Detection of Pneumocystis jirovecii in Hospitalized Children Less Than 3 Years of Age

Few data are available in the literature regarding Pneumocystis jirovecii infection in children under 3 years old. This retrospective cohort study aimed to describe medically relevant information among them. All children under 3 years old treated in the same medical units from April 2014 to August 2020 and in whom a P. jirovecii evaluation was undertaken were enrolled in the study. A positive case was defined as a child presenting at least one positive PCR for P. jirovecii in a respiratory sample. Medically relevant information such as demographical characteristics, clinical presentation, microbiological co-infections, and treatments were collected. The objectives were to describe the characteristics of these children with P. jirovecii colonization/infection to determine the key underlying diseases and risk factors, and to identify viral respiratory pathogens associated. The PCR was positive for P. jirovecii in 32 children. Cardiopulmonary pathologies (21.9%) were the most common underlying disease in them, followed by severe combined immunodeficiency (SCID) (18.8%), hyaline membrane disease (15.6%), asthma (9.4%) and acute leukaemia (6.3%). All SCID children were diagnosed with pneumocystis pneumonia. Co-infection with Pj/Rhinovirus (34.4%) was not significant. Overall mortality was 18.8%. Paediatric pneumocystis is not restricted to patients with HIV or SCID and should be considered in pneumonia in children under 3 years old.

Download Full-text

Co‐infection of Pneumocystis jirovecii pneumonia and pulmonary CMV in a infant with X‐linked severe combined immunodeficiency

Diagnostic Cytopathology ◽

10.1002/dc.24763 ◽

2021 ◽

Author(s):

Lin Cheng ◽

Keyu Liu ◽

Xiaojuan Luo ◽

Xiaoning Mao ◽

Yunsheng Chen ◽

...

Keyword(s):

Severe Combined Immunodeficiency ◽

Pneumocystis Jirovecii ◽

Pneumocystis Jirovecii Pneumonia ◽

Combined Immunodeficiency

Download Full-text

Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects

Radiologia Brasileira ◽

10.1590/0100-3984.2016.0157 ◽

2018 ◽

Vol 51 (1) ◽

pp. 20-25 ◽

Cited By ~ 2

Author(s):

Mariana Chiaradia Dominguez ◽

Beatriz Regina Alvares

Keyword(s):

Mechanical Ventilation ◽

Endotracheal Tube ◽

Left Lung ◽

Hyaline Membrane Disease ◽

Relevant Information ◽

Tube Placement ◽

Cross Sectional ◽

Pulmonary Atelectasis ◽

Radiology Reports ◽

Endotracheal Tube Placement

Abstract Objective: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. Materials and Methods: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher's exact test. The level of significance was set at p < 0.05. Results: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. Conclusion: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

Download Full-text

COVID-19 and anosmia: The story so far

Ear Nose & Throat Journal ◽

10.1177/01455613211048998 ◽

2021 ◽

pp. 014556132110489

Author(s):

Xiangming Meng ◽

Yuandan Pan

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Olfactory Epithelium ◽

Underlying Disease ◽

Predictive Tool ◽

Olfactory Testing ◽

High Prevalence ◽

Smoking Behaviors ◽

Recent Developments ◽

Underlying Diseases

Objectives The pandemic has affected over 182 million coronavirus disease 2019 (COVID-19) cases worldwide. Accumulated evidence indicates that anosmia is one of the significant characteristics of COVID-19 with a high prevalence. However, many aspects of COVID-19-induced anosmia are still far from being fully understood. The purpose of this review is to summarize recent developments in COVID-19-induced anosmia to increase awareness of the condition. Methods A literature search was carried out using the PubMed, Embase, Web of Science, and Scopus. We reviewed the latest literature on COVID-19-induced anosmia, including mechanisms of pathogenesis, olfactory testing, anosmia as predictive tool, pathological examinations, imaging findings, affected factors, co-existing diseases, treatments, prognosis, hypothesis theories, and future directions. Results The possible pathogenesis of COVID-19-induced anosmia may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The D614G spike variant may also play a role in the increased number of anosmia patients. Anosmia may also be an essential indicator of COVID-19 spread and an early indicator of the effectiveness of political decisions. The occurrence and development of COVID-19-induced anosmia may be influenced by smoking behaviors and underlying diseases such as type 2 diabetes, gastroesophageal disorders, and rhinitis. Most patients with COVID-19-induced anosmia can fully or partially recover their olfactory function for varying durations. COVID-19-induced anosmia can be treated with various approaches such as glucocorticoids and olfactory training. Conclusion Anosmia is one of the main features of COVID-19 and the underlying disease of the patient may also influence its occurrence and development. The possible pathogenesis of COVID-19-induced anosmia is very complicated, which may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system.

Download Full-text

Scalp Pruritus: Review of the Pathogenesis, Diagnosis, and Management

BioMed Research International ◽

10.1155/2019/1268430 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11

Author(s):

Ploysyne Rattanakaemakorn ◽

Poonkiat Suchonwanit

Keyword(s):

Therapeutic Strategy ◽

Skin Diseases ◽

Underlying Disease ◽

Review Article ◽

Skin Changes ◽

Underlying Condition ◽

Appropriate Treatment ◽

Underlying Diseases ◽

Frequent Problem

Scalp pruritus is a frequent problem encountered in dermatological practice. This disorder is caused by various underlying diseases and is a diagnostic and therapeutic challenge. Scalp pruritus may be localized to the scalp or extended to other body areas. It is sometimes not only associated with skin diseases or specific skin changes, but also associated with lesions secondary to rubbing or scratching. Moreover, scalp pruritus may be difficult to diagnose and manage and may have a great impact on the quality of life of patients. It can be classified as dermatologic, neuropathic, systemic, and psychogenic scalp pruritus based on the potential underlying disease. A thorough evaluation of patients presenting with scalp pruritus is important. Taking history and performing physical examination and further investigations are essential for diagnosis. Therapeutic strategy comprises removal of the aggravating factors and appropriate treatment of the underlying condition. All treatments should be performed considering an individual approach. This review article focuses on the understanding of the pathophysiology and the diagnostic and therapeutic management of scalp pruritus.

Download Full-text

Frequency of Pneumocystis jirovecii in sputum from HIV and TB patients in Namibia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3864 ◽

2014 ◽

Vol 8 (03) ◽

pp. 349-357 ◽

Cited By ~ 10

Author(s):

Vincent Nowaseb ◽

Esegiel Gaeb ◽

Marcin G Fraczek ◽

Malcolm D Richardson ◽

David W Denning

Keyword(s):

Pneumocystis Pneumonia ◽

Sub Saharan Africa ◽

Pneumocystis Jirovecii ◽

Aids Patients ◽

Limited Region ◽

Minimum Frequency ◽

Resource Limited ◽

Smear Negative ◽

Sub Saharan ◽

Hiv Aids

Introduction: The opportunistic fungus Pneumocystis jirovecii causes Pneumocystis pneumonia (PcP), which is a life-threatening infection in HIV/AIDS patients. The seemingly low prevalence of P. jirovecii pneumonia in sub-Saharan Africa has been a matter of great debate because many HIV/AIDS patients reside in this region. The lack of suitable diagnostic practices in this resource limited-region has been added to the uncertainty of PcP prevalence. Only a few studies have evaluated the utility of easily obtainable samples such as expectorated sputum for diagnosis of PcP. Thus, the aim of the current study was to evaluate the effectiveness of expectorated sputum for the routine diagnosis of PcP in a resource-limited sub-Saharan African setting. Methodology: Randomly collected sputum samples were analysed by microscopy after Grocott’s methenamine silver (GMS) stain staining and by qPCR to determine the minimum frequency of detectable P. jirovecii. Results: A total of 475 samples were analysed. Twenty five (5.3%) samples were positive for P. jirovecii, i.e., 17 (3.6%) using both qPCR and GMS staining and eight (1.7%) using qPCR only. P. jirovecii was present in 8/150 (5.3%) HIV-positive and tuberculosis (TB) smear-negative patients, and in 12/227 (5.3%) TB smear-negative patients with an unknown HIV status. The minimum frequency of PcP was 3.6% in Namibian HIV and TB patients, while the actual frequency is likely to be 5.3%. Conclusion: This study demonstrated that expectorated sputum can be used routinely for the diagnosis of PcP by GMS, although qPCR is more sensitive, and it requires less time and skill.

Download Full-text

Diagnostic Performance of Bronchoalveolar Lavage (1,3)-β-d-Glucan Assay for Pneumocystis jirovecii Pneumonia

Journal of Fungi ◽

10.3390/jof6040200 ◽

2020 ◽

Vol 6 (4) ◽

pp. 200

Author(s):

Shiwei Zhou ◽

Kathleen A. Linder ◽

Carol A. Kauffman ◽

Blair J. Richards ◽

Steve Kleiboeker ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Test Performance ◽

Predictive Value ◽

Operating Characteristic ◽

Area Under The Curve ◽

Lavage Fluid ◽

Pneumocystis Pneumonia ◽

Pneumocystis Jirovecii ◽

Pneumocystis Jirovecii Pneumonia ◽

Characteristic Area

We evaluated the performance of the (1,3)-β-d-glucan (BDG) assay on bronchoalveolar lavage fluid (BALF) as a possible aid to the diagnosis of Pneumocystis jirovecii pneumonia. BALF samples from 18 patients with well-characterized proven, probable, and possible Pneumocystis pneumonia and 18 well-matched controls were tested. We found that the best test performance was observed with a cut-off value of 128 pg/mL; receiver operating characteristic/area under the curve (ROC/AUC) was 0.70 (95% CI 0.52–0.87). Sensitivity and specificity were 78% and 56%, respectively; positive predictive value was 64%, and negative predictive value was 71%. The low specificity that we noted limits the utility of BALF BDG as a diagnostic tool for Pneumocystis pneumonia.

Download Full-text

WU Polyomavirus Associated with Severe Respiratory Failure in Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.744 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S317-S318

Author(s):

Kazuhiro Uda ◽

Kensuke Shoji ◽

Chitose Wakai-Koyama ◽

Isao Miyairi

Keyword(s):

Respiratory Failure ◽

Respiratory Tract ◽

Respiratory Infections ◽

Underlying Disease ◽

Respiratory Pathogens ◽

Immunocompromised Patients ◽

Severe Respiratory Failure ◽

Preterm Children ◽

Wu Polyomavirus ◽

Tract Infections

Abstract Background WU polyomavirus (WUPyV) is a relatively new virus associated with respiratory infections. However, its role is unclear in children with severe respiratory failure. We aimed to evaluate characteristics of severe respiratory failure associated with WUPyV in children. Methods We retrospectively reviewed the cases of respiratory tract infection at a tertiary children’s hospital in Tokyo between April 2010 and April 2017. We performed real-time polymerase chain reaction (PCR) for WUPyV using residual extracted nucleic acid samples taken from respiratory tract samples of pediatric patients, primarily with respiratory failure. We investigated the clinical characteristics of patients positive for WUPyV. Samples positive for WUPyV were evaluated for co-infection with fast-track diagnostic kit (FTD-2); a multiplex PCR capable of detecting 21 respiratory pathogens. Results WUPyV was detected in 14 among 318 samples obtained from respiratory tract infections. Median age was 34 months old and males were predominant (n = 11, 64%). Underlying disease was found in 11 (79%) cases, including five cases of preterm children and three immunocompromised patients. The most common clinical diagnosis was pneumonia (n = 13, 93%). Majority of the respiratory samples were endotracheal tube aspirates (n = 11, 79%) and the remaining were nasopharyngeal swabs. Co- infection was found in eight (57%) cases. WUPyV was the only pathogen detected in six cases, including two preterm children and one immunocompromised patient. Nine cases required mechanical ventilation, and two cases required extracorporeal membrane oxygenation (ECMO). Conclusion WUPyV was detected from children with severe respiratory failure due to pneumonia, independently or concurrently with other pathogens, especially in preterm and immunocompromised patients. Disclosures All authors: No reported disclosures.

Download Full-text

Severity and outcome of HIV-associated Pneumocystis pneumonia containing Pneumocystis jirovecii dihydropteroate synthase gene mutations

AIDS ◽

10.1097/01.aids.0000168974.67090.70 ◽

2005 ◽

Vol 19 (8) ◽

pp. 801-805 ◽

Cited By ~ 82

Author(s):

Kristina Crothers ◽

Charles B Beard ◽

Joan Turner ◽

Gena Groner ◽

Melissa Fox ◽

...

Keyword(s):

Gene Mutations ◽

Pneumocystis Pneumonia ◽

Pneumocystis Jirovecii ◽

Dihydropteroate Synthase

Download Full-text

Infectious Complications in Advanced Relapsed/Refractory Multiple Myeloma Patients Treated with Lenalidomide (Revlimid +/- Corticosteroids).

Blood ◽

10.1182/blood.v114.22.2876.2876 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2876-2876 ◽

Cited By ~ 1

Author(s):

Vishal Kukreti ◽

Esther Masih-Khan ◽

Saima Dean ◽

Deepali Kumar ◽

Joseph R. Mikhael ◽

...

Keyword(s):

Multiple Myeloma ◽

Respiratory Infections ◽

Underlying Disease ◽

Pneumocystis Pneumonia ◽

Infectious Complications ◽

National Study ◽

Cell Transplant ◽

Mycobacterium Chelonae ◽

Prior Therapy ◽

Heavily Pretreated

Abstract Abstract 2876 Poster Board II-852 Multiple myeloma (MM) patients (pts) are immunosuppressed given the underlying disease, previous treatments and myelosuppression seen on lenalidomide (Revlimid, Rev). We evaluated the infectious complications seen on Celgene's Expanded Access Rev program at Princess Margaret Hospital. We have treated 75 pts who had progressed after at least one prior therapy as part of a national study in Canada. At entry, pts were required to have a neutrophil count of ≥1.0 ×109/L. The median age was 61 yrs (range 35-79); 52% were males. Prior therapy included stem cell transplant in 65, thalidomide in 54 and bortezomib in 24. Number of lines of prior therapy were as follows: 24 (one), 29 (two), 16 (three), 8 (four) and one (five). Neupogen was used liberally (63%) after a patient had a dose delay on trial due to neutropenia. Patients were treated with full dose lenalidomide at entry onto clinical trial and were maintained on full dosing unless platelet counts were <30×109/L or ANC was <1.0×109/L. No other dose adjustments were made for renal dysfunction. Results: There were 32 pts (43%) who had a clinically evident infection; the majority (91%) was on prophylactic antibiotics (septra/ciprofloxacin) at the time. There were two deaths due to infection and 23 pts (72%) required hospitalization (range 2-27 days). The majority of infections occurred within the first 4 cycles of treatment (26 pts) and seemed to occur more in pts with several lines of prior therapy – 7/24 (29%) with 1 prior therapy, 14/29 (48%) with 2, 9/16 (56%) with 3 and 2/8 (25%) with 4 prior therapies. Sixteen were neutropenic of which 7 had febrile neutropenia (9%). The types of infections were: respiratory in 14 (1 with pneumocystis pneumonia), cellulitis in 4, herpes simplex and herpes zoster in 2 pts each. These included streptococcus pneumoniae (1), staphylococcus aureus (3), respiratory syncitial virus (1) and mycobacterium chelonae (1). Rev was held during the infection in 23 pts (72%). Conclusions: 1) Infections are frequent in this patient population (43%) and often lead to hospitalization (72%); respiratory infections accounted for a large majority (43%). 2) Early aggressive growth factor support and broader antibiotic prophylaxis may be of benefit especially in heavily pretreated patients. 3) Dose reduction of Rev in the context of serious infections should be further evaluated. Disclosures: Kukreti: Celgene: Honoraria. Trudel:Celgene: Honoraria, Speakers Bureau; Ortho Biotech: Honoraria. Chen:Celgene: Honoraria.

Download Full-text