scholarly journals A novel approach to resolve severe mediastinal and subcutaneous emphysema occurring in Pneumocystis jirovecii pneumonia using vacuum-assisted closure therapy

2020 ◽  
Vol 8 ◽  
pp. 2050313X2091898
Author(s):  
Noor H Bouwmeester ◽  
Hans Kieft ◽  
Ghada MM Shahin ◽  
Arno P Nierich
Keyword(s):  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Case Reports ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Vacuum Assisted Closure ◽  
Novel Approach ◽  
Immunodeficiency Virus ◽  
Promising Treatment ◽  
Vacuum Assisted Closure Therapy

A 50-year-old human immunodeficiency virus positive patient who was diagnosed with Pneumocystis jirovecii pneumonia developed severe subcutaneous and mediastinal emphysema, which was progressive despite low pressure mechanical ventilation. Infraclavicular skin incisions and vacuum-assisted closure therapy were used to resolve the emphysema. The subcutaneous emphysema decreased significantly, and after 1 week the vacuum-assisted closure therapy was ended successfully. This technique has previously been described in several case reports, where it is a promising treatment in severe subcutaneous emphysema, but it is not yet widely used. This case report supports the further use of vacuum-assisted closure therapy in subcutaneous emphysema. Successful treatment of severe mediastinal and subcutaneous emphysema in Pneumocystis jirovecii pneumonia can be achieved by vacuum-assisted closure therapy on infraclavicular skin incisions.

scholarly journals Vacuum-assisted Closure Therapy for Treating Patients with Severe Subcutaneous Emphysema

2015 ◽  
Vol 28 (4) ◽  
pp. 276-279
Author(s):  
Tak-hyuk Oh ◽  
Sang Cjeol Lee ◽  
Deok Heon Lee ◽  
Joon Yong Cho
Keyword(s):  
Subcutaneous Emphysema ◽  
Vacuum Assisted Closure ◽  
Vacuum Assisted Closure Therapy

Fatal Pneumocystis jirovecii pneumonia in a non-immunocompromised patient with alcohol-related liver cirrhosis

2019 ◽  
Vol 64 (4) ◽  
pp. 148-153 ◽  
Author(s):  
Nicholas J Hadfield ◽  
Subothini Selvendran ◽  
Michael P Johnston
Keyword(s):  
Risk Factors ◽  
Liver Cirrhosis ◽  
Hiv Infection ◽  
Alcoholic Hepatitis ◽  
Case Reports ◽  
Fatal Case ◽  
Case Series ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Acute Alcoholic Hepatitis

This report presents the fatal case of a 63-year-old man with a new presentation of liver cirrhosis, presumed concurrent acute alcoholic hepatitis and development of Pneumocystis jirovecii pneumonia. The patient had none of the traditional immunosuppressing risk factors associated with Pneumocystis jirovecii pneumonia such as corticosteroid use, haematological malignancy or HIV infection. In the literature, there are two case reports and a case series of two patients which describe the development of Pneumocystis jirovecii pneumonia in acute alcoholic hepatitis. However, all of these previously described cases include identifiable risk factors – namely corticosteroid use and HIV infection. This case suggests that special consideration should be given to Pneumocystis jirovecii pneumonia as a cause of opportunistic infection in acute alcoholic hepatitis.

Pneumocystis jirovecii Pneumonia and Human Immunodeficiency Virus Co-Infection in Western Iran

2020 ◽  
Author(s):  
Arezoo BOZORGOMID ◽  
Yazdan HAMZAVI ◽  
Sahar HEIDARI KHAYAT ◽  
Behzad MAHDAVIAN ◽  
Homayoon BASHIRI
Keyword(s):  
Human Immunodeficiency Virus ◽  
Signs And Symptoms ◽  
Rapid Identification ◽  
Diagnostic Methods ◽  
Pneumocystis Jirovecii ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cell Counts ◽  
Stage 4 ◽  
Immunodeficiency Virus

Background: The human immunodeficiency virus (HIV) is one of the greatest health challenges facing worldwide. The virus suppresses the immune system of the patient. The purpose of this study was to describe the epidemiology of Pneumocystis jirovecii colonization, rarely found in normal people, in patients with stage 4 HIV infection in Kermanshah, Iran, from Mar 1995 to Feb 2016. Methods: In this retrospective study, we surveyed medical records of stage 4 HIV-positive patients with Pneumocystis admitted to Behavioral Counseling Center of Kermanshah. Several parameters were analyzed including demographic characteristics, body mass index (BMI), treatment regimen, diagnostic methods, presenting signs and symptoms, presence of co-pathogens (bacteria, viruses, or fungi), and nadir of CD4 T-cell count before and after treatment. Results: During the study period, 114 HIV-positive patients were analyzed, of whom 93 were male and 21 were female, respectively. Of 114 cases, 26 (22.8%) patients had Pneumocystis. All 26 colonized patients had CD4 cell counts below 200 cells/mm3 (range 9–186). The median CD4 count increased from 91 cells/mm3 pretrimethoprim/sulfamethoxazole (TMP/SMX) to an estimated 263 cells/mm3 after starting (TMP/SMX). BMI was normal in the majority of the patients (85%) and coughs, sputum, and chest pain (19; 73%) followed by dyspnea, weakness, and lethargy (7; 27%) were the most common presentations of fungal pneumonia. Conclusion: HIV/AIDS-infected patients are an environmental reservoir of P. jirovecii infection that might transmit the infection from one person to another via the airborne route. In addition, rapid identification of such individuals may reduce the morbidity and mortality rate of this disease.

scholarly journals MON-367 Unusual Presentation of Hypercalcemia Preceding the Diagnosis of Methotrexate-Induced Pneumocystis Jirovecii Pneumonia from Treatment of Necrotizing Myopathy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Minhthao Nguyen ◽  
Afshan Mohiuddin
Keyword(s):  
Case Reports ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Necrotizing Myopathy ◽  
Negative Results ◽  
Common Opportunistic Infection ◽  
High Level ◽  
Extended Course ◽  
Work Up ◽  
A Company

Abstract Background: Pneumocystis Jirovecii infection is a common opportunistic infection often seen severely immunocompromised individuals, such as those with HIV/AIDs. This is an unusual case where the patient displayed persistent hypercalcemia, with an eventual diagnosis of PCP likely due to immunosuppression from methotrexate (MTX) therapy. Case: A 79 year old male was brought to the hospital for acute change in mental status and hypercalcemia (13.4mg/dl). The patient was acutely encephalopathic, oriented to self only; his baseline was a high level executive at a company. An extensive neurologic workup including CT, MRI, EEG, spinal fluid examination was negative with a persistent hypercalcemia. Additional workup showed no increase in bone turnover, suppressed PTH, non-elevated pPTHrP. He was found to have diffuse mild PET avidity of bilateral lungs on PET scan, with bronchoscopy for evaluation of potential granulomatous disease. PCR of the BAL fluid obtained during bronchoscopy was positive, and the patient was ultimately treated with an extended course of Atovaquone for Pneumocystis Jirovecii pneumonia (PCP). The patient was felt to have an immunosuppressed state secondary to being treated for a necrotizing myopathy with methotrexate. The patient’s mentation slowly but substantially improved with a combination of a prednisone taper and Atovaquone, with discontinuation of the MTX. The patient’s hypercalcemia improved with treatment of PCP. Conclusion: Although a cause of hypercalcemia secondary to primary hyperparathyroidism causing necrotizing myopathy is known in the literature, it is unusual to see the opposite, where few case reports have documented hypercalcemia due to immunosuppression from low-dose methotrexate treatment for necrotizing myopathy resulting in pulmonary pneumocystis and hypercalcemia. Additionally, MTX induced immunodeficiency is often associated with severe immunosuppression or lymphoproliferative disorders - however the patient had an extensive work up with negative results for malignancy

scholarly journals Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246296
Author(s):  
Tae-Ok Kim ◽  
Jae-Kyeong Lee ◽  
Yong-Soo Kwon ◽  
Yu-Il Kim ◽  
Sung-Chul Lim ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Hematological Malignancy ◽  
Immunosuppressive Agents ◽  
Mortality Rates ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Solid Organ ◽  
Immunodeficiency Virus ◽  
Immunocompromised Status ◽  
Median Interval

Objective Pneumocystis jirovecii pneumonia (PCP) is a fatal respiratory infection, mostly associated with immunocompromised conditions. Several reports have described PCP development in patients who were not immunocompromised, but the clinical course and prognosis of PCP are not well understood. We compared the clinical characteristics and prognoses between patients with and without immunocompromised conditions who developed PCP. Methods We retrospectively analyzed patients who had been treated for PCP from three hospitals. We defined immunocompromised (IC) status as following: human immunodeficiency virus (HIV) infection; hematological malignancy; solid organ tumor under chemotherapy; rheumatic disease; medication with immunosuppressive agents. Patients without immunocompromised status were defined as being non-immunocompromised (non-IC). Results The IC and non-IC groups comprised 173 and 14 patients. The median ages were 62.0 and 74.0 years in the IC and the non-IC group, respectively. The median interval between admission and anti-PCP treatment was significantly longer for patients in the non-IC group than that for patients in the IC group (7 vs. 2 days). The in-hospital mortality rates were significantly higher for patients in the non-IC group than that for patients in the IC group (71.4% vs. 43.9%; P = 0.047). A longer interval between admission and anti-PCP therapy was associated with increased 90-day mortality rate in patients with PCP (hazard ratio, 1.082; 95% confidence interval, 1.015–1.153; P = 0.016). Conclusions Patients with PCP with no predisposing illnesses were older and had higher mortality rates than IC patients with PCP. Delayed anti-PCP treatment was associated with increased 90-day mortality.

scholarly journals ECMO Support in HIV/AIDS with Pneumocystis Jirovecii Pneumonia: A Case Report and Short Review

2021 ◽  
Author(s):  
jianlei lv ◽  
yanfen Li ◽  
kang huang ◽  
ailian lv
Keyword(s):  
Human Immunodeficiency Virus ◽  
Case Report ◽  
Short Review ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Shortness Of Breath ◽  
Immunodeficiency Virus ◽  
Refractory Hypoxemia ◽  
Ecmo Therapy ◽  
Hiv Aids

Abstract Background We report a case of a patient with novel human immunodeficiency virus (HIV) and Pneumocystis jirovecii pneumonia (PJP) was successfully treated with veno-venous (V-V) ECMO owing to refractory hypoxemia and pneumomediastinum, and eventually discharged. In addition to the case report, several previous reports were reviewed for the discussion of some key therapies. Case report: A 30-year-old male patient was admitted to the our hospital presented with the shortness of breath. The patient showed a deteriorated oxygenation due to increasing pulmonary infiltrates and development of pneumomediastinum, necessitating ECMO. The diagnosis of ARDS, HIV, PJP was made. Trimethoprim/sulfamethoxazole (TMP/SMX) was provided for the treatment of PJP. After 7 days of ECMO therapy, the patient was successfully decannulated and eventually discharged. Conclusions ECMO may benefit adult patients with HIV/AIDS and refractory hypoxemia due to severe PCP. Post-ECMO antiretroviral therapy could improve outcomes.

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