancy: a case of Pneumocystis (carinii) jiroveci pneumonia.

    Science.gov (United States)

    Parisaei, Maryam; Hemelaar, Joris; Govind, Abha

    2010-01-01

    This review highlights the rising prevalence of HIV in pregnancy both in the developed and developing world. It focuses on the challenges of diagnosis and management of Pneumocystis (carinii) jiroveci pneumonia in an HIV-positive pregnant woman. Public health efforts need to continue addressing testing at the earliest opportunity, the psychosocial issues which impact negatively on the care of HIV-positive individuals and ways to reduce stigmatisation associated with this viral illness.

  13. 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...

  14. 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.

  15. Transmission of Pneumocystis carinii from patients to hospital staff

    DEFF Research Database (Denmark)

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

    1997-01-01

    rooms in departments of infectious diseases managing patients with P carinii pneumonia (PCP), suggesting the airborne route of transmission. Exposure of staff to P carinii may occur in hospital departments treating patients with PCP. METHODS: Exposure to P carinii was detected by serological responses...... to human P carinii by ELISA, Western blotting, and indirect immunofluorescence in 64 hospital staff with and 79 staff without exposure to patients with PCP from Denmark and Sweden. DNA amplification of oropharyngeal washings was performed on 20 Danish staff with and 20 staff without exposure to patients...... with PCP. RESULTS: There was no significant difference in the frequency or level of antibodies to P carinii between staff exposed and those unexposed to patients with PCP. None of the hospital staff had detectable P carinii DNA in oropharyngeal washings. CONCLUSIONS: There is no difference in antibodies...

  16. 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.

  17. 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...

  18. 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...

  19. 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.

  20. 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....... 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...

  1. 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

  2. Antibody responses to a major Pneumocystis carinii antigen in human immunodeficiency virus-infected patients with and without P. carinii pneumonia

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Lundgren, Jens Dilling; Nielsen, T

    1992-01-01

    of pulmonary symptoms. Significantly more patients with P. carinii pneumonia (PCP) had detectable antibodies compared with HIV-infected patients without PCP and with HIV-negative controls (50 [66%] of 76 vs. 18 [34%] of 53 and 7 [35%] of 20, respectively; P less than .001), and the level of antibody response...... was higher (mean optical density ratio: 0.6 vs. 0.23 and 0.2, respectively; P less than .01). Changes in antibody response were investigated in 78 patients for whom serial serum samples taken around the time of bronchoscopy were available. Of the 47 patients with verified PCP, 20 (43%) mounted an antibody...... response, compared with only 1 (3%) of 31 patients without PCP (P less than .001). This patient had PCP on the basis of clinical criteria, including response to therapy. Thus, despite severe immunosuppression, a proportion of HIV-infected patients with PCP can mount a specific IgG-mediated antibody...

  3. 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

  4. Radioimmunoimaging of pneumocystis carinii infection in rats

    Energy Technology Data Exchange (ETDEWEB)

    Vallabhajosula, S.; Shane, L.B.; Goldsmith, S.J.; Lipszyc, H.; Walzer, P.

    1984-01-01

    Pneumocystis carinil pneumonia (PCP) is seen in patients with impaired immunity due to chemotherapeutic suppression or to a primary disorder, congenital or AIDS. Although radiogallium imaging has been helpful in the workup of PCP, it is non-specific. Since there is no early specific non-invasive method to diagnose PCP, the authors are developing an imaging technique using radiolabeled antibodies. Fulminant PCP was induced in rats by injecting cortisone, 20mg 2-3 times/wk for 8 wks. PC cells isolated from rat lung were injected into rabbits. The antiserum thus derived was separated and purified using Protein-A bound sepharose column with identification of IgG by polyacrylamide gel electrophoresis. Both rabbit antipneumocystis antibodies and purified IgG(Sigma) were iodinated with I-131 to a high specific activity (3-5..mu..Ci/ug) using a lactoperoxidase method. /sup 131/I-labeled specific and non-specific IgG were injected into rats with PC infection and imaged with an Anger camera. After sacrifice, I-131 activity/gram tissue (lung, liver, heart) was determined and expressed as organ ratios. An increased uptake of specific antibody in lungs of rats with PCP was demonstrated by organ counting and imaging. This increase was not seen in normal controls or rats injected with non-specific IgG. These data provide a basis for radioimmunoimaging of infectious diseases.

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...... biosynthesis. We assessed whether mutations in the DHPS gene of P. carinii were associated with exposure to sulpha drugs and influenced outcome from PCP....

  10. 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.

  11. 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.

  12. 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...... for folate biosynthesis. We assessed whether mutations in the DHPS gene of P. carinii were associated with exposure to sulpha drugs and influenced outcome from PCP. METHODS: We studied bronchoalveolar samples collected in 1989-99 from a prospective cohort of HIV-1-infected patients who had PCP. In 144...... patients with 152 episodes of PCP, we analysed portions of DHPS using PCR and direct sequencing. The relation between survival, P. carinii DHPS mutations, and other predictors of treatment failure was assessed by Kaplan-Meier and multivariate Cox regression analysis. FINDINGS: P. carinii DHPS mutations...

  13. 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....

  14. 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....

  15. 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.

  16. 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.)

  17. 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...

  18. 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...

  19. 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...

  20. 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

  1. 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.

  2. Analysis of current antifungal agents and their targets within the Pneumocystis carinii genome.

    Science.gov (United States)

    Porollo, Aleksey; Meller, Jaroslaw; Joshi, Yogesh; Jaiswal, Vikash; Smulian, A George; Cushion, Melanie T

    2012-11-01

    Pneumocystis pneumonia (PCP) remains a leading opportunistic infection in patients with weakened immune systems. The fungus causing the infection belongs to the genus, Pneumocystis, and its members are found in a large variety of mammals. Adaptation to the lung environment of a host with an intact immune system has been a key to its successful survival. Unfortunately, the metabolic strategies used by these fungi to grow and survive in this context are largely unknown. There were considerable impediments to standard approaches for investigation of this unique pathogen, the most problematic being the lack of a long term in vitro culture system. The absence of an ex vivo cultivation method remains today, and many fundamental scientific questions about the basic biology, metabolism, and life cycle of Pneumocystis are unanswered. Recent progress in sequencing of the Pneumocystis carinii genome, a species infecting rats, permitted a more informative search for genes and biological pathways within this pathogen that are known to be targets for existing antifungal agents. In this work, we review the classes of antifungal drugs with respect to their potential applicability to the treatment of PCP. Classes covered in the review are the azoles, polyenes, allylamines, and echinocandins. Factors limiting the use of standard antifungal treatments and the currently available alternatives (trimethoprim-sulfamethoxazole, atovaquone, and pentamidine) are discussed. A summary of genomic sequences within Pneumocystis carinii associated with the corresponding targeted biological pathways is provided. All sequences are available via the Pneumocystis Genome Project at http://pgp.cchmc.org/.

  3. 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...

  4. 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

  5. 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...

  6. 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....

  7. The diagnosis of Pneumocystis Carinii pneumonia by new laboratory methods

    Directory of Open Access Journals (Sweden)

    Rahimifard N

    1999-09-01

    Full Text Available The object of this study was to find a suitable staining method for P.carinii. This parasite is not easily stained and clinical signs are not specific for the diagnosis of P.carinii pneumonia and therefore optimal laboratory methods for observing the organism are extremely valuable. In all 17 new conventional and modified staining techniques were used on lung impression smears and tissue section of sprague Dawley Rat treated with cortisone. Of these methods modified methylene blue 1 & 2, modified cresy violet 1, 2, 3, 4 modified Gram, modified Giemsa 2 and modified Griedley techniques have not previously been reported. After comparing readability of the slides, ease of performances, rapidity, availability and sensitivity of these 17 techniques for the diagnosis of P.carinii pneumonia, modified toluidine blue 01 & 2, modified methylene blue 1 & 2 and modified cresyl violet 3, 4 are suggested as the methods of choice for the rapid diagnosis of P.carinii pneumonia.

  8. 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 ...

  9. 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.

  10. 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...

  11. 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....

  12. 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...... with 0.2 to 5 microg of MSG/ml (P protection assay, increases in steady-state mRNA levels for IL-8 and TNF......-alpha were detectable at 4 h. These data show that recognition of MSG by monocytes involves a mannose-mediated mechanism and results in the release of the proinflammatory cytokines IL-8 and TNF-alpha....

  13. 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

  14. 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

  15. 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

  16. 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.

  17. Microarray studies on effects of Pneumocystis carinii infection on global gene expression in alveolar macrophages

    Directory of Open Access Journals (Sweden)

    Liao Chung-Ping

    2010-04-01

    Full Text Available Abstract Background Pneumocystis pneumonia is a common opportunistic disease in AIDS patients. The alveolar macrophage is an important effector cell in the clearance of Pneumocystis organisms by phagocytosis. However, both the number and phagocytic activity of alveolar macrophages are decreased in Pneumocystis infected hosts. To understand how Pneumocystis inactivates alveolar macrophages, Affymetrix GeneChip® RG-U34A DNA microarrays were used to study the difference in global gene expression in alveolar macrophages from uninfected and Pneumocystis carinii-infected Sprague-Dawley rats. Results Analyses of genes that were affected by Pneumocystis infection showed that many functions in the cells were affected. Antigen presentation, cell-mediated immune response, humoral immune response, and inflammatory response were most severely affected, followed by cellular movement, immune cell trafficking, immunological disease, cell-to-cell signaling and interaction, cell death, organ injury and abnormality, cell signaling, infectious disease, small molecular biochemistry, antimicrobial response, and free radical scavenging. Since rats must be immunosuppressed in order to develop Pneumocystis infection, alveolar macrophages from four rats of the same sex and age that were treated with dexamethasone for the entire eight weeks of the study period were also examined. With a filter of false-discovery rate less than 0.1 and fold change greater than 1.5, 200 genes were found to be up-regulated, and 144 genes were down-regulated by dexamethasone treatment. During Pneumocystis pneumonia, 115 genes were found to be up- and 137 were down-regulated with the same filtering criteria. The top ten genes up-regulated by Pneumocystis infection were Cxcl10, Spp1, S100A9, Rsad2, S100A8, Nos2, RT1-Bb, Lcn2, RT1-Db1, and Srgn with fold changes ranging between 12.33 and 5.34; and the top ten down-regulated ones were Lgals1, Psat1, Tbc1d23, Gsta1, Car5b, Xrcc5, Pdlim1, Alcam

  18. 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.

  19. 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.

  20. 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...

  1. Heterogeneity and compartmentalization of Pneumocystis carinii f. sp. hominis genotypes in autopsy lungs

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Lundgren, Bettina; Lundgren, Jens Dilling

    2001-01-01

    The extent and importance of genotype heterogeneity of Pneumocystis carinii f. sp. hominis within lungs have not previously been investigated. Two hundred forty PCR clones obtained from respiratory specimens and lung segments from three patients with fatal P. carinii pneumonia were investigated....... Not all genotypes present in the lungs at autopsy were detected in the diagnostic respiratory samples. Compartmentalization of specific ITS and mtLSU rRNA sequence types was observed in different lung segments. In conclusion, the interpretation of genotype data and in particular ITS sequence types...... in the assessment of epidemiological questions should be cautious since genotyping done on respiratory samples cannot a priori be assumed to represent all genotypes present within the lung....

  2. 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.

  3. 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....

  4. [Anatomo-clinical and experimental studies on pneumocystis carinii. Preliminary note].

    Science.gov (United States)

    Christol, D; Bouton, C; Trihn, D H; Kernbaum, S

    1976-01-09

    The authors have been interested over the last year in the detection of pneumocystis carinii in patients with immune deficiencies, whether natural or artificial. After a brief historical and general introduction, they discuss their procedures, the pathological substances available, the staining techniques and the examination of autopsy specimens. They undertook experimental work on this micro-organism, e.g. the development of the germ in immuno-depressed rats and, from this material, numerous varied trials of culture and inoculation in new-born animals, chick embryos and cell cultures. Microphotographs illustrate this work which is still in progress.

  5. 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".

  6. Alteration in expression of the rat mitochondrial ATPase 6 gene during Pneumocystis carinii infection

    Directory of Open Access Journals (Sweden)

    Bartlett Marilyn S

    2001-06-01

    Full Text Available Abstract Background Pneumocystis carinii causes pneumonia in immunocompromised patients with a high morbidity and mortality rate, but the interaction between this organism and the host cell is not well understood. The purpose of this research was to study the response of host cells to P. carinii infection on a molecular level. Results The technique of mRNA differential display was used to detect genes whose expression may be affected by P. carinii infection. The nucleotide sequence of one differentially displayed DNA fragment was found to be identical to that of the rat mitochondrial ATPase 6 gene, which is a subunit of the F0F1-ATP synthase complex. A four-fold increase in expression of this gene was verified by Northern blot analysis of total RNA extracted from P. carinii-infected rat lung versus that from mock-infected rat lung. Localization of the cells containing ATPase 6 mRNA was accomplished by in situ hybridization. In sections of non-infected rat lung, these cells were found lining the distal parts of the respiratory tree and in apical areas of the alveoli. Histological location of these cells suggested that they were Clara cells and type II pneumocytes. This hypothesis was confirmed by co-localizing the mRNAs for ATPase 6 and surfactant protein B (SP-B to the same cells by two-color fluorescent in situ hybridization. Conclusions The ATPase 6 gene is over expressed during P. carinii infection, and type II pneumocytes and Clara cells are the cell types responsible for this over-expression.

  7. 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....

  8. 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...... 55 and 57 of the P. carinii DHPS gene. The RFLP-assay was compared with direct DNA sequencing on 27 PCP isolates from HIV-1 positive patients with a mixture of wildtype and mutant DHPS types. In all samples the RFLP-assay correctly identified wildtype or DHPS mutation at codon 55 or 57. Combined...

  9. 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

  10. Neutrophil chemotactic activity in bronchoalveolar lavage fluid of patients with AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Kharazmi, A; Larsen, C G

    1997-01-01

    Pneumocystis carinii pneumonia (PCP) is accompanied by an acute inflammatory infiltration of the lung parenchyma. The cellular infiltrate is characterized by inflammatory cells including neutrophils, lymphocytes and macrophages. Furthermore, neutrophilia in bronchoalveolar lavage (BAL) fluid has...... been shown to confer a poor prognosis in PCP. We therefore investigated the potential of BAL fluid from 17 patients with PCP to induce neutrophil chemotaxis. BAL fluid from patients induced considerable neutrophil chemotactic activity compared to normal controls. Elevated levels of IL-8 were detected...... in patient samples as compared to controls. A specific anti-IL-8 antibody significantly reduced chemotactic activity of patient samples by more than 50%. In conclusion, IL-8 appears to be a significant participant of neutrophil chemotaxis in AIDS-associated PCP, and may participate in the recruitment...

  11. 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......-hazards regression models. RESULTS: Univariate analysis showed that age, one or more prior episodes of PCP, use of antimicrobial therapy other than trimethoprim-sulfamethoxazole (TMP-SMZ), use of PCP prophylaxis at diagnosis, and culture of cytomegalovirus (CMV) in BAL predicted progression to death within 3 months...

  12. 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...... ventilation were discharged. Long term prognosis for these patients was not worse than for patients who did not require mechanical ventilation. Relapse of PCP occurred in 3/50 patients (6%) during secondary prophylaxis, 160 mg trimethoprim and 800 mg sulfamethoxazole (TMP-SMZ) every 24 h, compared to 11...

  13. 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...... as pentamidine isethionate is the second drug of choice in the treatment of acute PCP, careful biochemical and cardial monitoring of patients during treatment is recommended....

  14. 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....

  15. 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....

  16. 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.

  17. 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.

  18. 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.

  19. 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....

  20. 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%)....

  1. 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.

  2. 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.

  3. 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...

  4. [Clinical characteristics of Pneumocystis carinii pneumonia in children with systemic lupus erythematosus].

    Science.gov (United States)

    Tang, Xiao-yan; Li, Ji; Dong, Fen; Song, Hong-mei

    2013-12-01

    To identify the risk factors which will indicate the Pneumocystis carinii (Pc) infection in children with systemic lupus erythematosus (SLE) and investigate the clinical features and to elevate the level to find out the high-risk patients and make early diagnosis and treatment. The characteristics, clinical features, laboratory examinations, treatment and prognosis of Pneumocystis carinii pneumonia (PCP) in children with SLE under 18 years of age treated in our hospital between January 2000 and January 2013 were prospectively reviewed. A comparison was made with the 26 cases of SLE children without PCP who were matched for gender, age and course, and a literature review was made. (1) Five cases were enrolled, 3 were male and 2 female. Their age range was 13-17 (14.0 ± 1.6) years. All the children had kidney involvement. The courses were from 3 months to 4.5 years. All patients were receiving daily glucocorticoid therapy and immunosuppressive drugs before the diagnosis of PCP.Four patients were in the inactive phase of SLE (SLEDAI 2-4 points), and the fifth case was in active phase (SLEDAI 8, low complement 2 points, anti-dsDNA antibody positive 2 points, urine-protein 4 points). (2) Besides the clinical manifestations of SLE, most patients had progressive dyspnea, fever and dry cough at onset of PCP. Two children accepted mechanical ventilation because of respiratory failure. The mean duration of the symptoms to diagnosis was 10-30 (17.6 ± 7.8) days. Lactose dehydrogenase (LDH) was elevated more or less, median was (700 ± 263) U/L. Lymphocyte count were (0.3-1.4)×10(9)/L (median 0.5×10(9)/L), and three children had CD4 T lymphocyte count <0.3×10(9)/L. Arterial blood gas analyses showed severe hypoxemia. Chest radiographs showed in all cases diffuse interstitial infiltration. Pc was positive in the sputum. All patients were treated with trimethoprim-sulfamethoxazole and corticosteroids. When SLE children are treated with corticosteroids and immunosuppressive

  5. 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

  6. Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis.

    Science.gov (United States)

    Liu, Yao; Su, Lili; Jiang, Shu-Juan; Qu, Hui

    2017-08-29

    The number of patients with non-human immunodeficiency virus (HIV) related pneumocystis carinii pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We performed a meta-analysis to describe the clinical characteristics and factors associated with outcomes of PCP in HIV-negative patients. A total of 13 studies including 867 patients with non-HIV related PCP was included. The overall mortality for non-HIV patients with PCP was 30.6%. The most common underlying disorder for the development of PCP is hematological malignancies (29.1%), followed by autoimmune disease (20.1%), organ or bone marrow transplantation (14.0%), and solid tumors (6.0%). Risk factors associated with increased mortality rate including old age, female sex, longer time from onset of symptoms to diagnosis, respiratory failure, solid tumors, high lactate dehydrogenase, low serum albumin, bacterial, and aspergillus co-infection, etc (P PCP prophylaxis was not shown to improve the outcome of PCP in non-HIV patients (P > 0.05). Our findings indicate that mortality in non-HIV patients with PCP is high. Improved knowledge about the prognostic factors may guide the early treatment.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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...

  12. 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...

  13. Update on Pneumocystis carinii f. sp. hominis typing based on nucleotide sequence variations in internal transcribed spacer regions of rRNA genes

    DEFF Research Database (Denmark)

    Lee, C H; Helweg-Larsen, J; Tang, X

    1998-01-01

    Pneumocystis carinii f. sp. hominis isolates from 207 clinical specimens from nine countries were typed based on nucleotide sequence variations in the internal transcribed spacer regions I and II (ITS1 and ITS2, respectively) of rRNA genes. The number of ITS1 nucleotides has been revised from the...

  14. 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 ...

  15. 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.

  16. Serum type III procollagen peptide in patients with Pneumocystis carinii infection. The Copenhagen-Amsterdam PCP-Prednisolone Study Group

    DEFF Research Database (Denmark)

    Bentsen, K D; Nielsen, T L; Eaftinck Schattenkerk, J K

    1993-01-01

    Inflammation may play a central role in the pathogenesis of HIV-related Pneumocystis carinii pneumonia (PCP). Serum levels of the amino-terminal propeptide of Type III procollagen (PIIINP) reflect inflammatory activity in granulation tissue and in chronic rheumatic and liver disorders. To investi......Inflammation may play a central role in the pathogenesis of HIV-related Pneumocystis carinii pneumonia (PCP). Serum levels of the amino-terminal propeptide of Type III procollagen (PIIINP) reflect inflammatory activity in granulation tissue and in chronic rheumatic and liver disorders....... To investigate changes in PIIINP serum levels during an episode of HIV-related PCP, consecutive serum samples were taken from 48 HIV-infected patients with PCP in a randomized, placebo-controlled study of the effect of adjunctive methylprednisolone therapy (26 in corticosteroid [CS] group and 22 in control group...... steroid was administered. At Days 21 to 28 there were no difference in the levels of PIIINP between the two groups. PIIINP serum levels may predict the clinical outcome of PCP. The antimicrobial therapy may exacerbate the inflammatory reaction in HIV-related PCP, leading to respiratory failure. CS...

  17. 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.

  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. A randomized trial of the discontinuation of primary and secondary prophylaxis against Pneumocystis carinii pneumonia after highly active antiretroviral therapy in patients with HIV infection. Grupo de Estudio del SIDA 04/98.

    Science.gov (United States)

    Lopez Bernaldo de Quiros, J C; Miro, J M; Peña, J M; Podzamczer, D; Alberdi, J C; Martínez, E; Cosin, J; Claramonte, X; Gonzalez, J; Domingo, P; Casado, J L; Ribera, E

    2001-01-18

    Prophylaxis against Pneumocystis carinii pneumonia is indicated in patients with human immunodeficiency virus (HIV) infection who have less than 200 CD4 cells per cubic millimeter and in those with a history of P. carinii pneumonia. However, it is not clear whether prophylaxis can be safely discontinued after CD4 cell counts increase in response to highly active antiretroviral therapy. We conducted a randomized trial of the discontinuation of primary or secondary prophylaxis against P. carinii pneumonia in HIV-infected patients with a sustained response to antiviral therapy, defined by a CD4 cell count of 200 or more per cubic millimeter and plasma HIV type 1 (HIV-1) RNA level of less than 5000 copies per milliliter for at least three months. Prophylactic treatment was restarted if the CD4 cell count declined to less than 200 per cubic millimeter. The 474 patients receiving primary prophylaxis had a median CD4 cell count at entry of 342 per cubic millimeter, and 38 percent had detectable HIV-1 RNA. After a median follow-up period of 20 months (758 person-years), there had been no episodes of P. carinii pneumonia in the 240 patients who discontinued prophylaxis (95 percent confidence interval, 0 to 0.85 episode per 100 person-years). For the 113 patients receiving secondary prophylaxis, the median CD4 cell count at entry was 355 per cubic millimeter, and 24 percent had detectable HIV-1 RNA. After a median follow-up period of 12 months (123 person-years), there had been no episodes of P. carinii pneumonia in the 60 patients who discontinued prophylaxis (95 percent confidence interval, 0 to 4.5 episodes per 100 person-years). In HIV-infected patients receiving highly active antiretroviral therapy, primary and secondary prophylaxis against P. carinii pneumonia can be safely discontinued after the CD4 cell count has increased to 200 or more per cubic millimeter for more than three months.

  20. 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.

  1. 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...

  2. 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....

  3. 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.

  4. Pneumocystis carinii pneumonia in AIDS patients: clinical course in relation to the parasite number found in routine specimens obtained by fiberoptic bronchoscopy

    DEFF Research Database (Denmark)

    Orholm, M; Nielsen, T L; Holten-Andersen, W

    1992-01-01

    The aim of this study was to evaluate whether the amount of Pneumocystis carinii organisms found at fiberoptic bronchoscopy (FB) performed on HIV-positive patients correlated to the character of the P. carinii pneumonia (PCP). A consecutive series of 105 patients presented with 131 episodes...... of pulmonary symptoms requiring FB, and in 75 of these episodes a diagnosis of PCP was made. Specimens were stained with Giemsa and methenamine silver nitrate and the number of parasites found was given as: numerous, many, few or none. The following signs and symptoms were registered: cough, dyspnoea, fever......, loss of weight, chest radiograph, haemoglobin, WBC, CD4 cell count, PO2 and HIV p24 antigen. The PCP was characterized by the clinical course: mild, moderate, severe, and by the outcome: pulmonary healthy, pulmonary insufficiency and death. No correlations between the number of P. carinii organisms...

  5. 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.)

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

    Science.gov (United States)

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

    2014-01-01

    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 P. 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 (HPLC) and proton nuclear magnetic resonance spectroscopy (1H-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 Δ24(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. PMID:25230683

  7. 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.

  8. 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.

  9. 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.

  10. 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...... (PG) and leukotrienes (LT)] are pro-inflammatory mediators released from arachidonic acid by action of phospholipase A2 (PLA2) and have been implicated in the host response to micro-organisms. Bronchoalveolar lavage (BAL) was performed on patients with PCP as part of a randomized study of adjuvant...... corticosteroids vs. placebo, in addition to standard antimicrobial therapy. Re-bronchoscopy was offered at day 10. BAL fluid was available for 26 patients who had follow-up bronchoscopy performed. At diagnosis, IL-8 levels were elevated in patients with PCP, compared to healthy controls, and correlated...

  11. 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...... methodology for obtaining Pneumocystis from experimental hosts or from human clinical samples; methods are still far from reaching standardization, as discussed here by the members of the European Concerted Action (ECA) on Pneumocystis carinii, which is co-ordinated by Eduardo Dei-Cas and Jean...

  12. 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...

  13. Clinical correlation of variations in the internal transcribed spacer regions of rRNA genes in Pneumocystis carinii f.sp. hominis

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Lee, C H; Jin, S

    2001-01-01

    OBJECTIVES: To analyse the importance of sequence variations in the internal transcribed spacer (ITS) regions 1 and 2 of the nuclear rRNA operon in AIDS patients with Pneumocystis carinii pneumonia (PCP). DESIGN AND METHODS: ITS 1 and 2 genotypes were determined in 162 bronchoalveolar lavage...... samples from 130 patients participating in a prospective cohort study of PCP. RESULTS: A total of 49 different ITS genotypes were detected. ITS genotype was not associated with the clinical severity or outcome of PCP. In 37 of 162 (23%) samples infection with two or more genotypes was observed. A genotype...... switch was detected in six of 10 patients (60%) with recurrent episodes of PCP. However, genotype changes were also seen in 10 of 19 patients (53%) who had repeated bronchoscopies within the same episode of PCP. The same ITS type was observed twice in 13 (46%) of the 28 patients with repeat...

  14. 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...

  15. Pneumocystis Pneumonia

    Science.gov (United States)

    ... Statistics More Resources en Español Definición Síntomas Las Personas en Riesgo y Prevención Fuentes Diagnóstico y Exámenes ... Pneumocystis carinii infection: evidence for high prevalence in normal and immunosuppressed children. Pediatrics 1978;61:35-41. ...

  16. 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...

  17. 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。

  18. 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

  19. 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 ].

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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)

  5. 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

  6. 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...

  7. 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。

  8. 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....

  9. 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...

  10. 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...

  11. 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.

  12. 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

  13. 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

  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. 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.

  17. 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.

  18. 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 , ...

  19. "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.

  20. 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 , ...

  1. 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.

  2. 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 ...

  3. 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.

  4. 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

  5. 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

  6. 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....

  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. Variation in the Major Surface Glycoprotein Genes in Pneumocystis jirovecii

    Science.gov (United States)

    Kutty, Geetha; Maldarelli, Frank; Achaz, Guillaume; Kovacs, Joseph A.

    2008-01-01

    The genome of Pneumocystis, which causes life-threatening pneumonia in immunosuppressed patients, contains a multi-copy gene family that encodes the major surface glycoprotein (Msg). Pneumocystis can vary the expressed Msg, presumably as a mechanism to avoid host immune responses. Analysis of 24 msg gene sequences obtained from a single human Pneumocystis isolate demonstrated that the sequences segregate into two branches. Based on a number of analyses, recombination among msg genes appears to be an important mechanism for generating msg diversity. Intra-branch recombination occurred more frequently than inter-branch recombination. Restriction fragment length polymorphism analysis demonstrated substantial variation in the repertoire of the msg gene family among isolates of human Pneumocystis, which was not observed in laboratory isolates of rat or mouse Pneumocystis; this may be the result of examining outbred vs. captive populations. Increased diversity in the Msg repertoire, generated in part by recombination, increases the potential for antigenic variation in this abundant surface protein. PMID:18627244

  9. 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.

  10. 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

  11. Pulmonary disease in patients with human immunodeficiency virus infection

    DEFF Research Database (Denmark)

    Lundgren, J D; Orholm, Marianne; Lundgren, B

    1989-01-01

    Pulmonary disease is the most important cause of morbidity and mortality in patients infected with human immunodeficiency virus (HIV). All parts of the hospital system are expected to be involved in the diagnosis and treatment of HIV infected patients in the coming years. Many different processes...... cause pulmonary disease alone or in combination. Bilateral interstitial infiltrates are the most frequent chest x-ray abnormality and are most frequently caused by infection with Pneumocystis carinii. Cytomegalovirus, Mycobacterium tuberculosis, nonspecific interstitial pneumonitis and pulmonary Kaposi...

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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...... 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...

  20. 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.

  1. 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.

  2. 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...

  3. 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

    ) survival to discharge, (b) need for mechanical ventilation, and (c) survival at day 90. CS was given within 24 h of standard therapy as intravenous methylprednisolone 2 mg/kg body weight daily for 10 days. All patients received cotrimoxazole as standard treatment. Inclusion criteria were a PaO2 less than 9...

  4. 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.

  5. 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...

  6. 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.

  7. 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

  8. 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.

  9. 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 ...

  10. 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...

  11. 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...

  12. 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...

  13. 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

  14. Single-day trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis pneumonia in children with cancer.

    Science.gov (United States)

    Caselli, Désirée; Petris, Maria Grazia; Rondelli, Roberto; Carraro, Francesca; Colombini, Antonella; Muggeo, Paola; Ziino, Ottavio; Melchionda, Fraia; Russo, Giovanna; Pierani, Paolo; Soncini, Elena; DeSantis, Raffaella; Zanazzo, Giulio; Barone, Angelica; Cesaro, Simone; Cellini, Monica; Mura, Rossella; Milano, Giuseppe M; Meazza, Cristina; Cicalese, Maria P; Tropia, Serena; De Masi, Salvatore; Castagnola, Elio; Aricò, Maurizio

    2014-02-01

    To determine whether a simplified, 1-day/week regimen of trimethoprim/sulfamethoxazole is sufficient to prevent Pneumocystis (jirovecii [carinii]) pneumonia (PCP). Current recommended regimens for prophylaxis against PCP range from daily administration to 3 consecutive days per week dosing. A prospective survey of the regimens adopted for the PCP prophylaxis in all patients treated for childhood cancer at pediatric hematology-oncology centers of the Associazione Italiana Ematologia Oncologia Pediatrica. The 20 centers participating in the study reported a total of 2466 patients, including 1093 with solid tumor and 1373 with leukemia/lymphoma (or primary immunodeficiency; n = 2). Of these patients, 1371 (55.6%) received the 3-day/week prophylaxis regimen, 406 (16.5%) received the 2-day/week regimen, and 689 (27.9%), including 439 with leukemia/lymphoma, received the 1-day/week regimen. Overall, only 2 cases of PCP (0.08%) were reported, both in the 2-day/week group. By intention to treat, the cumulative incidence of PCP at 3 years was 0.09% overall (95% CI, 0.00-0.40%) and 0.51% for the 2-day/week group (95% CI, 0.10%-2.00%). Remarkably, both patients who failed had withdrawn from prophylaxis. A single-day course of prophylaxis with trimethoprim/sulfamethoxazole may be sufficient to prevent PCP in children with cancer undergoing intensive chemotherapy regimens. This simplified strategy might have implications for the emerging need for PCP prophylaxis in other patients subjected to the increased use of biological and nonbiological agents that induce higher levels of immune suppression, such as those with rheumatic diseases. Copyright © 2014 The Authors. Published by Mosby, Inc. All rights reserved.

  15. 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.

  16. Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa.

    Science.gov (United States)

    McLeod, D T; Neill, P; Robertson, V J; Latif, A S; Emmanuel, J C; Els, J E; Gwanzura, L K; Trijssenaar, F E; Nziramasanga, P; Jongeling, G R

    1989-01-01

    During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. 'Tru-cut' lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.

  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. Outbreak of Pneumocystis Pneumonia in Renal and Liver Transplant Patients Caused by Genotypically Distinct Strains of Pneumocystis jirovecii

    DEFF Research Database (Denmark)

    Rostved, Andreas A; Sassi, Monica; Kurtzhals, Jørgen A L

    2013-01-01

    An outbreak of 29 cases of Pneumocystis jirovecii pneumonia (PCP) occurred among renal and liver transplant recipients (RTR and LTR) in the largest Danish transplantation centre between 2007 and 2010, when routine PCP prophylaxis was not used.......An outbreak of 29 cases of Pneumocystis jirovecii pneumonia (PCP) occurred among renal and liver transplant recipients (RTR and LTR) in the largest Danish transplantation centre between 2007 and 2010, when routine PCP prophylaxis was not used....

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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 ...

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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....

  11. 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

  12. Good's Syndrome with Pneumocystis Jiroveci Lymphadenitis and Pure Red Cell Aplasia

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    Jintana - Srisompong, Torpong - Thongngarm, Popchai - Ngamskulrungroj, Ruchira - Ruangchira-urai, Adhiratha - Boonyasiri

    2016-06-01

    Full Text Available Pneumocystis jiroveci lymphadenitis is a rare manifestation of extrapulmonary pneumocystosis. A case of recurrent infection with lymphadenitis caused by Pneumocystis jiroveci in a middle-aged patient is described. He presented with prolonged fever, recurrent diarrhea, and severe anemia required frequent blood transfusion recognized to be Good’s syndrome. Cervical lymph node biopsy revealed caseating granulomas and presence of organisms morphologically consistent with Pneumocystis spp. Bone marrow biopsy was compatible with pure red cell aplasia associated with Good’s syndrome. According to our knowledge, it is the first case diagnosed with Good’s syndrome, Pneumocystis jiroveci lymphadenitis and pure red cell aplasia. J Microbiol Infect Dis 2016;6(2: 87-91

  13. 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...

  14. Pneumocystis jirovecii colonisation in HIV-positive and HIV-negative subjects in Cameroon.

    Science.gov (United States)

    Riebold, D; Enoh, D O; Kinge, T N; Akam, W; Bumah, M K; Russow, K; Klammt, S; Loebermann, M; Fritzsche, C; Eyong, J E; Eppel, G; Kundt, G; Hemmer, C J; Reisinger, E C

    2014-06-01

    To determine the prevalence of Pneumocystis pneumonia (PCP), a major opportunistic infection in AIDS patients in Europe and the USA, in Cameroon. Induced sputum samples from 237 patients without pulmonary symptoms (126 HIV-positive and 111 HIV-negative outpatients) treated at a regional hospital in Cameroon were examined for the prevalence of Pneumocystis jirovecii by specific nested polymerase chain reaction (nPCR) and staining methods. CD4 counts and the history of antiretroviral therapy of the subjects were obtained through the ESOPE database system. Seventy-five of 237 study participants (31.6%) were colonised with Pneumocystis, but none showed active PCP. The Pneumocystis colonisation rate in HIV-positive subjects was more than double that of HIV-negative subjects (42.9% vs. 18.9%, P 500 cells/μl were colonised at a rate of 20.0%, subjects with CD4 counts between 200 and 500 cells/μl of 42.5%, and subjects with CD4 counts <200 cells/μl of 57.1%. Colonisation with Pneumocystis in Cameroon seems to be comparable to rates found in Western Europe. Prophylactic and therapeutic measures against Pneumocystis should be taken into account in HIV care in western Africa. © 2014 John Wiley & Sons Ltd.

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

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    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.

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

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    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.

  17. Dihydropteroate synthase gene mutations in Pneumocystis and sulfa resistance

    DEFF Research Database (Denmark)

    Huang, Laurence; Crothers, Kristina; Atzori, Chiara

    2004-01-01

    Pneumocystis pneumonia (PCP) remains a major cause of illness and death in HIV-infected persons. Sulfa drugs, trimethoprim-sulfamethoxazole (TMP-SMX) and dapsone are mainstays of PCP treatment and prophylaxis. While prophylaxis has reduced the incidence of PCP, its use has raised concerns about...... 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...... for PCP treatment remains unclear. We review studies of DHPS mutations in P. jirovecii and summarize the evidence for resistance to sulfamethoxazole and dapsone....

  18. 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

  19. 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.

  20. Pneumocystis jirovecii and Cystic Fibrosis in Brittany, France.

    Science.gov (United States)

    Nevez, Gilles; Robert-Gangneux, Florence; Pougnet, Laurence; Virmaux, Michèle; Belleguic, Chantal; Deneuville, Eric; Rault, Gilles; Chevrier, Sylviane; Ramel, Sophie; Le Bihan, Jean; Guillaud-Saumur, Thibaud; Calderon, Enrique; Le Govic, Yohann; Gangneux, Jean-Pierre; Le Gal, Solène

    2017-07-07

    Pneumocystis jirovecii is a transmissible fungus with a high pulmonary tropism. The prevalence of P. jirovecii in patients with cystic fibrosis (CF) has been estimated in Germany at 7.4%, in Spain at 21.5% and in Brazil at 38.2%. Data on the prevalence of P. jirovecii in CF patients in France remain scarce, particularly in Brittany, where the prevalence of CF is high (from 1/1600 to 1/4500). Our objectives were to determine the prevalence of colonization of the airways by P. jirovecii in Brittany in CF patients monitored at the "Centre de Ressources et de Compétences de la Mucoviscidose (CRCM)" of Rennes compared to that previously observed at the CRCM of Roscoff-Brest. Sputa from 86 patients (178 specimens) followed in Rennes were analyzed retrospectively. The detection of P. jirovecii was performed using real-time PCR targeting the gene encoding the mitochondrial large subunit of ribosomal RNA. Pneumocystis jirovecii DNA was detected in 3/86 patients (3.5%) monitored at Rennes, whereas it had previously been detected in 1/76 patients (1.3%) monitored at Roscoff-Brest, thus showing an overall prevalence of 2.5% in Brittany. These results obtained from two Breton centers taken together show that P. jirovecii prevalence in patients with CF in Brittany is lower than those observed in Germany, Spain, Brazil or in other regions of France. This study is a preliminary step in determining the risk factors for P. jirovecii acquisition, its epidemiological and clinical significance in CF patients through a prospective multicenter study.

  1. Near-Universal Prevalence of Pneumocystis and Associated Increase in Mucus in the Lungs of Infants With Sudden Unexpected Death

    Science.gov (United States)

    Vargas, Sergio L.; Ponce, Carolina A.; Gallo, Miriam; Pérez, Francisco; Astorga, J.-Felipe; Bustamante, Rebeca; Chabé, Magali; Durand-Joly, Isabelle; Iturra, Pablo; Miller, Robert F.; Aliouat, El Moukthar; Dei-Cas, Eduardo

    2013-01-01

    Background. Pneumocystis without obvious accompanying pathology is occasionally reported in autopsied infant lungs. Its prevalence and significance are unknown. Interestingly, this mild infection induces a strong activation of mucus secretion–related genes in young immunocompetent rodents that has not been explored in infants. Excess mucus is induced by multiple airway offenders through nonspecific pathways and would explain a cofactor role of Pneumocystis in respiratory disease. We undertook characterization of the prevalence of Pneumocystis and associated mucus in infant lungs. Methods. Samples from 128 infants (mean age, 101 days) who died suddenly and unexpectedly in Santiago during 1999–2004 were examined for Pneumocystis using nested polymerase chain reaction (nPCR) amplification of the P. jirovecii mtLSU ribosomal RNA gene and immunofluorescence microscopy (IF). Pneumocystis-negative infants 28 days and older and their age-closest positives were studied for MUC5AC expression and Pneumocystis burden by Western blot and quantitative PCR, respectively. Results. Pneumocystis DNA was detected by nPCR in 105 of the 128 infants (82.0%) and Pneumocystis organisms were visualized by IF in 99 (94.3%) of the DNA-positive infants. The infection was commonest at 3–4 months with 40 of 41 (97.6%) infants of that age testing positive. MUC5AC was significantly increased in Pneumocystis-positive tissue specimens (P = .013). Death was unexplained in 113 (88.3%) infants; Pneumocystis was detected in 95 (84.0%) of them vs 10 of 15 (66.7%) with explained death (P = .28). Conclusions. A highly focal Pneumocystis infection associated to increased mucus expression is almost universally present in the lungs of infants dying unexpectedly in the community regardless of autopsy diagnosis. PMID:23074306

  2. 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

  3. 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

  4. 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.

  5. 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.

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

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    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.

  7. Estimation of CD4+ and CD8+ T-lymphocytes in human immunodeficiency virus infection and acquired immunodeficiency syndrome patients in Manipur

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    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. 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

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

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    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.

  10. 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.

  11. Postmortem Investigations Following Human Immunodeficiency Virus Infection

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    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

  12. 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.

  13. 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.

  14. 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,

  15. Lower incidence of Pneumocystis jirovecii pneumonia among Africans in the Netherlands host or environmental factors?

    NARCIS (Netherlands)

    Schoffelen, Annelot F; van Lelyveld, Steven F L; Barth, Roos E; Gras, Luuk; de Wolf, Frank; Netea, Mihai G; Hoepelman, Andy I M; Schölvinck, Elisabeth H.

    2013-01-01

    BACKGROUND AND OBJECTIVE: HIV-associated Pneumocystis jirovecii pneumonia (PJP) remains one of the commonest opportunistic infections in Western countries. Although it has been suggested that racial differences in PJP incidence exist, early studies report conflicting results. This study aimed to inv

  16. Life-threatening Pneumocystis jiroveci pneumonia following treatment of severe Cushing's syndrome

    NARCIS (Netherlands)

    Oosterhuis, J. K.; van den Berg, G.; Monteban-Kooistra, W. E.; Ligtenberg, J. J. M.; Tulleken, J. E.; Zijlstra, J. G.; Meertens, John

    We describe two patients with a severe Cushing's syndrome due to ectopic production of ACTH. Both patients developed a life-threatening Pneumocystis jiroveci pneumonia (PCP) shortly after treatment of the hypercortisolism was started by means of inhibition of production of glucocorticoids and

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. [Pneumocystis jiroveci pneumonia: Clinical characteristics and mortality risk factors in an Intensive Care Unit].

    Science.gov (United States)

    Solano L, M F; Alvarez Lerma, F; Grau, S; Segura, C; Aguilar, A

    2015-01-01

    To describe the epidemiological characteristics of the population with Pneumocystis jiroveci (P. jiroveci) pneumonia, analyzing risk factors associated with the disease, predisposing factors for admission to an intensive care unit (ICU), and prognostic factors of mortality. A retrospective observational study was carried out, involving a cohort of patients consecutively admitted to a hospital in Spain from 1 January 2007 to 31 December 2011, with a final diagnosis of P. jiroveci pneumonia. The ICU and hospitalization service of Hospital del Mar, Barcelona (Spain). We included 36 patients with pneumonia due to P. jiroveci. Of these subjects, 16 required ICU admission (44.4%). The average age of the patients was 41.3 ± 12 years, and 23 were men (63.9%). A total of 86.1% had a history of human immunodeficiency virus (HIV) infection, and the remaining 13.9% presented immune-based disease subjected to immunosuppressive therapy. Risk factors associated to hospital mortality were age (51.8 vs. 37.3 years, P=.002), a higher APACHE score upon admission (17 vs. 13 points, P=.009), the need for invasive mechanical ventilation (27.8% vs. 11.1%, P=.000), requirement of vasoactive drugs (25.0% vs. 11.1%, P=.000), fungal coinfection (22.2% vs. 11.1%, P=.001), pneumothorax (16.7% vs. 83.3%, P=.000) and admission to the ICU (27.8% vs. 72.2% P=.000). The high requirement of mechanical ventilation and vasoactive drugs associated with fungal coinfection and pneumothorax in patients admitted to the ICU remain as risk factors associated with mortality in patients with P. jiroveci pneumonia. Copyright © 2013 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. 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 ...

  4. 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

  5. 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

  6. Refractory acute respiratory failure due to Pneumocystis jiroveci (PCP) and Cytomegalovirus (CMV) pneumonitis: A case report and review of literature.

    Science.gov (United States)

    Shah, Kairav; Cherabuddi, Kartikeya; Beal, Stacy G; Kalyatanda, Gautam

    2017-01-01

    Opportunistic infections with Pneumocystis jiroveci pneumonia (PCP) are common in patients with HIV (human immunodeficiency virus) and are encountered once the CD4 count decreases below 200 cells/mm3. Cytomegalovirus (CMV) tends to cause disease once the CD4 count drops below 50 cells/mm3. CMV pneumonitis is not common in this population. However, detecting its presence in broncho-alveolar lavage (BAL) fluid has been associated with increased morbidity and mortality. The role of antiviral therapy against CMV remains unclear. We report a newly diagnosed HIV patient with a CD4 count of 44 cells/mm3 presenting with acute respiratory failure secondary to PCP that failed to respond to 3 weeks of standard therapy with trimethoprim-sulfamethoxazole and corticosteroids. He was later diagnosed to have a CMV co-infection causing pneumonitis with BAL cytology findings showing CMV cytopathic effects and PCP. Plasma CMV DNA PCR was 17,424 copies/mL. He responded well after introduction of intravenous ganciclovir. The presence of histopathologic changes demonstrating viral cytopathic effects on BAL cytology along with a high plasma CMV DNA PCR should raise the specificity for diagnosing CMV pneumonitis. True PCP and CMV pneumonitis can occur, and the addition of antiviral therapy with ganciclovir may benefit such patients in the right clinical scenario.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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...

  12. 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.

  13. 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.

  14. New Short Tandem Repeat-Based Molecular Typing Method for Pneumocystis jirovecii Reveals Intrahospital Transmission between Patients from Different Wards.

    Directory of Open Access Journals (Sweden)

    Maud Gits-Muselli

    Full Text Available Pneumocystis pneumonia is a severe opportunistic infection in immunocompromised patients caused by the unusual fungus Pneumocystis jirovecii. Transmission is airborne, with both immunocompromised and immunocompetent individuals acting as a reservoir for the fungus. Numerous reports of outbreaks in renal transplant units demonstrate the need for valid genotyping methods to detect transmission of a given genotype. Here, we developed a short tandem repeat (STR-based molecular typing method for P. jirovecii. We analyzed the P. jirovecii genome and selected six genomic STR markers located on different contigs of the genome. We then tested these markers in 106 P. jirovecii PCR-positive respiratory samples collected between October 2010 and November 2013 from 91 patients with various underlying medical conditions. Unique (one allele per marker and multiple (more than one allele per marker genotypes were observed in 34 (32% and 72 (68% samples, respectively. A genotype could be assigned to 55 samples (54 patients and 61 different genotypes were identified in total with a discriminatory power of 0.992. Analysis of the allelic distribution of the six markers and minimum spanning tree analysis of the 61 genotypes identified a specific genotype (Gt21 in our hospital, which may have been transmitted between 10 patients including six renal transplant recipients. Our STR-based molecular typing method is a quick, cheap and reliable approach to genotype Pneumocystis jirovecii in hospital settings and is sensitive enough to detect minor genotypes, thus enabling the study of the transmission and pathophysiology of Pneumocystis pneumonia.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Combination of Echinocandins and Trimethoprim/Sulfamethoxazole for the Treatment of Pneumocystis jiroveci Pneumonia After Heart Transplantation.

    Science.gov (United States)

    Lu, Y-M; Lee, Y-T; Chang, H-C; Yang, H-S; Chang, C-Y; Huang, C-M; Wei, J

    2017-10-01

    The echinocandins have shown anti-Pneumocystis jiroveci activity in nonhuman animal models; however, the corresponding human clinical experience has been rarely reported. We report a clinical picture of P jiroveci pneumonia (PJP) and determine the effects of concomitant therapy with echinocandins and trimethoprim (TMP)-sulfamethoxazole (SMZ). We investigated a retrospective case series of heart transplantation (HT) recipients with PJP from July 1988 to December 2015. Recipient charts were reviewed for their demographic characteristics, underlying conditions, concomitant infections, PJP prophylaxis, TMP-SMZ dosages, adverse events, echinocandin use, oxygenation, and outcomes. Eleven of 451 HT recipients developed PJP after a median duration of 2.8 years after transplantation. All 11 were treated with TMP-SMZ; 5 of them were treated with echinocandins added to the standard TMP-SMZ regimen. The longest interval between transplantation and PJP development was 16.3 years. The mortality rate was 33.3% in recipients receiving TMP-SMZ alone, whereas it was 20% in those receiving echinocandins as well. The most common side effects of TMP-SMZ include nausea and vomiting, metabolic acidosis, and hyperkalemia. Five recipients developed acute psychosis after a median duration of 6 days of TMP-SMZ therapy. The incidence of psychosis increased from 25% in recipients receiving TMP at ≤15 mg/kg/d to 100% in those receiving TMP at >15 mg/kg/d. Echinocandins along with the standard TMP-SMZ regimen may effectively alleviate PJP developed after HT. The ideal prophylaxis duration is lifelong owing to the late onset of PJP. The typically intolerable adverse effects of TMP-SMZ therapy for PJP may necessitate dosage adjustments in some cases. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. 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...

  2. 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

  3. 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...

  4. 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...

  5. 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).

  6. 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.

  7. Coinfection pulmonaire par pneumocystis jirovecii et pseudomonas aeruginosa au cours du SIDA: à propos de deux cas

    Science.gov (United States)

    Mamoudou, Savadogo; Bellaud, Guillaume; Ana, Canestri; Gilles, Pialoux

    2015-01-01

    Rapporter deux cas cliniques de coinfections pulmonaires par Pneumocystis jirovecii et par Pseudomonas aeruginosa chez des patients vivant avec le VIH. Les deux patients étaient âgés respectivement de 32 ans et 46 ans. Un patient a été pris en charge à l'hôpital Yalgado Ouédraogo de Ouagadougou au Burkina Faso et l'autre a été pris en charge à l'hôpital Ténon de Paris, en France. Les deux souffraient de pneumopathie confirmée à la radiographie et à la tomodensitométrie. L'un des patients était sévèrement immuno déprimé, contrairement à l'autre. L'examen bactériologique dans les crachats avait permis d'isoler Pseudomonas aeruginosa et Pneumocystis jirovecii chez les deux patients. Sous traitement, l’évolution a été favorable. Les coinfections morbides sont relativement fréquentes chez les patients vivant avec le VIH. Devant une symptomatologie respiratoire du sujet vivant avec le VIH, il faut savoir rechercher en plus du Bacille de Koch, Pneumocystis jirovecii et Pseudomonas aeruginosa par un lavage broncho alvéolaire. PMID:26516396

  8. Low prevalence of Pneumocystis pneumonia (PCP) but high prevalence of pneumocystis dihydropteroate synthase (dhps) gene mutations in HIV-infected persons in Uganda.

    Science.gov (United States)

    Taylor, Steve M; Meshnick, Steven R; Worodria, William; Andama, Alfred; Cattamanchi, Adithya; Davis, J Lucian; Yoo, Samuel D; Byanyima, Patrick; Kaswabuli, Sylvia; Goodman, Carol D; Huang, Laurence

    2012-01-01

    Pneumocystis jirovecii pneumonia (PCP) is an important opportunistic infection in patients infected with HIV, but its burden is incompletely characterized in those areas of sub-Saharan Africa where HIV is prevalent. We explored the prevalence of both PCP in HIV-infected adults admitted with pneumonia to a tertiary-care hospital in Uganda and of putative P. jirovecii drug resistance by mutations in fungal dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr). In 129 consecutive patients with sputum smears negative for mycobacteria, 5 (3.9%) were diagnosed with PCP by microscopic examination of Giemsa-stained bronchoalveolar lavage fluid. Concordance was 100% between Giemsa stain and PCR (dhps and dhfr). PCP was more prevalent in patients newly-diagnosed with HIV (11.4%) than in patients with known HIV (1.1%; p = 0.007). Mortality at 2 months after discharge was 29% overall: 28% among PCP-negative patients, and 60% (3 of 5) among PCP-positive patients. In these 5 fungal isolates and an additional 8 from consecutive cases of PCP, all strains harbored mutant dhps haplotypes; all 13 isolates harbored the P57S mutation in dhps, and 3 (23%) also harbored the T55A mutation. No non-synonymous dhfr mutations were detected. PCP is an important cause of pneumonia in patients newly-diagnosed with HIV in Uganda, is associated with high mortality, and putative molecular evidence of drug resistance is prevalent. Given the reliability of field diagnosis in our cohort, future studies in sub-Saharan Africa can investigate the clinical impact of these genotypes.

  9. 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

  10. 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

  11. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients.

    Science.gov (United States)

    Stern, Anat; Green, Hefziba; Paul, Mical; Vidal, Liat; Leibovici, Leonard

    2014-10-01

    Pneumocystis pneumonia (PCP) is a disease affecting immunocompromised patients. PCP among these patients is associated with significant morbidity and mortality. To assess the effectiveness of PCP prophylaxis among non-HIV immunocompromised patients; and to define the type of immunocompromised patient for whom evidence suggests a benefit for PCP prophylaxis. Electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE and EMBASE (to March 2014), LILACS (to March 2014), relevant conference proceedings; and references of identified trials. Randomised controlled trials (RCTs) or quasi-RCTs comparing prophylaxis with an antibiotic effective against PCP versus placebo, no intervention, or antibiotic(s) with no activity against PCP; and trials comparing different antibiotics effective against PCP among immunocompromised non-HIV patients. We only included trials in which Pneumocystis infections were available as an outcome. Two review authors independently assessed risk of bias in each trial and extracted data from the included trials. We contacted authors of the included trials to obtain missing data. The primary outcome was documented PCP infections. Risk ratios (RR) with 95% confidence intervals (CI) were estimated and pooled using the random-effects model. Thirteen trials performed between the years 1974 and 2008 were included, involving 1412 patients. Four trials included 520 children with acute lymphoblastic leukemia and the remaining trials included adults with acute leukemia, solid organ transplantation or autologous bone marrow transplantation. Compared to no treatment or treatment with fluoroquinolones (inactive against Pneumocystis), there was an 85% reduction in the occurrence of PCP in patients receiving prophylaxis with trimethoprim/sulfamethoxazole, RR of 0.15 (95% CI 0.04 to 0.62; 10 trials, 1000 patients). The evidence was graded as moderate due to possible risk of bias. PCP

  12. 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.

  13. 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

  14. 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.

  15. 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......-year period (1/1 1990 to 31/12 2010). Using Danish registry data, first-time diagnoses of PCP were identified. Results: We identified 13 296 adult patients with ESRD and 244 255 controls, yielding 63 560 and 2 223 660 person-years of follow-up (PYFU), respectively. Fifty-eight first-time diagnoses...... of PCP were recorded in the ESRD group. Forty-six episodes occurred among renal transplant recipients (RTx) and 12 among haemodialysis patients (HD), yielding incidence rates of 181 (136-242) and 43.1 (24.5-75.9) per 100 000 PYFU. Compared to population controls, we found incidence rate-ratios of 125...

  16. Risk factors for Pneumocystis jiroveci pneumonia (PcP) in renal transplant recipients.

    Science.gov (United States)

    Eitner, Frank; Hauser, Ingeborg A; Rettkowski, Olaf; Rath, Thomas; Lopau, Kai; Pliquett, Rainer U; Fiedler, Roman; Guba, Markus; Hilgers, Ralf-Dieter; Floege, Jürgen; Fischereder, Michael

    2011-06-01

    Pneumocystis jiroveci pneumonia (PcP) is a potentially life-threatening complication in renal transplant recipients with increased reports during the past few years. Individual risk factors for susceptibility to PcP are incompletely understood. We retrospectively analysed 60 cases of confirmed PcP, diagnosed in six German transplant centres between 2004 and 2008, as well as 60 matched controls. Compared with controls, PcP cases revealed the following significant differences: PcP cases had a poorer renal function (eGFR 31 vs. 42 mL/min in controls), more biopsy-proven rejections (18 vs. 5 patients), more frequent treatment with mycophenolate mofetil (53 vs. 44 patients) and less frequent treatment with interleukin-2 receptor antagonist (20 vs. 32 patients). According to centre policy, in those years, none of the patients or controls had received PcP prophylaxis after transplantation. Of the 60 patients with PcP, 30% developed the disease after the currently recommended duration of prophylactic treatment, 27% died in the course of the disease and 45% required treatment in the ICU. Our case-control study reveals a novel risk profile for PcP. Renal transplant recipients with more pronounced renal insufficiency following rejection episodes and treated with intensified immunosuppression are at particular risk for PcP.

  17. Pneumocystis Pneumonia and the Rheumatologist: Which Patients Are At Risk and How Can PCP Be Prevented?

    Science.gov (United States)

    Wolfe, Rachel M; Peacock, James E

    2017-06-01

    Immunosuppressive therapy for connective tissue diseases (CTDs) is steadily becoming more intense. The resultant impairment in cell-mediated immunity has been accompanied by an increasing risk for opportunistic infection (OI). Pneumocystis pneumonia (PCP) has been recognized as an OI in patients with CTDs, but specific risk factors and precise indications for PCP prophylaxis remain poorly defined. This review was undertaken to update information on the risk of PCP in patients with CTDs and to examine current guidelines for PCP prophylaxis in this population. Data on the occurrence of PCP and indications for prophylaxis in patients with CTDs is sparse. Large systematic reviews did not incorporate patients with CTD secondary to the lack of randomized control trials. Upon reviewing guidelines published since 2015, prophylaxis for PCP is recommended only for patients with ANCA-positive vasculitis, specifically granulomatosis with polyangiitis (GPA), who are undergoing intense induction therapy. Evidence-based recommendations for the prophylaxis of PCP in patients with CTDs cannot be provided. There is expert consensus that PCP prophylaxis is warranted in patients with GPA undergoing induction therapy. Prophylaxis should perhaps also be considered for other CTD patients who are receiving similar intense immunosuppressive therapy especially if they are lymphopenic or have a low CD4 count.

  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. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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...

  7. 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

  8. 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...

  9. 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.

  10. Evaluation of Loop-Mediated Isothermal Amplification Assay for the Detection of Pneumocystis jirovecii in Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Preeti Singh

    2015-01-01

    Full Text Available Pneumocystis pneumonia (PCP is one of the common opportunistic infection among HIV and non-HIV immunocompromised patients. The lack of a rapid and specific diagnostic test necessitates a more reliable laboratory diagnostic test for PCP. In the present study, the loop-mediated isothermal amplification (LAMP assay was evaluated for the detection of Pneumocystis jirovecii. 185 clinical respiratory samples, including both BALF and IS, were subjected to GMS staining, nested PCR, and LAMP assay. Of 185 respiratory samples, 12/185 (6.5%, 41/185 (22.2%, and 49/185 (26.5% samples were positive by GMS staining, nested PCR, and LAMP assay, respectively. As compared to nested PCR, additional 8 samples were positive by LAMP assay and found to be statistically significant (p<0.05 with the detection limit of 1 pg. Thus, the LAMP assay may serve as a better diagnostic tool for the detection of P. jirovecii with high sensitivity and specificity, less turn-around time, operational simplicity, single-step amplification, and immediate visual detection.

  11. 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...

  12. 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...

  13. 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) ...

  14. Prevalencia de "Pneumocystis jirovecii" con mutaciones asociadas a resistencia a las sulfamidas en pacientes con infección por VIH-1. Estudio de los factores de riesgo y valor pronóstico en la neumonía por "Pneumocystis jirovecii" (PCP)

    OpenAIRE

    Álvarez Martínez, Míriam

    2008-01-01

    OBJETIVO GENERAL:Desarrollo de técnicas de diagnóstico molecular de Pneumocystis jirovecii, y conocimiento de la prevalencia de la resistencia a sulfamidas. OBJETIVOS DETALLADOS: 1. Desarrollar técnicas de diagnóstico molecular de P. jirovecii y de tipado del gen de la Dihidropteroato Sintetasa (DHPS) de P. jirovecii, sitio activo de las sulfamidas.2. Determinar la prevalencia de P. jirovecii con mutaciones en el gen de la DHPS, en pacientes VIH-positivos con neumonía por Pneumocystis (PcP) e...

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

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    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

  16. Relationship between Radiological Stages and Prognoses of Pneumocystis Pneumonia in Non-AIDS Immunocompromised Patients.

    Science.gov (United States)

    Mu, Xiang-Dong; Jia, Peng; Gao, Li; Su, Li; Zhang, Cheng; Wang, Ren-Gui; Wang, Guang-Fa

    2016-09-05

    Although radiological features of pneumocystis 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. Retrospective analysis of radiological 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). 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 0.05), and 37 cases were at late stage and CFR was 59.5% (22/37, 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 CFR was 77.8% (14/18, P< 0.01). 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.

  17. 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

  18. 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

  19. 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

  20. 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

    BACKGROUND: Limited clinical data exist to guide the choice of second-line salvage treatment for AIDS-associated Pneumocystis jirovecii pneumonia (PCP). METHODS: We did a systematic search of MEDLINE for all randomized and observational studies of PCP treatment published up to August 2007...... and included individual treatment data of AIDS-associated PCP from a tricenter study. We calculated pooled estimates of reported outcome of second-line treatment using averaged odds ratios (ORs). RESULTS: Twenty-nine studies with sufficient detail of second-line treatment and outcome, including data from 82...... individual cases from the tricenter study, yielded a total of 468 PCP second-line treatment episodes. Response rates to second-line treatment were comparable for trimethoprim-sulfamethoxazole (TMP-SMX; 68%) and clindamycin-primaquine (73%) (OR for response = 2.1 [95% confidence interval (CI): 1.1 to 3...

  1. 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 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...

  2. 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.

  3. 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.

  4. [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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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...

  10. Immune reconstitution syndrome in a human immunodeficiency virus infected child due to giardiasis leading to shock

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    Sneha Nandy

    2015-01-01

    Full Text Available Human immunodeficiency virus (HIV-associated immune reconstitution inflammatory syndrome has been reported in association with tuberculosis, herpes zoster (shingles, Cryptococcus neoformans, Kaposi′s sarcoma, Pneumocystis pneumonia, hepatitis B virus, hepatitis C virus, herpes simplex virus, Histoplasma capsulatum, human papillomavirus, and Cytomegalovirus. However, it has never been documented with giardiasis. We present a 7-year-old HIV infected girl who developed diarrhea and shock following the initiation of antiretroviral therapy, and her stool showed the presence of giardiasis.

  11. 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

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

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    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

  13. Molecular Demonstration of a Pneumocystis Outbreak in Stem Cell Transplant Patients: Evidence for Transmission in the Daycare Center

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    Catherine Cordonnier

    2017-04-01

    Full Text Available Pneumocystis jirovecii pneumonia (PCP is a life-threatening infection in hematology. Although occasionally reported, the role of interhuman transmission of P. jirovecii in PCP, compared to that of reactivation, remains an unresolved question; the recommendation to isolate PCP patients in the hematology ward are not well evidence-based. Following an unexpected increase in the number of febrile pneumonia patients with P. jirovecii DNA detected in respiratory samples in our hematology ward, we explored 12 consecutive patients from November 2015 to May 2016. Genotyping of P jirovecii was performed using microsatellite markers. The frequency of simultaneous occupancy of these 12 patients in the same unit on the same day from 4 months prior to the first diagnosis was recorded. In three patients, the P. jirovecii genotype could not be determined because DNA was insufficient. One rare single genotype (Gt2 was found in four of the other nine, all allogeneic stem cell transplant recipients. The transmission map showed that these 4 patients had multiple opportunities to meet on the same day (median, 6.5; range, 4–10 at the daycare center. It was much less among the eight non-Gt2 patients (median, 1; range, 0–9; P = 0.048. This study, based on modern molecular technics, strongly suggests that interhuman transmission of P. jirovecii between allogeneic stem cell transplant recipients is possible. P. jirovecii DNA detected in respiratory specimens supports that isolation and respiratory precautions be recommended in such cases in the hematology ward.

  14. 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.

  15. 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.

  16. 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.

  17. Inflammatory/granulomatous diseases of the lung; Entzuendliche/granulomatoese Erkrankungen der Lunge

    Energy Technology Data Exchange (ETDEWEB)

    Ivancevic, V.; Munz, D.L. [Humboldt Univ., Berlin (Germany). Kinik und Poliklinik fuer Nuklearmedizin

    1998-05-01

    The term `inflammatory` and `granulomatous` lung disease represents a pool of many etiologically different diseases, the pathologic mechanisms of which are characterized by inflammatory reactions of varying intensity and cell composition. In sarcoidosis and other granulomatous diseases as well as in lung fibroses, gallium scintigraphy allows reliable non-invasive estimation of alveolitis activity and is suitable for therapy monitoring. Granulomatous diseases seem to be detectable sensitively by means of somatostatin receptor scintigraphy as well. It is yet uncertain, whether positron emission tomography with F-18 fluordeoxyglucose will play a role in quantitative assessment of disease activity in sarcoidosis. Gallium scintigraphy is very useful in the early detection of pulmonary complications in AIDS patients. Pneumocystis carinii pneumonia, which is important in this patient population, can also be detected by both Tc-99m and In-111 labelled polyclonal human immunoglobulin, and in future possibly with a monoclonal antibody fragment against Pneumocystis carinii as well. The significance of primary bacterial pneumonias has decreased and nuclear medicine procedures for diagnosing inflammation are needed only exceptionally in this indication. (orig.) [Deutsch] Der Begriff der `entzuendlichen` und `granulomatoesen` Erkrankungen der Lunge stellt ein Sammelbecken fuer eine Vielzahl aetiologisch verschiedener Erkrankungen dar, deren Pathomechanismen durch eine entzuendliche Reaktion unterschiedlicher Intensitaet und Zellzusammensetzung gepraegt werden. Bei der Sarkoidose und anderen granulomatoesen Erkrankungen mit pulmonaler Manifestation sowie den Lungenfibrosen erlaubt die Galliumszintigraphie eine zuverlaessige nicht invasive Beurteilung des Aktivitaetsgrades der Alveolitis und eignet sich zum Therapiemonitoring. Granulomatoese Erkrankungen scheinen auch mit der Somatostatinrezeptorszintigraphie sensitiv nachweisbar zu sein. Ob die Positronen

  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. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. (1-3)-beta-D-glucan in association with lactate dehydrogenase as biomarkers of Pneumocystis pneumonia (PcP) in HIV-infected patients.

    Science.gov (United States)

    Esteves, F; Lee, C-H; de Sousa, B; Badura, R; Seringa, M; Fernandes, C; Gaspar, J F; Antunes, F; Matos, O

    2014-07-01

    Pneumocystis pneumonia (PcP) is a major HIV-related illness caused by Pneumocystis jirovecii. Definitive diagnosis of PcP requires microscopic detection of P. jirovecii in pulmonary specimens. The objective of this study was to evaluate the usefulness of two serum markers in the diagnosis of PcP. Serum levels of (1-3)-beta-d-glucan (BG) and lactate dehydrogenase (LDH) were investigated in 100 HIV-positive adult patients and 50 healthy blood donors. PcP cases were confirmed using indirect immunofluorescence with monoclonal anti-Pneumocystis antibodies and nested-PCR to amplify the large subunit mitochondrial rRNA gene of P. jirovecii in pulmonary specimens. BG and LDH levels in serum were measured using quantitative microplate-based assays. BG and LDH positive sera were statistically associated with PcP cases (P ≤ 0.001). Sensitivity, specificity, positive/negative predictive values (PPV/NPV), and positive/negative likelihood ratios (PLR/NLR) were 91.3 %, 61.3 %, 85.1 %, 79.2 %, 2.359, and 0.142, respectively, for the BG kit assay, and 91.3 %, 35.5 %, 75.9 %, 64.7 %, 1.415 and 0.245, respectively, for the LDH test. Serologic markers levels combined with the clinical diagnostic criteria for PcP were evaluated for their usefulness in diagnosis of PcP. The most promising cutoff levels for diagnosis of PcP were determined to be 400 pg/ml of BG and 350 U/l of LDH, which combined with clinical data presented 92.8 % sensitivity, 83.9 % specificity, 92.8 % PPV, 83.9 % NPV, 5.764 PLR and 0.086 NLR (P PcP diagnosis.

  1. 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

    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....

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. Prevalencia de "Pneumocystis jirovecii" con mutaciones asociadas a resistencia a las sulfamidas en pacientes con infección por VIH-1. Estudio de los factores de riesgo y valor pronóstico en la neumonía por "Pneumocystis jirovecii" (PCP)

    OpenAIRE

    Álvarez Martínez, Míriam

    2008-01-01

    [spa] OBJETIVO GENERAL: Desarrollo de técnicas de diagnóstico molecular de Pneumocystis jirovecii, y conocimiento de la prevalencia de la resistencia a sulfamidas. OBJETIVOS DETALLADOS: 1. Desarrollar técnicas de diagnóstico molecular de P. jirovecii y de tipado del gen de la Dihidropteroato Sintetasa (DHPS) de P. jirovecii, sitio activo de las sulfamidas. 2. Determinar la prevalencia de P. jirovecii con mutaciones en el gen de la DHPS, en pacientes VIH-positivos con neumoní...

  7. 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.

  8. 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

    OBJECTIVES: First-line therapy for Pneumocystis jirovecii pneumonia (PCP) is trimethoprim/sulfamethoxazole. Few data exist to guide the choice of second-line therapy for patients failing or developing toxicity to first-line therapy. METHODS: A case note review of 1122 patients with 1188 episodes...... 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......-associated PCP, and was associated with more treatment changes. Clindamycin/primaquine appeared superior to pentamidine as second-line therapy for PCP in patients failing or developing toxicity with trimethoprim/sulfamethoxazole. In patients failing first-line treatment with non...

  9. 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...

  10. 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.

  11. 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

  12. 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.

  13. 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

  14. 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

  15. High-dose calcineurin inhibitor-free everolimus as a maintenance regimen for heart transplantation may be a risk factor for Pneumocystis pneumonia.

    Science.gov (United States)

    Hu, Yu-Ning; Lee, Nan-Yao; Roan, Jun-Neng; Hsu, Chi-Hsin; Luo, Chwan-Yau

    2017-08-01

    Everolimus reduces the incidence of cardiac-allograft vasculopathy (CAV) and is less renally toxic than are calcineurin inhibitors (CNIs). We evaluated the safety of CNI-free everolimus for post-heart transplant (HTx) patients. We retrospectively reviewed the records of 36 consecutive patients who had undergone an HTx between January 2006 and December 2013 in National Cheng Kung University Hospital. All patients initially had been treated with the standard tacrolimus regimen. The Study group-12 patients with CAV, renal impairment, or a history of malignancy-were switched from tacrolimus to everolimus. The Control group consisted of 19 patients who remained on the standard regimen. The target everolimus trough concentration was 8-14 ng/mL. The primary outcome was survival, and the secondary outcomes were bacterial, viral, fungal, and other infections; Pneumocystis jirovecii pneumonia (PJP); and rejection (≥2R). During a 53.3±25.6-month follow-up, the survival rate, rejection rate, and number of infections, except for PJP, were not significantly different between the two groups. In the Study group, 6 patients were diagnosed with PJP 33±18.2 months after switching. None of the Control group patients were diagnosed with PJP during follow-up. A high-dose CNI-free everolimus maintenance regimen might yield a higher incidence of post-transplantation PJP. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  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. [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.

  18. 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

  19. 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

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. [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.

  16. Human Herpesvirus 8-Negative and Epstein-Barr Virus-Positive Effusion-Based Lymphoma in a Patient with Human Immunodeficiency Virus

    Directory of Open Access Journals (Sweden)

    Jung-Woo Choi

    2015-09-01

    Full Text Available A 39-year-old man infected with human immunodeficiency virus (HIV was admitted to our hospital because of sudden onset of chest pain. Chest radiography revealed pneumothorax of the right lung. Computed tomographic scans disclosed a 5.8-cm-sized emphysematous bulla in the right middle lobe of the lung. Histologically, the wedge-resected lung showed medium to large atypical cells within the bullous cavity of the Pneumocystis jirovecii pneumonia, without solid mass formation. These atypical cells were confirmed to be large B-cell lymphoma, Epstein-Barr virus–positive and human herpesvirus 8–negative. Therefore, this case was not diagnosed as primary effusion lymphoma, but effusion-based lymphoma arising in an emphysematous cavity of an HIV-infected patient. This type of effusion-based lymphoma has never been reported, and, although rare, it should be noted in order to clinically diagnose this lymphoma.

  17. Synthesis and antiparasitic and antitumor activity of 2, 4-diamino-6-(arylmethyl)-5,6,7,8-tetrahydroquinazoline analogues of piritrexim.

    Science.gov (United States)

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

    1999-03-25

    Nineteen previously undescribed 2,4-diamino-6-(arylmethyl)-5,6,7, 8-tetrahydroquinazolines (5a-m, 10-12) were synthesized as part of a larger effort to assess the therapeutic potential of lipophilic dihydrofolate reductase (DHFR) inhibitors against opportunistic infections of AIDS. Condensation of appropriately substituted (arylmethyl)triphenylphosphoranes with 4, 4-ethylenedioxycyclohexanone, followed by hydrogenation (H2/Pd-C) and acidolysis, yielded the corresponding 4-(arylmethyl)cyclohexanones, which were then condensed with cyanoguanidine to form the tetrahydroquinazolines. Three simple 2, 4-diamino-6-alkyl-5,6,7,8-tetrahydroquinazoline model compounds (9a-c) were also prepared in one step from commercially available 4-alkylcyclohexanones by this method. Enzyme inhibition assays against rat liver DHFR, Pneumocystis carinii DHFR, and the bifunctional DHFR-TS enzyme from Toxoplasma gondii were carried out, and the selectivity ratios IC50(rat)/IC50(P. carinii) and IC50(rat)/IC50(T. gondii) were compared. The three most potent inhibitors of P. carinii DHFR were the 2,5-dimethoxybenzyl (5j), 3, 4-dimethoxybenzyl (5k), and 3,4,5-trimethoxybenzyl (5l) analogues, with IC50 values of 0.057, 0.10, and 0.091 microM, respectively. The remaining compounds generally had IC50 values in the 0.1-1.0 microM range. However all the compounds were more potent against the rat liver enzyme than the P. carinii enzyme and thus were nonselective. The T. gondii enzyme was always more sensitive than the P. carinii enzyme, with most of the analogues giving IC50 values of 0.01-0.1 microM. Moderate 5-10-fold selectivity for T. gondii versus rat liver DHFR was observed with five compounds, the best combination of potency and selectivity being achieved with the 2-methoxybenzyl analogue 5d, which had an IC50 of 0.014 microM and a selectivity ratio of 8.6. One compound (5l) was tested for antiproliferative activity against P. carinii trophozoites in culture at a concentration of 10 microgram

  18. 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

  19. 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.

  20. 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.

  1. 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...

  2. 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...

  3. 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...

  4. 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.

  5. 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.

  6. The impact of trimethoprim-sulfamethoxazole as Pneumocystis jiroveci pneumonia prophylaxis on the occurrence of asymptomatic bacteriuria and urinary tract infections among renal allograft recipients: a retrospective before-after study.

    Science.gov (United States)

    Singh, Ramandeep; Bemelman, Frederike J; Hodiamont, Caspar J; Idu, Mirza M; Ten Berge, Ineke J M; Geerlings, Suzanne E

    2016-02-25

    The international guidelines recommend the administration of trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jiroveci pneumonia (PJP) prophylaxis for six months after transplantation. The aim of this study is to evaluate the influence of TMP-SMX prophylaxis on the occurrence of asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) as cystitis and allograft pyelonephritis (AGPN) and its impact on the antimicrobial resistance pattern of causative microorganisms. We have conducted a retrospective before-after study in adult renal allograft recipients with one year follow-up after transplantation. We compared the ("after") group that received TMP-SMX as PJP prophylaxis to the ("before") group that did not receive it. In total, 343 renal allograft recipients were analysed, of whom 212 (61.8 %) received TMP-SMX as PJP prophylaxis. In this study, 63 (18.4 %) did only develop ASB without UTI, 26 (7.6 %) developed cystitis and 43 (12.5 %) developed AGPN. The remaining 211 (61.5 %) renal allograft recipients did not develop any bacteriuria at all. Multivariable Cox proportional regression analysis indicated that TMP-SMX as PJP prophylaxis was not associated with reduced prevalence of ASB (Hazard ratio (HR) = 1.52, 95 % CI = 0.79-2.94, p = 0.213), nor with reduced incidence of cystitis (HR = 2.21, 95 % CI = 0.76-6.39, p = 0.144), nor AGPN (HR = 1.12, 95 % CI = 0.57-2.21, p = 0.751). Among the group receiving TMP-SMX as PJP prophylaxis there was a trend was observed in increase of both amoxicillin (86 % versus 70 %) and TMP-SMX (89 % versus 48 %) resistance which already appeared within the first 30 days after TMP-SMX exposure. Among renal allograft recipients, administration of TMP-SMX as PJP prophylaxis does not prevent ASB nor UTI, however it is associated with tendency towards increased amoxicillin and TMP-SMX resistance.

  7. 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.

  8. 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。

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. Acquired immune deficiency syndrome in Thailand. A report of two cases.

    Science.gov (United States)

    Limsuwan, A; Kanapa, S; Siristonapun, Y

    1986-03-01

    As a major tourist attraction for heterosexuals and homosexuals, Thailand stands to experience major increases in the rate of acquired immunodeficiency syndrome (AIDS). This article describes 2 AIDS cases in Thailand, including the 1st documented case. The 1st case involved a 28-year-old unmarried Thai male who travelled to the US in 1981 for postgraduate work and had contact with both female prostitutes and homosexual men. In 1982-83, the patient demonstrated fever, fatigue, meningitis, and finally Pneumocystis carinii. He was hospitalized in 1984 for fever, bilateral deafness, and diarrhea. Serologic analysis revealed antibodies to human T-cell lymphotropic virus type III (HTLV- III). Death occurred in January 1985. The 2nd patient was a 52-year- old single man who had moved from West Germany to Thailand 10 years previously to admission in 1985 for upper gastrointestinal bleeding. The patient, a homosexual, make frequent visits to Germany and was an alcoholic. The initial clinical diagnosis was ruptured esophageal varices with cirrhosis. The patient further had a history of herpes simplex genitalis. The subsequent course of the disease process included massive blood loss and interstitial pneumonitis. Serology revealed antibodies to HTLV-III. Death occurred in August 1985. Both of these patients belonged to groups at high risk of AIDS and had clinical, serologic, and immunologic indicators that enabled confirmation of the AIDS diagnosis.

  14. 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.

  15. THE PATIENT-DOCTOR-PSYCHOLOGIST TRIANGLE IN A CASE Of SEVERE IMUNOSUPRESSION IN THE HIV INFECTION.

    Science.gov (United States)

    Manciuc, Carmen; Filip-Ciubotaru, Florina; Badescu, Aida; Duceag, Letiţia Doina; Largu, Alexandra Maria

    2016-01-01

    In the last two years the Romanian adult population infected with the human immunodeficiency virus (HIV) has increased due to sexual transmission, both heterosexual and homosexual. The case presented is that of a 33 year-old man, admitted to the Infectious Diseases Hospital in Iasi with acute respiratory failure and a confirmation of Kaposi's sarcoma. Tests later proved positive for HIV, the patient being included in the stage AIDS C3 (acute immunodeficiency syndrome). The respiratory failure was suspected to be caused by Pneumocystis carinii and cotrimoxazol therapy, oxygen therapy and anti-retroviral therapy were established. He was also referred to the oncology hospital for treatment of Kaposi's sarcoma. The patient's adherence to therapy was influenced by a strong doctor-patient relationship, as well as by psychological counseling and support. Creating a functional doctor-patient-psychologist team is key throughout the HIV-positive patient's existence, for supporting long term adherence to therapy and acceptance of the diagnosis. This case highlights the need for a strong psychosocial compartment in every medical center that deals with HIV-infected individuals.

  16. 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.

  17. 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).

  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. 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.

  20. 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 ...

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.)

  7. 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.

  8. Mutations in the dihydropteroate synthase gene of Pneumocystis jiroveci isolates from Portuguese patients with Pneumocystis pneumonia

    DEFF Research Database (Denmark)

    Costa, M C; Helweg-Larsen, J; Lundgren, Bettina

    2003-01-01

    The aim of this study was to evaluate the frequency of mutations of the P. jiroveci dihydropteroate synthase (DHPS) gene in an immunocompromised Portuguese population and to investigate the possible association between DHPS mutations and sulpha exposure. In the studied population, DHPS gene...... mutations were not significantly more frequent in patients exposed to sulpha drugs compared with patients not exposed (P=0.390). The results of this study suggest that DHPS gene mutations are frequent in the Portuguese immunocompromised population but do not seem associated with previous sulpha exposure...

  9. 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.

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. Human See, Human Do.

    Science.gov (United States)

    Tomasello, Michael

    1997-01-01

    A human demonstrator showed human children and captive chimpanzees how to drag food or toys closer using a rakelike tool. One side of the rake was less efficient than the other for dragging. Chimps tried to reproduce results rather than methods while children imitated and used the more efficient rake side. Concludes that imitation leads to…

  15. More Human than Human.

    Science.gov (United States)

    Lawrence, David

    2017-07-01

    Within the literature surrounding nonhuman animals on the one hand and cognitively disabled humans on the other, there is much discussion of where beings that do not satisfy the criteria for personhood fit in our moral deliberations. In the future, we may face a different but related problem: that we might create (or cause the creation of) beings that not only satisfy but exceed these criteria. The question becomes whether these are minimal criteria, or hierarchical, such that those who fulfill them to greater degree should be afforded greater consideration. This article questions the validity and necessity of drawing divisions among beings that satisfy the minimum requirements for personhood; considering how future beings-intelligent androids, synthezoids, even alternate-substrate sentiences-might fit alongside the "baseline" human. I ask whether these alternate beings ought to be considered different to us, and why this may or may not matter in terms of a notion of "human community." The film Blade Runner, concerned in large part with humanity and its key synthezoid antagonist Roy Batty, forms a framing touchstone for my discussion. Batty is stronger, faster, more resilient, and more intelligent than Homo sapiens. His exploits, far beyond the capability of normal humans, are contrasted with his frailty and transient lifespan, his aesthetic appreciation of the sights he has seen, and his burgeoning empathy. Not for nothing does his creator within the mythos term him "more human than human."

  16. 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.

  17. 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).

  18. 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

  19. Post-transplantation Infections in Bolivia.

    Science.gov (United States)

    Arze, S; Arze, L; Abecia, C

    2016-03-01

    Over 26 years, we found 46 infectious episodes in 350 kidney transplant recipients. Fifteen were urinary tract infections, recurrent in 4 patients. There were 8 cytomegalovirus infections, three of them fatal when intravenous (IV) ganciclovir was not available. Seven patients had a reactivation of tuberculosis (TB) in the pleura, cervical spine, lumbar spine, knee, ankle, skin and peritoneum, respectively, and were all resolved satisfactorily with conventional anti-TB therapy. Three patients transplanted before routine prophylaxis with the use of acyclovir developed an extensive herpes zoster infection in the 1st 6 months after transplantation, which was resolved with the use of oral acyclovir, and 1 had a disseminated herpes simplex infection resolved with the use of IV acyclovir. Three patients transplanted before routine prophylaxis with trimethoprim sulfa developed Pneumocystis carinii pneumonia in the 1st 6 months after transplantation, which was fatal in one of them. In 2 patients, we found a Nocardia infection, confined to the lung, which was cured in one of the cases and systemic and fatal in the other. Two patients transplanted before routine prophylaxis with the use of nystatin developed esophageal candidiasis in the 1st 6 months after transplantation. One patient developed infective endocarditis in a stenotic bicuspid aortic valve and died 10 years later after another incident of infective endocarditis at the prosthetic aortic valve. Two patients developed an extensive condyloma at the penis, perianal region, and perineum owing to human papillomavirus, requiring extensive surgical resection and podophyllin applications. Another patient developed fatal post-transplantation lymphoproliferative disease due to Epstein-Barr virus infection 15 years after transplantation. One patient developed a severe and fatal mucocutaneous leishmaniasis with no response to conventional antimonial therapy. It is interesting to note that despite Chagas disease being endemic

  20. Human Development, Human Evolution.

    Science.gov (United States)

    Smillie, David

    One of the truly remarkable events in human evolution is the unprecedented increase in the size of the brain of "Homo" over a brief span of 2 million years. It would appear that some significant selective pressure or opportunity presented itself to this branch of the hominid line and caused a rapid increase in the brain, introducing a…

  1. 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

  2. Causes of death in the human immunodeficiency virus population in Western Jamaica

    Directory of Open Access Journals (Sweden)

    Nikkiah Forbes

    2014-01-01

    Full Text Available Background: Monitoring the causes of death in patients with human immunodeficiency virus (HIV in the era of expanding access to antiretroviral therapy in resource-limited settings has implications as more deaths are reported for reasons other than AIDS. Aims: To determine the causes of mortality in HIV-infected adults in Western Jamaica. Materials and Methods: Patients with HIV infection with a death certificate with a known cause of death between 2005 and 2010 were reviewed. Results: There were 189 patients. Co-morbidities were present in 25.3%. The mean age at death was 42.4 years. Early disease (World Health Organization [WHO] stages 1 or 2 was the presentation in 21.5% while 78.6% presented with advanced disease (WHO stages 3 or 4. The mean CD4 count at diagnosis was 95 cells/mm 3 . In patients presenting with early disease, 14.2% presented with sexually transmitted infections, 22.8% skin manifestations, and 14.2% lymphadenopathy. In patients presenting with late disease, 41.7% had Pneumocystis jirovecii pneumonia (PCP, 18.9% central nervous system (CNS toxoplasmosis, 11.3% HIV-associated nephropathy, and 5% cryptococcal meningitis. At death, 72.6% were in WHO class 4, and 21.2% class 3. The average CD4 count at death was 75.5 cells/mm 3 . Overall, 55.2% of the patients had received highly active antiretroviral therapy. PCP accounted for 42.9% of deaths, 27.3% had CNS opportunistic infections, HIV nephropathy 16.4%, and 4.6% had malignancies. About 52.3% of patients died within 1 year of diagnosis with HIV, while 68.3% died within 2 years. Conclusion: Patients with HIV are presenting with late disease and dying of conditions that are AIDS-related. Efforts to improve early diagnosis and treatment are urgently needed in Jamaica.

  3. Clinical manifestations and outcome of patients with human immunodeficiency virus infection at tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Virendra Chandrashekhar Patil

    2016-01-01

    Full Text Available Background: AIDS has become chronic illness which is well treated with antiretroviral therapy and management of opportunistic infections (OIs. Aims and Objectives: The study clinical profile and outcome of human immunodeficiency virus (HIV seropositive patients. Materials and Methods: This was retrospective observational study carried out over a period of 1 year (January 2011–December 2011. All HIV patients admitted in medicine ward, and ICU were enrolled. Statistical analysis was performed using SSPE statistical software trial version 11. The P< 0.05 was considered as statistically significant. Results: Of total 111 patients with a diagnosis of HIV/AIDS, 75 (67.56% were male and 36 (32.43% were female patients. A total 52 (46.84% patients presented with respiratory manifestations, of them 23 (44.23% had pulmonary tuberculosis (TB, 6 (11.53% had tubercular effusion, and 3 (5.76% had Pneumocystis jirovecii pneumonia. Respiratory manifestations including pulmonary TB were the most common presentation (P< 0.001. Total 27 (24.32% patients were presented with the neurological manifestation of them 8 (29.62% had a cerebro-vascular accident, 5 (18.51% had cryptococcal meningitis, 4 (14.81% had tubercular meningitis, and 1 (3.70% had progressive multifocal leukoencephalopathy. Total 12 (38.70% had acute gastroenteritis 6 (19.35% had oral candidiasis, 8 (25% had general tonic clonic seizure and 7 (21.87% had pyrexia of unknown origin, 6 (18.75% had septicemia, 6 (18.75% had acute renal failure, and 6 (94.11% had anemia. A total 11 (9.90% patients succumbed. Conclusions: Overall respiratory manifestations were the common presentation in a present cohort of HIV seropositive patients and TB was the most common OI and the cerebrovascular accident was the most common neurological manifestation.

  4. Human rights

    NARCIS (Netherlands)

    Gaay Fortman, B. de

    2006-01-01

    Human rights reflect a determined effort to protect the dignity of each and every human being against abuse of power. This endeavour is as old as human history. What is relatively new is the international venture for the protection of human dignity through internationally accepted legal standards an

  5. Deficiency of caspase recruitment domain family, member 11 (CARD11), causes profound combined immunodeficiency in human subjects.

    Science.gov (United States)

    Stepensky, Polina; Keller, Baerbel; Buchta, Mary; Kienzler, Anne-Kathrin; Elpeleg, Orly; Somech, Raz; Cohen, Sivan; Shachar, Idit; Miosge, Lisa A; Schlesier, Michael; Fuchs, Ilka; Enders, Anselm; Eibel, Hermann; Grimbacher, Bodo; Warnatz, Klaus

    2013-02-01

    Profound combined immunodeficiency can present with normal numbers of T and B cells, and therefore the functional defect of the cellular and humoral immune response is often not recognized until the first severe clinical manifestation. Here we report a patient of consanguineous descent presenting at 13 months of age with hypogammaglobulinemia, Pneumocystis jirovecii pneumonia, and a suggestive family history. We sought to identify the genetic alteration in a patient with combined immunodeficiency and characterize human caspase recruitment domain family, member 11 (CARD11), deficiency. Molecular, immunologic, and functional assays were performed. The immunologic characterization revealed only subtle changes in the T-cell and natural killer cell compartment, whereas B-cell differentiation, although normal in number, was distinctively blocked at the transitional stage. Genetic evaluation revealed a homozygous deletion of exon 21 in CARD11 as the underlying defect. This deletion abrogated protein expression and activation of the canonical nuclear factor κB (NF-κB) pathway in lymphocytes after antigen receptor or phorbol 12-myristate 13-acetate stimulation, whereas CD40 signaling in B cells was preserved. The abrogated activation of the canonical NF-κB pathway was associated with severely impaired upregulation of inducible T-cell costimulator, OX40, cytokine production, proliferation of T cells, and B cell-activating factor receptor expression on B cells. Thus in patients with CARD11 deficiency, the combination of impaired activation and especially upregulation of inducible T-cell costimulator on T cells, together with severely disturbed peripheral B-cell differentiation, apparently leads to a defective T-cell/B-cell cooperation and probably germinal center formation and clinically results in severe immunodeficiency. This report discloses the crucial and nonredundant role of canonical NF-κB activation and specifically CARD11 in the antigen-specific immune response

  6. Human Rights, Human Needs, Human Development, Human Security

    OpenAIRE

    Gasper, Des

    2009-01-01

    Human rights, human development and human security form increasingly important, partly interconnected, partly competitive and misunderstood ethical and policy discourses. Each tries to humanize a pre-existing and unavoidable major discourse of everyday life, policy and politics; each has emerged within the United Nations world; each relies implicitly on a conceptualisation of human need; each has specific strengths. Yet mutual communication, understanding and co-operation are deficient, espec...

  7. Human Technology and Human Affects

    DEFF Research Database (Denmark)

    Fausing, Bent

    2009-01-01

    Human Technology and Human Affects  This year Samsung introduced a mobile phone with "Soul". It was made with a human touch and included itself a magical touch. Which function does technology and affects get in everyday aesthetics like this, its images and interactions included this presentation ...... often mentioned post-human condition....

  8. Human microbiomics

    OpenAIRE

    Rajendhran, J.; P. Gunasekaran

    2010-01-01

    The sequencing of the human genome has driven the study of human biology in a significant way and enabled the genome-wide study to elucidate the molecular basis of complex human diseases. Recently, the role of microbiota on human physiology and health has received much attention. The influence of gut microbiome (the collective genomes of the gut microbiota) in obesity has been demonstrated, which may pave the way for new prophylactic and therapeutic strategies such as bacteriotherapy. The sig...

  9. Human Smuggling

    NARCIS (Netherlands)

    Siegel - Rozenblit, Dina; Zaitch, Damian

    2014-01-01

    Human smuggling is based on a consensus between smuggler, smuggled, and his/her family (which usually guarantees or effectuates payment). However, unauthorized immigrants are violating immigration laws and human smugglers are profiting from enabling illegal immigration. Both human smuggling and its

  10. Diversity of Pneumocystis jirovecii Across Europe: A Multicentre Observational Study

    Directory of Open Access Journals (Sweden)

    Alexandre Alanio

    2017-08-01

    Our study showed the wide population diversity across Europe, with evidence of local clusters of patients harbouring a given genotype. These data suggest a specific association between genotype and underlying disease, with evidence of a different natural history of PCP in HIV patients and renal transplant recipients.

  11. Lung fibrosis in deceased HIV-infected patients with Pneumocystis ...

    African Journals Online (AJOL)

    2012-06-02

    Jun 2, 2012 ... Management included use of ARDSNET low tidal volume strategies,3 conservative fluid .... and loss of surface area for diffusion with ... despite initial low P/F ratios. The latter ... effect of these mutations on clinical outcomes.

  12. 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....

  13. Human Rights/Human Needs.

    Science.gov (United States)

    Canning, Cynthia

    1978-01-01

    The faculty of Holy Names High School developed an interdisciplinary human rights program with school-wide activities focusing on three selected themes: the United Nations Universal Declaration of Human Rights, in conjunction with Human Rights Week; Food; and Women. This article outlines major program activities. (SJL)

  14. Digital Humanities

    DEFF Research Database (Denmark)

    Brügger, Niels

    2016-01-01

    the humanities for decades, starting with research fields such as humanities computing or computational linguistics in the 1950s, and later new media studies and internet studies. The historical development of digital humanities has been characterized by a focus on three successive, but co-existing types......Digital humanities is an umbrella term for theories, methodologies, and practices related to humanities scholarship that use the digital computer as an integrated and essential part of its research and teaching activities. The computer can be used for establishing, finding, collecting......, and preserving material to study, as an object of study in its own right, as an analytical tool, or for collaborating, and for disseminating results. The term "digital humanities" was coined around 2001, and gained currency within academia in the following years. However, computers had been used within...

  15. Human Rights, Human Needs, Human Development, Human Security - Relationships between four international human discourses.

    NARCIS (Netherlands)

    D.R. Gasper (Des)

    2007-01-01

    markdownabstractAbstract: Human rights, human development and human security form increasingly important, partly interconnected, partly competitive and misunderstood ethical and policy discourses. Each tries to humanize a pre-existing and unavoidable major discourse of everyday life, policy and

  16. Human Rights and Human Nature

    Directory of Open Access Journals (Sweden)

    Vittorio Possenti

    2013-11-01

    Full Text Available There seems to be two different versions of human rights in Western tradition: say Rationalistic and Christian; the former adopted in revolutionary France, the latter highly developed in Renaissance Spain. Current relativistic criticisms attempt to deny the universality of human rights alleging that this theory has been created in Western countries or it has no strong justification, and therefore cannot have universal approach; but this objection can be dismissed with an alternative justification of human rights.

  17. Human kapital

    DEFF Research Database (Denmark)

    Grosen, Anders; Nielsen, Peder Harbjerg

    2007-01-01

    finansiel og human kapital. Den traditionelle rådgivnings snævre synsvinkel kan føre til forkerte investeringsråd. Der skal derfor opfordres til, at de finansielle virksomheder i tilrettelæggelsen af deres rådgivning af private kunder systematisk inddrager den humane kapitals størrelse og karakteristika i...

  18. Human trichuriasis

    DEFF Research Database (Denmark)

    Betson, Martha; Søe, Martin Jensen; Nejsum, Peter

    2015-01-01

    Human trichuriasis is a neglected tropical disease which affects hundreds of millions of people worldwide and is particularly prevalent among children living in areas where sanitation is poor. This review examines the current knowledge on the taxonomy, genetics and phylogeography of human Trichuris...

  19. Think Human

    DEFF Research Database (Denmark)

    Nielsen, Charlotte Marie Bisgaard

    2013-01-01

    years' campaigns suggests that the theory of communication underlying the campaign has its basis in mechanical action rather than in human communication. The practice of 'Communication design' is investigated in relation to this metaphorical 'machine thinking' model of communication and contrasted...... with the human-centered theory of communication advocated by integrationism....

  20. Human evolution

    DEFF Research Database (Denmark)

    Llamas, Bastien; Willerslev, Eske; Orlando, Ludovic Antoine Alexandre

    2017-01-01

    , and true population genomic studies of Bronze Age populations. Among the emerging areas of aDNA research, the analysis of past epigenomes is set to provide more new insights into human adaptation and disease susceptibility through time. Starting as a mere curiosity, ancient human genetics has become...

  1. Think Human

    DEFF Research Database (Denmark)

    Nielsen, Charlotte Marie Bisgaard

    2013-01-01

    years' campaigns suggests that the theory of communication underlying the campaign has its basis in mechanical action rather than in human communication. The practice of 'Communication design' is investigated in relation to this metaphorical 'machine thinking' model of communication and contrasted...... with the human-centered theory of communication advocated by integrationism....

  2. Teaching humanism.

    Science.gov (United States)

    Stern, David T; Cohen, Jordan J; Bruder, Ann; Packer, Barbara; Sole, Allison

    2008-01-01

    As the "passion that animates authentic professionalism," humanism must be infused into medical education and clinical care as a central feature of medicine's professionalism movement. In this article, we discuss a current definition of humanism in medicine. We will also provide detailed descriptions of educational programs intended to promote humanism at a number of medical schools in the United States (and beyond) and identify the key factors that make these programs effective. Common elements of programs that effectively teach humanism include: (1) opportunities for students to gain perspective in the lives of patients; (2) structured time for reflection on those experiences; and (3) focused mentoring to ensure that these events convert to positive, formative learning experiences. By describing educational experiences that both promote and sustain humanism in doctors, we hope to stimulate the thinking of other medical educators and to disseminate the impact of these innovative educational programs to help the profession meet its obligation to provide the public with humanistic physicians.

  3. Human Computation

    CERN Document Server

    CERN. Geneva

    2008-01-01

    What if people could play computer games and accomplish work without even realizing it? What if billions of people collaborated to solve important problems for humanity or generate training data for computers? My work aims at a general paradigm for doing exactly that: utilizing human processing power to solve computational problems in a distributed manner. In particular, I focus on harnessing human time and energy for addressing problems that computers cannot yet solve. Although computers have advanced dramatically in many respects over the last 50 years, they still do not possess the basic conceptual intelligence or perceptual capabilities...

  4. Practicing Humanities

    DEFF Research Database (Denmark)

    Gimmler, Antje

    2016-01-01

    In contemporary societies, the humanities are under constant pressure and have to justify their existence. In the ongoing debates, Humboldt’s ideals of ‘Bildung’ and ‘pure science’ are often used to justify the unique function of the humanities of ensuring free research and contributing to a vital...... philosophy. Contrary to Humboldt’s idea that the non-practical is the most practical in the long run, philosophical pragmatism recommends to the humanities to situate knowledge in practices and apply knowledge to practices....

  5. Human Toxicity

    DEFF Research Database (Denmark)

    Jolliet, Olivier; Fantke, Peter

    2015-01-01

    This chapter reviews the human toxicological impacts of chemicals and how to assess these impacts in life cycle impact assessment (LCIA), in order to identify key processes and pollutants. The complete cause-effect pathway – from emissions of toxic substances up to damages on human health...... on characterisation factors means that results should by default be reported and interpreted in log scales when comparing scenarios or substance contribution! We conclude by outlining future trends in human toxicity modelling for LCIA, with promising developments for (a) better estimates of degradation halflives, (b......) the inclusion of ionization of chemicals in human exposure including bioaccumulation, (c) metal speciation, (d) spatialised models to differentiate the variability associated with spatialisation from the uncertainty, and (e) the assessment of chemical exposure via consumer products and occupational settings...

  6. Human Toxicity

    DEFF Research Database (Denmark)

    Jolliet, Olivier; Fantke, Peter

    2015-01-01

    . The first section of this chapter outlines the complete cause-effect pathway, from emissions of toxic substances to intake by the population up to damages in terms of human health effects. Section 2 outlines the framework for assessing human toxicity in LCIA. Section 3 discusses the contributing substances......This chapter reviews the human toxicological impacts of chemicals and how to assess these impacts in life cycle impact assessment (LCIA), in order to identify key processes and pollutants. The complete cause-effect pathway – from emissions of toxic substances up to damages on human health...... – demonstrates the importance to account for both outdoor and indoor exposure, including consumer products. Analysing the variations in intake fraction (the fraction of the emitted or applied chemical that is taken in by the consumer and the general population), effect factor and characterisation factor across...

  7. Human influences

    NARCIS (Netherlands)

    Lanen, van H.A.J.; Kasparek, L.; Novicky, O.; Querner, E.P.; Fendeková, M.; Kupczyk, E.

    2004-01-01

    Human activities can cause drought, which was not previously reported (man-induced hydrological drought). Groundwater abstractions for domestic and industrial use are a well-known example of such an environmental change

  8. Human phantom

    CERN Multimedia

    CERN PhotoLab

    1973-01-01

    This human phantom has been received by CERN on loan from the State Committee of the USSR for the Utilization of Atomic Energy. It is used by the Health Physics Group to study personel radiation doses near the accelerators.

  9. Human expunction

    Science.gov (United States)

    Klee, Robert

    2017-10-01

    Thomas Nagel in `The Absurd' (Nagel 1971) mentions the future expunction of the human species as a `metaphor' for our ability to see our lives from the outside, which he claims is one source of our sense of life's absurdity. I argue that the future expunction (not to be confused with extinction) of everything human - indeed of everything biological in a terran sense - is not a mere metaphor but a physical certainty under the laws of nature. The causal processes by which human expunction will take place are presented in some empirical detail, so that philosophers cannot dismiss it as merely speculative. I also argue that appeals to anthropic principles or to forms of mystical cosmology are of no plausible avail in the face of human expunction under the laws of physics.

  10. Human babesiosis.

    Science.gov (United States)

    Rożej-Bielicka, Wioletta; Stypułkowska-Misiurewicz, Hanna; Gołąb, Elżbieta

    2015-01-01

    Babesiosis is an emerging parasitic, anthropo-zoonotic tick-borne disease, seldom diagnosed in humans. Caused by Protozoa, Babesia (also called Piroplasma) intraerytrocytic piriform microorganism. Infection of vertebrates is transmitted by ticks. Out of more than 100 Babesia species/genotypes described so far, only some were diagnosed in infected humans, mostly B. microti, B. divergens and B. venatorum (Babesia sp. EU1). Infection in humans is often asymptomatic or mild but is of a particular risk for asplenic individuals, those with congenital or acquired immunodeficiencies, and elderly. Infections transmitted with blood and blood products raise concerns in hemotherapy. Epidemiological situation of babesiosis varies around the world. In Europe, no increase in the number of cases was reported, but in the USA its prevalence is increasing and extension of endemic areas is observed. The aim of this publication is to describe the problems connected with the current epidemiological situation, diagnosis and treatment of human babesiosis with regard to clinical status of patients.

  11. Human energy

    OpenAIRE

    2010-01-01

    In the midst of big-oil record profits and growing debate on global warming, the Chevron Corporation launched its “Human Energy” public relations campaign. In television commercials and print advertisements, Chevron portrays itself as a compassionate entity striving to solve the planet’s energy crisis. Yet, the first term in this corporate oxymoron misleadingly reframes the significance of the second, suggesting that the corporation has a renewed focus. In depicting Chevron as a green/human o...

  12. Human Echolocation

    OpenAIRE

    Teng, Santani

    2013-01-01

    The use of active natural echolocation as a mobility aid for blind humans has received increased scientific and popular attention in recent years (Engber, 2006; Kreiser, 2006; NPR, 2011), in part due to a focus on several blind individuals who have developed remarkable expertise. However, perhaps surprisingly, the history of empirical human echolocation research is not much younger than the era of echolocation research (cf. Griffin, 1958). Nevertheless, compared to its bat and cetacean count...

  13. Human ehrlichiosis

    Directory of Open Access Journals (Sweden)

    Đokić Milomir

    2006-01-01

    Full Text Available Background. Human ehrlichiosis is a newly recognized disease. It is a tick-borne disease caused by several bacterial species of the genhus Erlichia. These are small gram-negative pleomorphic cocci, that are obligatory intracellular bacteria. Tick Ixodes is the principle vector in Europe, and Amblyomma americanum in the United States. Bacterial organisms replicate in a tick, and are transmited from infected cells in a vector to the blood cells of animals or humans. Human ehrlichiosis is a name for a group of diseases caused by different species of Ehrlichia. One of them is the disease named human monocytic ehrlichiosis, caused by Ehrlichia chaffeensis, and the other is a human granulocytic ehrlichiosis caused by Anaplasma phagocytophilia. Case report. We reported a 23-year-old patient admitted for the clinical treatment with the symptoms of high febrility (above 40 °C, headache, vomiting, general weakness and exhaustion, but without data on a tick bite. The patient was treated with trimetoprim-sulfamethoxazole for a week when Ehrlichia chaffeensis was confirmed by the immunofluoroscence test, and the therapy contimed with doxacyclin. Conclusion. Human ehrlichiosis is also present in our country, so this disease should be considered everyday, especially in infectology practice.

  14. [Human influenza].

    Science.gov (United States)

    Stock, Ingo

    2006-10-01

    Human influenza is one of the most common human infectious diseases, contributing to approximately one million deaths every year. In Germany, each year between 5.000 and 20.000 individuals die from severe influenza infections. In several countries, the morbidity and mortality of influenza is greatly underestimated. This is reflected by general low immunization rates. The emergence of avian influenza against the background of the scenario of a human influenza pandemic has revived public interest in the disease. According to the World Health Organisation, it is only the question on the beginning of a new influenza pandemic. The virus type of the new pandemic is still uncertain and it is also unclear, if a pandemic spread of the virus may be prevented by consistent controlling of avian influenza.

  15. [Humanized childbirth].

    Science.gov (United States)

    Kuo, Su-Chen

    2005-06-01

    Childbirth is a major event in a family. The expectant parent's perception of the childbirth experience influences his or her development as a parent. Making childbirth a positive and satisfying experience for women is the responsibility of health care providers. Women want to have physical and emotional privacy during labor and delivery, and to experience both in a friendly, comfortable environment. For women expected to undergo normal deliveries, humanized childbirth is one accessible approach. This article explores the definition and evolution of humanized childbirth and the care practice that it involves. It also explores birth plans and birth experiences, and the improvements necessary to routine labor practices to enable women to participate in decision making about their childbirth experiences. The author emphasizes that when health-care providers recognize the value of humanized childbirth and make changes accordingly, the dignity of women's childbirth experiences will be enhanced.

  16. Beyond Humanisms

    Directory of Open Access Journals (Sweden)

    Capurro, Rafael

    2012-01-01

    Full Text Available In the first part of this paper a short history of Western humanisms (Socrates, Pico della Mirandola, Descartes, Kant is presented. As far as these humanisms rest on a fixation of the ‘humanum’ they are metaphysical, although they might radically differ from each other. The second part deals with the present debate on trans- and posthumanism in the context of some breath-taking developments in science and technology.Angeletics, a theory of messengers and messages, intends to give an answer to the leading question of this paper, namely: ‘what does it mean to go beyond humanisms?’ The conclusion exposes briefly an ethics of hospitality and care from an angeletic perspective.

  17. 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..........................

  18. 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....

  19. 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...

  20. Changes in insurance status and access to care for persons with AIDS in the Boston Health Study.

    Science.gov (United States)

    Weissman, J S; Makadon, H J; Seage, G R; Massagli, M P; Gatsonis, C A; Craven, D E; Stone, V E; Bennett, I A; Epstein, A M

    1994-12-01

    The purpose of this study was to measure unmet needs and changes in insurance status for persons with acquired immunodeficiency syndrome (AIDS). Thirty-six percent of the study's Boston-area respondents (n = 305) had a change in insurance coverage between AIDS diagnosis and interview. Medicaid coverage increased from 14% to 41%. Pneumocystis carinii pneumonia prophylaxis was nearly universal. Only 5% did not receive zidovudine, and intravenous drug users were at higher risk. Approximately 14% to 15% of patients reported problems in obtaining medical and dental services; Blacks, homeless persons, and those who were not high school graduates were at higher risk. Use of selected treatments for which there were clear clinical guidelines was adequate, yet disadvantaged groups were more likely than other persons with AIDS to face obstacles to other services.

  1. 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...

  2. Survival differences in European patients with AIDS, 1979-89. The AIDS in Europe Study Group

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Pedersen, C; Clumeck, N

    1994-01-01

    . The regional differences in survival were less pronounced for patients diagnosed in 1989 compared with earlier years. Improved survival in recent years was observed for patients with a variety of manifestations used to define AIDS but was significant only for patients diagnosed with Pneumocystis carinii...... pneumonia. The three year survival, however, remains unchanged over time. CONCLUSIONS--Survival of AIDS patients seems to vary within Europe, being shorter in southern than central and northern Europe. The magnitude of these differences, however, has declined gradually over time. Short term survival has......OBJECTIVES--To examine the pattern of survival and factors associated with the outcome of disease in patients with AIDS. DESIGN--Inception cohort. Data collected retrospectively from patients' charts. SETTING--52 clinical centres in 17 European countries. SUBJECTS--6578 adults diagnosed with AIDS...

  3. 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.

  4. 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...

  5. 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.

  6. 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.

  7. Human Rights, Human Needs, Human Development, Human Security : Relationships between four international 'human' discourses

    NARCIS (Netherlands)

    D.R. Gasper (Des)

    2007-01-01

    textabstractHuman rights, human development and human security form increasingly important, partly interconnected, partly competitive and misunderstood ethical and policy discourses. Each tries to humanize a pre-existing and unavoidable major discourse of everyday life, policy and politics; each

  8. Nothing Human

    Science.gov (United States)

    Wharram, C. C.

    2014-01-01

    In this essay C. C. Wharram argues that Terence's concept of translation as a form of "contamination" anticipates recent developments in philosophy, ecology, and translation studies. Placing these divergent fields of inquiry into dialogue enables us read Terence's well-known statement "I am a human being--I deem nothing…

  9. Human Trafficking

    Science.gov (United States)

    Wilson, David McKay

    2011-01-01

    The shadowy, criminal nature of human trafficking makes evaluating its nature and scope difficult. The U.S. State Department and anti-trafficking groups estimate that worldwide some 27 million people are caught in a form of forced servitude today. Public awareness of modern-day slavery is gaining momentum thanks to new abolitionist efforts. Among…

  10. Human waste

    NARCIS (Netherlands)

    Amin, Md Nurul; Kroeze, Carolien; Strokal, Maryna

    2017-01-01

    Many people practice open defecation in south Asia. As a result, lot of human waste containing nutrients such as nitrogen (N) and phosphorus (P) enter rivers. Rivers transport these nutrients to coastal waters, resulting in marine pollution. This source of nutrient pollution is, however, ignored in

  11. Nothing Human

    Science.gov (United States)

    Wharram, C. C.

    2014-01-01

    In this essay C. C. Wharram argues that Terence's concept of translation as a form of "contamination" anticipates recent developments in philosophy, ecology, and translation studies. Placing these divergent fields of inquiry into dialogue enables us read Terence's well-known statement "I am a human being--I deem nothing…

  12. Practicing Humanities

    DEFF Research Database (Denmark)

    Gimmler, Antje

    2016-01-01

    and self-reflective democracy. Contemporary humanities have adopted a new orientation towards practices, and it is not clear how this fits with the ideals of ‘Bildung’ and ‘pure science’. A possible theoretical framework for this orientation towards practices could be found in John Dewey’s pragmatic...

  13. Human Rights in the Humanities

    Science.gov (United States)

    Harpham, Geoffrey

    2012-01-01

    Human rights are rapidly entering the academic curriculum, with programs appearing all over the country--including at Duke, Harvard, Northeastern, and Stanford Universities; the Massachusetts Institute of Technology; the Universities of Chicago, of Connecticut, of California at Berkeley, and of Minnesota; and Trinity College. Most of these…

  14. Human Rights in the Humanities

    Science.gov (United States)

    Harpham, Geoffrey

    2012-01-01

    Human rights are rapidly entering the academic curriculum, with programs appearing all over the country--including at Duke, Harvard, Northeastern, and Stanford Universities; the Massachusetts Institute of Technology; the Universities of Chicago, of Connecticut, of California at Berkeley, and of Minnesota; and Trinity College. Most of these…

  15. Digital Humanities

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørn

    2015-01-01

    Artiklen præsenterer først nogle generelle problemstillinger omkring Digital Humanities (DH) med det formål at undersøge dem nærmere i relation til konkrete eksempler på forskellige digitaliseringsmåder og ændringer i dokumentproduktion. I en nærmere afgrænsning vælger artiklen den tendens i DH...

  16. Human paleoneurology

    CERN Document Server

    2015-01-01

    The book presents an integrative review of paleoneurology, the study of endocranial morphology in fossil species. The main focus is on showing how computed methods can be used to support advances in evolutionary neuroanatomy, paleoanthropology and archaeology and how they have contributed to creating a completely new perspective in cognitive neuroscience. Moreover, thanks to its multidisciplinary approach, the book addresses students and researchers approaching human paleoneurology from different angles and for different purposes, such as biologists, physicians, anthropologists, archaeologists

  17. Digital Humanities

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørn

    2015-01-01

    Artiklen præsenterer først nogle generelle problemstillinger omkring Digital Humanities (DH) med det formål at undersøge dem nærmere i relation til konkrete eksempler på forskellige digitaliseringsmåder og ændringer i dokumentproduktion. I en nærmere afgrænsning vælger artiklen den tendens i DH...

  18. Human universe

    CERN Document Server

    Cox, Brian

    2014-01-01

    Human life is a staggeringly strange thing. On the surface of a ball of rock falling around a nuclear fireball in the blackness of a vacuum the laws of nature conspired to create a naked ape that can look up at the stars and wonder where it came from. What is a human being? Objectively, nothing of consequence. Particles of dust in an infinite arena, present for an instant in eternity. Clumps of atoms in a universe with more galaxies than people. And yet a human being is necessary for the question itself to exist, and the presence of a question in the universe - any question - is the most wonderful thing. Questions require minds, and minds bring meaning. What is meaning? I don't know, except that the universe and every pointless speck inside it means something to me. I am astonished by the existence of a single atom, and find my civilisation to be an outrageous imprint on reality. I don't understand it. Nobody does, but it makes me smile. This book asks questions about our origins, our destiny, and our place i...

  19. 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.

  20. Human Capital, (Human) Capabilities and Higher Education

    Science.gov (United States)

    Le Grange, L.

    2011-01-01

    In this article I initiate a debate into the (de)merits of human capital theory and human capability theory and discuss implications of the debate for higher education. Human capital theory holds that economic growth depends on investment in education and that economic growth is the basis for improving the quality of human life. Human capable…

  1. Human Capital, (Human) Capabilities and Higher Education

    Science.gov (United States)

    Le Grange, L.

    2011-01-01

    In this article I initiate a debate into the (de)merits of human capital theory and human capability theory and discuss implications of the debate for higher education. Human capital theory holds that economic growth depends on investment in education and that economic growth is the basis for improving the quality of human life. Human capable…

  2. Humanizing Architecture

    DEFF Research Database (Denmark)

    Toft, Tanya Søndergaard

    2015-01-01

    The article proposes the urban digital gallery as an opportunity to explore the relationship between ‘human’ and ‘technology,’ through the programming of media architecture. It takes a curatorial perspective when proposing an ontological shift from considering media facades as visual spectacles...... agency and a sense of being by way of dematerializing architecture. This is achieved by way of programming the symbolic to provide new emotional realizations and situations of enlightenment in the public audience. This reflects a greater potential to humanize the digital in media architecture....

  3. Human steroidogenesis

    DEFF Research Database (Denmark)

    Andersen, Claus Y; Ezcurra, Diego

    2014-01-01

    steroid concentrations cause alterations in endometrial development, affecting oocyte viability in assisted reproductive technology. Furthermore, it has been proposed that elevated progesterone levels have a negative effect on the reproductive outcome of COS. This may arise from an asynchrony between...... reviews current knowledge of the regulation of progesterone in the human ovary during the follicular phase and highlights areas where knowledge remains limited. In this review, we provide in-depth information outlining the regulation and function of gonadotropins in the complicated area of steroidogenesis...

  4. Humanizing Architecture

    DEFF Research Database (Denmark)

    Toft, Tanya Søndergaard

    2015-01-01

    The article proposes the urban digital gallery as an opportunity to explore the relationship between ‘human’ and ‘technology,’ through the programming of media architecture. It takes a curatorial perspective when proposing an ontological shift from considering media facades as visual spectacles...... agency and a sense of being by way of dematerializing architecture. This is achieved by way of programming the symbolic to provide new emotional realizations and situations of enlightenment in the public audience. This reflects a greater potential to humanize the digital in media architecture....

  5. Human Toxocariasis

    Directory of Open Access Journals (Sweden)

    Mehmet Burak Selek

    2013-09-01

    Full Text Available Human toxocariasis is an parasitic infection caused by the ingestion of larvae of dog nematode Toxocara canis and less frequently of cat nematode T.cati. Toxocara eggs, shed to environment by infected dogs' and cats' droppings, become infective by embryonation. Humans, particularly children, can be infected by accidentally ingesting embryonated Toxocara eggs. Larvae hatch in the small intestine, penetrate the intestinal wall and migrate to other parts of body via the bloodstream. It is generally a benign, asymptomatic, and self-limiting disease, although migrating larvae can cause damage to tissues and organs, especially brain involvement can cause severe morbidity. The two main clinical presentations of toxocariasis are visceral larva migrans (VLM (a systemic disease caused by larval migration through major organs and ocular larva migrans (OLM (a disease limited to the eyes and optic nerves. There are also two less-severe syndromes which have recently been described, one mainly in children (covert toxocariasis and the other mainly in adults (common toxocariasis. Diagnosis is usually made by clinical signs/symptoms, epidemiological background of the patient and the use of immunological methods (ELISA or western-blot. On the other hand definitive diagnosis is much more challenging, since it requires the demonstration of larvae via biopsy or autopsy. Most cases of toxocariasis clear up without any treatment. VLM is primarily treated with antihelmintic drugs, such as; albendazole or mebendazole. Treatment of OLM is more difficult and usually consists of measures to prevent progressive damage to the eye like steroids. Laser photocoagulation and cryoretinopexy may also be used to treat severe cases. Since eradicating T.canis infection is difficult due to the complexity of its life cycle, prevention of toxocariasis is always preferred. Toxocara eggs have a strong protective layer which makes the eggs able to survive in the environment for months or

  6. NATO Human View Architecture and Human Networks

    Science.gov (United States)

    Handley, Holly A. H.; Houston, Nancy P.

    2010-01-01

    The NATO Human View is a system architectural viewpoint that focuses on the human as part of a system. Its purpose is to capture the human requirements and to inform on how the human impacts the system design. The viewpoint contains seven static models that include different aspects of the human element, such as roles, tasks, constraints, training and metrics. It also includes a Human Dynamics component to perform simulations of the human system under design. One of the static models, termed Human Networks, focuses on the human-to-human communication patterns that occur as a result of ad hoc or deliberate team formation, especially teams distributed across space and time. Parameters of human teams that effect system performance can be captured in this model. Human centered aspects of networks, such as differences in operational tempo (sense of urgency), priorities (common goal), and team history (knowledge of the other team members), can be incorporated. The information captured in the Human Network static model can then be included in the Human Dynamics component so that the impact of distributed teams is represented in the simulation. As the NATO militaries transform to a more networked force, the Human View architecture is an important tool that can be used to make recommendations on the proper mix of technological innovations and human interactions.

  7. [Human papillomaviruses].

    Science.gov (United States)

    Gross, G

    2003-10-01

    Human papillomaviruses (HPV) infect exclusively the basal cells of the skin and of mucosal epithelia adjacent to the skin such as the mouth, the upper respiratory tract, the lower genital tract and the anal canal. HPV does not lead to a viremia. Basically there are three different types of HPV infection: Clinically visible lesions, subclinical HPV infections and latent HPV infections. Distinct HPV types induce morphologically and prognostically different clinical pictures. The most common HPV associated benign tumor of the skin is the common wart. Infections of the urogenitoanal tract with specific HPV-types are recognised as the most frequent sexually transmitted viral infections. So-called "high-risk" HPV-types (HPV16, 18 and others) are regarded by the world health organisation as important risk-factors for the development of genital cancer (mainly cervical cancer), anal cancer and upper respiratory tract cancer in both genders. Antiviral substances with a specific anti-HPV effect are so far unknown. Conventional therapies of benign skin warts and of mucosal warts are mainly nonspecific. They comprise tissue-destroying therapies such as electrocautery, cryotherapy and laser. In addition cytotoxic substances such as podophyllotoxin and systemic therapy with retinoids are in use. Systemically and topically administered immunotherapies represent a new approach for treatment. Both interferons and particularly the recently developed imiquimod, an interferon-alpha and cytokine-inductor lead to better results and are better tolerated then conventional therapies. HPV-specific vaccines have been developed in the last 5 years and will be used in future for prevention and treatment of benign and malignant HPV-associated tumors of the genitoanal tract in both sexes.

  8. 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

  9. Human Development Report 1991: Financing Human Development

    OpenAIRE

    United Nations Development Programme, UNDP

    1991-01-01

    Lack of political commitment rather than financial resources is often the real barrier to human development. This is the main conclusion of Human Development Report 1991 - the second in a series of annual reports on the subject.

  10. The golden triangle of human dignity: human security, human development and human rights

    NARCIS (Netherlands)

    Gaay Fortman, B. de

    2004-01-01

    The success or failure of processes of democratization cannot be detached from processes of development related to the aspirations of people at the grassroots. Human rights, in a more theoretical terminology, require human development in order to enhance human security.

  11. Human-machine interactions

    Science.gov (United States)

    Forsythe, J. Chris; Xavier, Patrick G.; Abbott, Robert G.; Brannon, Nathan G.; Bernard, Michael L.; Speed, Ann E.

    2009-04-28

    Digital technology utilizing a cognitive model based on human naturalistic decision-making processes, including pattern recognition and episodic memory, can reduce the dependency of human-machine interactions on the abilities of a human user and can enable a machine to more closely emulate human-like responses. Such a cognitive model can enable digital technology to use cognitive capacities fundamental to human-like communication and cooperation to interact with humans.

  12. Special Section: Human Rights

    Science.gov (United States)

    Frydenlund, Knut; And Others

    1978-01-01

    Eleven articles examine human rights in Europe. Topics include unemployment, human rights legislation, role of the Council of Europe in promoting human rights, labor unions, migrant workers, human dignity in industralized societies, and international violence. Journal available from Council of Europe, Directorate of Press and Information, 67006…

  13. Scalability of human models

    NARCIS (Netherlands)

    Rodarius, C.; Rooij, L. van; Lange, R. de

    2007-01-01

    The objective of this work was to create a scalable human occupant model that allows adaptation of human models with respect to size, weight and several mechanical parameters. Therefore, for the first time two scalable facet human models were developed in MADYMO. First, a scalable human male was

  14. Visualizing Humans by Computer.

    Science.gov (United States)

    Magnenat-Thalmann, Nadia

    1992-01-01

    Presents an overview of the problems and techniques involved in visualizing humans in a three-dimensional scene. Topics discussed include human shape modeling, including shape creation and deformation; human motion control, including facial animation and interaction with synthetic actors; and human rendering and clothing, including textures and…

  15. The Human/Machine Humanities: A Proposal

    Directory of Open Access Journals (Sweden)

    Ollivier Dyens

    2016-03-01

    Full Text Available What does it mean to be human in the 21st century? The pull of engineering on every aspect of our lives, the impact of machines on how we represent ourselves, the influence of computers on our understanding of free-will, individuality and species, and the effect of microorganisms on our behaviour are so great that one cannot discourse on humanity and humanities without considering their entanglement with technology and with the multiple new dimensions of reality that it opens up. The future of humanities should take into account AI, bacteria, software, viruses (both organic and inorganic, hardware, machine language, parasites, big data, monitors, pixels, swarms systems and the Internet. One cannot think of humanity and humanities as distinct from technology anymore.

  16. From Human Past to Human Future

    OpenAIRE

    Robert G. Bednarik

    2013-01-01

    This paper begins with a refutation of the orthodox model of final Pleistocene human evolution, presenting an alternative, better supported account of this crucial phase. According to this version, the transition from robust to gracile humans during that period is attributable to selective breeding rather than natural selection, rendered possible by the exponential rise of culturally guided volitional choices. The rapid human neotenization coincides with the development of numerous somatic an...

  17. ISS Payload Human Factors

    Science.gov (United States)

    Ellenberger, Richard; Duvall, Laura; Dory, Jonathan

    2016-01-01

    The ISS Payload Human Factors Implementation Team (HFIT) is the Payload Developer's resource for Human Factors. HFIT is the interface between Payload Developers and ISS Payload Human Factors requirements in SSP 57000. ? HFIT provides recommendations on how to meet the Human Factors requirements and guidelines early in the design process. HFIT coordinates with the Payload Developer and Astronaut Office to find low cost solutions to Human Factors challenges for hardware operability issues.

  18. Has Human Evolution Stopped?

    OpenAIRE

    TEMPLETON, Alan R

    2010-01-01

    It has been argued that human evolution has stopped because humans now adapt to their environment via cultural evolution and not biological evolution. However, all organisms adapt to their environment, and humans are no exception. Culture defines much of the human environment, so cultural evolution has actually led to adaptive evolution in humans. Examples are given to illustrate the rapid pace of adaptive evolution in response to cultural innovations. These adaptive responses have important ...

  19. Preference for human eyes in human infants.

    Science.gov (United States)

    Dupierrix, Eve; de Boisferon, Anne Hillairet; Méary, David; Lee, Kang; Quinn, Paul C; Di Giorgio, Elisa; Simion, Francesca; Tomonaga, Masaki; Pascalis, Olivier

    2014-07-01

    Despite evidence supporting an early attraction to human faces, the nature of the face representation in neonates and its development during the first year after birth remain poorly understood. One suggestion is that an early preference for human faces reflects an attraction toward human eyes because human eyes are distinctive compared with other animals. In accord with this proposal, prior empirical studies have demonstrated the importance of the eye region in face processing in adults and infants. However, an attraction for the human eye has never been shown directly in infants. The current study aimed to investigate whether an attraction for human eyes would be present in newborns and older infants. With the use of a preferential looking time paradigm, newborns and 3-, 6-, 9-, and 12-month-olds were simultaneously presented with a pair of nonhuman primate faces (chimpanzees and Barbary macaques) that differed only by the eyes, thereby pairing a face with original nonhuman primate eyes with the same face in which the eyes were replaced by human eyes. Our results revealed that no preference was observed in newborns, but a preference for nonhuman primate faces with human eyes emerged from 3months of age and remained stable thereafter. The findings are discussed in terms of how a preference for human eyes may emerge during the first few months after birth.

  20. Economics of human trafficking.

    Science.gov (United States)

    Wheaton, Elizabeth M; Schauer, Edward J; Galli, Thomas V

    2010-01-01

    Because freedom of choice and economic gain are at the heart of productivity, human trafficking impedes national and international economic growth. Within the next 10 years, crime experts expect human trafficking to surpass drug and arms trafficking in its incidence, cost to human well-being, and profitability to criminals (Schauer and Wheaton, 2006: 164-165). The loss of agency from human trafficking as well as from modern slavery is the result of human vulnerability (Bales, 2000: 15). As people become vulnerable to exploitation and businesses continually seek the lowest-cost labour sources, trafficking human beings generates profit and a market for human trafficking is created. This paper presents an economic model of human trafficking that encompasses all known economic factors that affect human trafficking both across and within national borders. We envision human trafficking as a monopolistically competitive industry in which traffickers act as intermediaries between vulnerable individuals and employers by supplying differentiated products to employers. In the human trafficking market, the consumers are employers of trafficked labour and the products are human beings. Using a rational-choice framework of human trafficking we explain the social situations that shape relocation and working decisions of vulnerable populations leading to human trafficking, the impetus for being a trafficker, and the decisions by employers of trafficked individuals. The goal of this paper is to provide a common ground upon which policymakers and researchers can collaborate to decrease the incidence of trafficking in humans.

  1. Human assisted robotic exploration

    Science.gov (United States)

    Files, B. T.; Canady, J.; Warnell, G.; Stump, E.; Nothwang, W. D.; Marathe, A. R.

    2016-05-01

    In support of achieving better performance on autonomous mapping and exploration tasks by incorporating human input, we seek here to first characterize humans' ability to recognize locations from limited visual information. Such a characterization is critical to the design of a human-in-the-loop system faced with deciding whether and when human input is useful. In this work, we develop a novel and practical place-recognition task that presents humans with video clips captured by a navigating ground robot. Using this task, we find experimentally that human performance does not seem to depend on factors such as clip length or familiarity with the scene and also that there is significant variability across subjects. Moreover, we find that humans significantly outperform a state-of-the-art computational solution to this problem, suggesting the utility of incorporating human input in autonomous mapping and exploration techniques.

  2. Human Use Index (Future)

    Data.gov (United States)

    U.S. Environmental Protection Agency — Human land uses may have major impacts on ecosystems, affecting biodiversity, habitat, air and water quality. The human use index (also known as U-index) is the...

  3. Human Papillomavirus (HPV) Vaccines

    Science.gov (United States)

    ... Directory Cancer Prevention Overview Research Human Papillomavirus (HPV) Vaccines On This Page What are human papillomaviruses? Which ... infections? Can HPV infections be prevented? What HPV vaccines are available? Who should get the HPV vaccines? ...

  4. Human Use Index

    Data.gov (United States)

    U.S. Environmental Protection Agency — Human land uses may have major impacts on ecosystems, affecting biodiversity, habitat, air and water quality. The human use index (also known as U-index) is the...

  5. Telling the Human Story.

    Science.gov (United States)

    Richardson, Miles

    1987-01-01

    Proposes that one of the fundamental human attributes is telling stories. Explores the debate on whether Neanderthals possessed language ability. Discusses the role of the "human story" in teaching anthropology. (DH)

  6. Human Services Offices

    Data.gov (United States)

    Fairfax County, Virginia — This data contains point features representing the human services offices within Fairfax County.“HS_Region” is the office for each human services region, “DFS_Area”...

  7. Human Resource Accounting System

    Science.gov (United States)

    Cerullo, Michael J.

    1974-01-01

    Main objectives of human resource accounting systems are to satisfy the informational demands made by investors and by operating managers. The paper's main concern is with the internal uses of a human asset system. (Author)

  8. The Growing Human Population.

    Science.gov (United States)

    Keyfitz, Nathan

    1989-01-01

    Discusses the issue of human population. Illustrates the projections of the growing human population in terms of developed and less developed countries. Describes the family planning programs in several countries. Lists three references for further reading. (YP)

  9. Human bites (image)

    Science.gov (United States)

    Human bites present a high risk of infection. Besides the bacteria which can cause infection, there is ... the wound extends below the skin. Anytime a human bite has broken the skin, seek medical attention.

  10. Monogenic human obesity syndromes

    National Research Council Canada - National Science Library

    Farooqi, I S; O'Rahilly, S

    2004-01-01

    .... This chapter will consider the human monogenic obesity syndromes that have been characterized to date and discuss how far such observations support the physiological role of these molecules in the regulation of human body weight and neuroendocrine function.

  11. Skin and the non-human human

    DEFF Research Database (Denmark)

    Rösing, Lilian Munk

    2013-01-01

    The article puts forward an aesthetic and psychoanalytic analysis of Titian's painting, The Flaying of Marsyas, arguing that the painting is a reflection on the human subject as a being constituted by skin and by a core of non-humanity. The analysis is partly an answer to Melanie Hart's (2007......) article 'Visualizing the mind: Looking at Titian's Flaying of Marsyas', addressing features of the painting not commented on by Hart, and supplementing Hart's (Kleinian) theoretical frame by involving Didier Anzieu's 'skin ego', Slavoj Zizek's concept of the 'non-human', Giorgio Agamben's term...

  12. Human productivity program definition

    Science.gov (United States)

    Cramer, D. B.

    1985-01-01

    The optimization of human productivity on the space station within the existing resources and operational constraints is the aim of the Human Productivity Program. The conceptual objectives of the program are as follows: (1) to identify long lead technology; (2) to identify responsibility for work elements; (3) to coordinate the development of crew facilities and activities; and (4) to lay the foundation for a cost effective approach to improving human productivity. Human productivity work elements are also described and examples are presented.

  13. Human Resource Management System

    OpenAIRE

    Navaz, A. S. Syed; Fiaz, A. S. Syed; Prabhadevi, C.; V.Sangeetha; Gopalakrishnan,S.

    2013-01-01

    The paper titled HUMAN RESOURCE MANAGEMENT SYSTEM is basically concerned with managing the Administrator of HUMAN RESOURCE Department in a company. A Human Resource Management System, refers to the systems and processes at the intersection between human resource management and information technology. It merges HRM as a discipline and in particular its basic HR activities and processes with the information technology field, whereas the programming of data processing systems evolved into standa...

  14. Human nature and enhancement.

    Science.gov (United States)

    Buchanan, Allen

    2009-03-01

    Appeals to the idea of human nature are frequent in the voluminous literature on the ethics of enhancing human beings through biotechnology. Two chief concerns about the impact of enhancements on human nature have been voiced. The first is that enhancement may alter or destroy human nature. The second is that if enhancement alters or destroys human nature, this will undercut our ability to ascertain the good because, for us, the good is determined by our nature. The first concern assumes that altering or destroying human nature is in itself a bad thing. The second concern assumes that human nature provides a standard without which we cannot make coherent, defensible judgments about what is good. I will argue (1) that there is nothing wrong, per se, with altering or destroying human nature, because, on a plausible understanding of what human nature is, it contains bad as well as good characteristics and there is no reason to believe that eliminating some of the bad would so imperil the good as to make the elimination of the bad impermissible, and (2) that altering or destroying human nature need not result in the loss of our ability to make judgments about the good, because we possess a conception of the good by which we can and do evaluate human nature. I will argue that appeals to human nature tend to obscure rather than illuminate the debate over the ethics of enhancement and can be eliminated in favor of more cogent considerations.

  15. Human Document Project

    NARCIS (Netherlands)

    Vries, de J.; Abelmann, L.; Manz, A.; Elwenspoek, M.C.

    2012-01-01

    “The Human Document Project” is a project which tries to answer all of the questions related to preserving information about the human race for tens of generations of humans to come or maybe even for a future intelligence which can emerge in the coming thousands of years. This document mainly focuss

  16. Has Human Evolution Stopped?

    Directory of Open Access Journals (Sweden)

    Alan R. Templeton

    2010-07-01

    Full Text Available It has been argued that human evolution has stopped because humans now adapt to their environment via cultural evolution and not biological evolution. However, all organisms adapt to their environment, and humans are no exception. Culture defines much of the human environment, so cultural evolution has actually led to adaptive evolution in humans. Examples are given to illustrate the rapid pace of adaptive evolution in response to cultural innovations. These adaptive responses have important implications for infectious diseases, Mendelian genetic diseases, and systemic diseases in current human populations. Moreover, evolution proceeds by mechanisms other than natural selection. The recent growth in human population size has greatly increased the reservoir of mutational variants in the human gene pool, thereby enhancing the potential for human evolution. The increase in human population size coupled with our increased capacity to move across the globe has induced a rapid and ongoing evolutionary shift in how genetic variation is distributed within and among local human populations. In particular, genetic differences between human populations are rapidly diminishing and individual heterozygosity is increasing, with beneficial health effects. Finally, even when cultural evolution eliminates selection on a trait, the trait can still evolve due to natural selection on other traits. Our traits are not isolated, independent units, but rather are integrated into a functional whole, so selection on one trait can cause evolution to occur on another trait, sometimes with mildly maladaptive consequences.

  17. Has human evolution stopped?

    Science.gov (United States)

    Templeton, Alan R

    2010-07-01

    It has been argued that human evolution has stopped because humans now adapt to their environment via cultural evolution and not biological evolution. However, all organisms adapt to their environment, and humans are no exception. Culture defines much of the human environment, so cultural evolution has actually led to adaptive evolution in humans. Examples are given to illustrate the rapid pace of adaptive evolution in response to cultural innovations. These adaptive responses have important implications for infectious diseases, Mendelian genetic diseases, and systemic diseases in current human populations. Moreover, evolution proceeds by mechanisms other than natural selection. The recent growth in human population size has greatly increased the reservoir of mutational variants in the human gene pool, thereby enhancing the potential for human evolution. The increase in human population size coupled with our increased capacity to move across the globe has induced a rapid and ongoing evolutionary shift in how genetic variation is distributed within and among local human populations. In particular, genetic differences between human populations are rapidly diminishing and individual heterozygosity is increasing, with beneficial health effects. Finally, even when cultural evolution eliminates selection on a trait, the trait can still evolve due to natural selection on other traits. Our traits are not isolated, independent units, but rather are integrated into a functional whole, so selection on one trait can cause evolution to occur on another trait, sometimes with mildly maladaptive consequences.

  18. (Human) Resourcing For CI

    DEFF Research Database (Denmark)

    Jørgensen, Frances; S., Jacob; Kofoed, Lise Busk

    2005-01-01

    More and more, the ability to compete in today’s market is viewed as being dependent on human capital. One of the most challenging aspects of human resource management involves supplying the organization with the human capital necessary to fulfill its objectives. This task becomes especially...

  19. Human Machine Learning Symbiosis

    Science.gov (United States)

    Walsh, Kenneth R.; Hoque, Md Tamjidul; Williams, Kim H.

    2017-01-01

    Human Machine Learning Symbiosis is a cooperative system where both the human learner and the machine learner learn from each other to create an effective and efficient learning environment adapted to the needs of the human learner. Such a system can be used in online learning modules so that the modules adapt to each learner's learning state both…

  20. Monogenic human obesity.

    Science.gov (United States)

    Farooqi, I Sadaf

    2008-01-01

    We and others have identified several single gene defects that disrupt the molecules in the leptinmelanocortin pathway causing severe obesity in humans. In this review, we consider these human monogenic obesity syndromes and discuss how far the characterisation of these patients has informed our understanding of the physiological role of leptin and the melanocortins in the regulation of human body weight and neuroendocrine function.