A Rare Case of Pneumocystis jirovecii Pneumonia Presenting With Caseating Granuloma in a Non-HIV Positive Patient

CHEST Journal ◽  
2014 ◽  
Vol 145 (3) ◽  
pp. 105A
Author(s):  
John Kern ◽  
Corinne Kern ◽  
Cristina Cicogna
Keyword(s):  
Rare Case ◽  
Positive Patient ◽  
Pneumocystis Jirovecii ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Caseating Granuloma

scholarly journals A Rare Case of Pyoderma Gangrenosum in a HIV Positive Patient

2011 ◽  
Vol 2 (2) ◽  
pp. 128-130
Author(s):  
Eswari Loganathan ◽  
Asima Banu
Keyword(s):  
Pyoderma Gangrenosum ◽  
Rare Case ◽  
Positive Patient ◽  
Neutrophilic Dermatosis ◽  
Hiv Positive ◽  
Medical Sciences ◽  
First Line ◽  
Hodgkins Lymphoma ◽  
Lymphoid Malignancies ◽  
Non Hodgkins Lymphoma

HIV infection can lead to varied spectrum of associated disease conditions. Pyoderma gangrenosum is a neutrophilic dermatosis that may be associated with myeloid malignancies. Less information is available about the association of pyoderma gangrenosum with lymphoid malignancies. We report a rare case of pyoderma gangrenosum in association with Non hodgkins lymphoma(NHL) of diffuse large B cell type. In this case the lesion which showed NHL features occurred in the perianal region, coexisting with pyoderma gangrenosum lesions in the perianal, lower limb and abdominal region. Another interesting feature is the occurrence of both these conditions in a HIV-positive patient with severe immunologic failure to first line antiretroviral therapy contributing to the refractoriness to treatment. Key Words: HIV; pyoderma gangrenosum; Non Hodgkins Lymphoma DOI: http://dx.doi.org/10.3126/ajms.v2i2.4029 Asian Journal of Medical Sciences 2 (2011) 128-130

scholarly journals Dihydropteroate synthase (DHPS) gene mutation study in HIV-Infected Indian patients with Pneumocystis jirovecii pneumonia

2010 ◽  
Vol 4 (11) ◽  
pp. 761-766 ◽  
Author(s):  
Anuj Kumar Tyagi ◽  
Bijay Ranjan Mirdha ◽  
Kalpana Luthra ◽  
Randeep Guleria ◽  
Anant Mohan ◽  
...  
Keyword(s):  
Silver Staining ◽  
Tertiary Care ◽  
Pneumocystis Carinii ◽  
Pneumocystis Jirovecii ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Sulfa Drug ◽  
Dihydropteroate Synthase ◽  
Methenamine Silver ◽  
Dhps Gene

Introduction: Pneumocystis jirovecii dihydropteroate synthase (DHPS) gene mutations' (55th and 57th codon) association with prior sulfa prophylaxis failure has been reported from both developed and developing countries. We conducted a prospective study to determine the prevalence of P. jirovecii DHPS mutations from 2006 to 2009 on P. jirovecii isolates obtained from HIV-infected patients with a clinical diagnosis of Pneumocystis carinii pneumonia (PCP) admitted to our tertiary care reference health center in New Delhi, India. Methodology: Detection of P. jirovecii cysts was performed by direct fluorescent antibody (DFA) staining and by Grocott's-Gomori methenamine silver staining (GMS). DNA detection was performed by polymerase chain reaction (PCR) using primers for the major surface glycoprotein (MSG) gene. P. jirovecii DHPS gene was amplified by nested PCR protocol and sequenced for detecting mutations at the 55th and 57th codons. Results: Out of 147 HIV-positive patients with suspected Pneumocystis pneumonia (PCP), 16 (10.8%) PCP positive cases were detected. Of 16 cases, nine (56.2%) were positive by DFA staining, four (25%) were positive by Grocott's-Gomori methenamine silver staining, and all 16 were positive by MSG PCR. DHPS mutations at the 55th and 57th codons were observed in 6.2% of HIV patients studied, which was relatively low compared to reports from developed nations. Conclusions:  Prevalence of Pneumocystis jirovecii DHPS mutations associated with cotrimoxazole treatment failure may be low in the Indian subpopulation of HIV-positive patients and warrants larger studies to elucidate the true picture of Pneumocystis jirovecii sulfa drug resistance in India.

scholarly journals Evaluation of Three Different Laboratory Methods for Identifi-cation of Pneumocystis jirovecii Pneumonia (PCP) among HIV Positive Asymptomatic Prisoners

2019 ◽  
Author(s):  
Shohreh AZIMI ◽  
Azar SABOKBAR ◽  
Amir BAIRAMI ◽  
Mohammad Javad GHARAVI
Keyword(s):  
Prophylactic Antibiotic ◽  
Mean Value ◽  
Pneumocystis Jirovecii ◽  
Hiv Positive ◽  
Molecular Testing ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cd4 Counts ◽  
Hiv Therapy ◽  
Infection Disease ◽  
Prophylactic Antibiotic Therapy

Background: Pneumocystis jirovecii pneumonia (PCP) remains a leading cause of mortality among HIV-infected patients. The aim of study was to find out P. jirovecii in versatile group of HIV-positive patients prisoners. Methods: Overall, 102 HIV positive patients from Ghezel Hesar Prison, Karaj, Iran from October 2016 to March 2017 without any respiratory symptoms were selected with different medication histories against HIV and PCP. Microscopic and molecular (qualitative real-time PCR) examination were applied on sputum specimens and serological investigation (β-D-glucan assay for fungal diseases) carried out on patient’s sera. Results: Only 3 and 1 patients were positive for PCP by microscopic and molecular testing, respectively. Twenty-four (23.5%) and 78 (76.5%) out of 102 patients were seropositive and seronegative for fungi disease, respectively. Seropositive patients were older than seronegative subjects (P<0.001). Most of seropositive individuals showed less mean value of CD4 counts compared to seronegative group (P<0.001). Of 54 patients who were under HIV therapy, 13 were seropositive compared to 11 out of 24 seropositives who were no adhere to treatment (P<0.001). In terms of prophylactic antibiotic therapy against PCP, of 24 patients who received prophylaxis, 3 (12.5%) and 21 (87.5%) were seropositive and seronegative, respectively (P<0.001). On the contrary, among 78 patients who did not receive prophylaxis, 21 (27%) and 57 (73%) belonged to seropositive and seronegative patients, respectively (P<0.001). Conclusion: There was no strong evidence for PCP infection/disease among symptomless, HIV positive patients. According to their mean CD4 counts, the hypothesis for being negative in a majority of applied tests would be the absence of severe immunosuppression in the patients.

scholarly journals A DRY COUGH CONUNDRUM: A RARE CASE OF PNEUMOCYSTIS JIROVECII PNEUMONIA IN SYSTEMIC LUPUS ERYTHEMATOUS PATIENT ON HYDROXYCHLOROQUINE

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A419 ◽  
Author(s):  
Elizabeth Verghese ◽  
Urbee Haque ◽  
Ahmad Jabri ◽  
Sujith Modugula ◽  
Sanjiv Tewari
Keyword(s):  
Rare Case ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus

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 A Systematic Review and Meta-analysis of Diagnostic Accuracy of Serum (1-3)-Beta-D-glucan for Pneumocystis Jirovecii Pneumonia Using the Fungitell Assay: Focus on Cutoff Levels

2021 ◽  
Author(s):  
wenzhang long ◽  
kunting xiao ◽  
yongqiang yuan
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Pneumocystis Jirovecii ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cutoff Value ◽  
Subgroup Analyses ◽  
Sensitivity Specificity

Abstract PurposeWe conducted a meta-analysis to evaluate the diagnostic performance of various levels of serum (1-3)-Beta-D-glucan(BDG) for Pneumocystis jirovecii(PJ) infection using Fungitell assay.MethodsEMBASE, MEDLINE, and the reference lists of relevant studies were identified up to March 12,2021, with no language restrictions. Meta-analysis was performed using random-effects models for bivariate analysis. Subgroup analyses were implemented in HIV-positive Pneumocystis jirovecii pneumonia (PJP), HIV-negative PJP, and PJP versus colonized patients.ResultsNineteen individual studies that included a total of 2,310 participants met our inclusion criteria. The overall sensitivity, specificity, positive likelihood ratio(LR+) and negative likelihood ratio (LR−),and 95 % confidence interval CI of serum-BDG were 0.94(95 % CI: 0.89–0.96),0.76 (95 % CI: 0.65–0.85), 3.99 (95 % CI: 2.59–6.13),0.08 (95 % CI: 0.05–0.15), respectively. Futher stratified analysis of diagnostic values showed that various levels of serum BDG differed in sensitivity, specificity, LR+ and LR− in the diagnosis of PJP. Subgroup analyses also indicated that the cutoff value of 200 pg/mL had sufficient diagnostic accuracy in HIV-positive PJP patients versus controls. Moreover, the 80 pg/mL cutoff value had satisfactory diagnostic accuracy in PJP versus colonized patients, a overall sensitivity of 0.86 (95% CI, 0.73-0.93), a overall specificity of 0.82(95% CI,0.73-0.88), a overall LR+ 4.70(95 % CI: 3.11–7.08), and a overall LR−0.17(95 % CI: 0.09–0.34),individually.ConclusionsThis meta-analysis suggests that the optimal positive threshold for serum BDG, tested by the Fungitell assay, requires better definition and clinical validation rather than the recommended cutoff of 80pg/mL by the manufacturer in the diagnosis of PJP. These cutoff values could be further refined in additional studies that focus on populations that are as homogeneous as possible.

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