scholarly journals An overview of Pneumocystis jirovecii pneumonia for the African generalist practitioner

1970 ◽  
Vol 19 (4) ◽  
pp. 3200-3207
Author(s):  
I Govender ◽  
O M Maphasha ◽  
S Rangiah ◽  
C Steyn
Keyword(s):  
Pneumocystis Pneumonia ◽  
Diagnostic Methods ◽  
Pneumocystis Jirovecii ◽  
Causative Organism ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Productive Cough ◽  
First Line ◽  
Duration Of Symptoms ◽  
Uninfected Patient

Introduction: Pneumocystis jirovecii is the causative organism of Pneumocystis pneumonia (PCP) in humans, which is more common among immunocompromised patients. Classically patients present with fever, non-productive cough, and dyspnoea. In the HIV-infected individuals the symptoms may be subtle at first, but gradually progress over several weeks. In the HIV-uninfected patient, however, the duration of symptoms is shorter and more severe, mainly due to the increased inflammatory response of the HIV-uninfected patient.Methods: This article focuses on the diagnostic methods and then the management and prophylaxis principles of PCP by reviewing the best current practices and guidelines in Africa.Conclusion: This overview is presented by clinicians who have experience with PCP and is directed mainly at first-line healthcare providers.Keywords: Pneumocystis jirovecii pneumonia, african generalist practitioner.

scholarly journals Point-Counterpoint: Should Serum β-d-Glucan Testing Be Used for the Diagnosis of Pneumocystis jirovecii Pneumonia?

2019 ◽  
Vol 58 (1) ◽  
Author(s):  
Gabriela Corsi-Vasquez ◽  
Luis Ostrosky-Zeichner ◽  
Edward F. Pilkington ◽  
Paul E. Sax
Keyword(s):  
High Risk ◽  
Prophylactic Antibiotics ◽  
Induced Sputum ◽  
Pneumocystis Jirovecii ◽  
Outpatient Clinics ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Content Type ◽  
Aids Epidemic

Despite the widespread use of prophylactic antibiotics in high-risk individuals, Pneumocystis jirovecii remains an important cause of pneumonia in immunocompromised patients. During the peak of the AIDS epidemic, many hospitals and outpatient clinics were very proficient at collecting induced sputum specimens for the diagnosis of Pneumocystis jirovecii pneumonia (PJP).

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

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.

scholarly journals Pneumocystis jirovecii Pneumonia in Children with Hematological Malignancies: Diagnosis and Approaches to Management

2020 ◽  
Vol 6 (4) ◽  
pp. 331
Author(s):  
Elpis Mantadakis
Keyword(s):  
Lymphoblastic Leukemia ◽  
Fluorescent Microscopy ◽  
Significant Risk ◽  
Diagnostic Technique ◽  
Allogeneic Transplantation ◽  
Diagnostic Methods ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Hematopoietic Stem ◽  
High Negative Predictive Value

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that mostly affects children with suppressed cellular immunity. PJP was the most common cause of infectious death in children with acute lymphoblastic leukemia prior to the inclusion of cotrimoxazole prophylaxis as part of the standard medical care in the late 1980s. Children with acute leukemia, lymphomas, and those undergoing hematopoietic stem cell transplantation, especially allogeneic transplantation, are also at high risk of PJP. Persistent lymphopenia, graft versus host disease, poor immune reconstitution, and lengthy use of corticosteroids are significant risk factors for PJP. Active infection may be due to reactivation of latent infection or recent acquisition from environmental exposure. Intense hypoxemia and impaired diffusing capacity of the lungs are hallmarks of PJP, while computerized tomography of the lungs is the diagnostic technique of choice. Immunofluorescence testing with monoclonal antibodies followed by fluorescent microscopy and polymerase chain reaction testing of respiratory specimens have emerged as the best diagnostic methods. Measurement of (1-3)-β-D-glucan in the serum has a high negative predictive value in ruling out PJP. Oral cotrimoxazole is effective for prophylaxis, but in intolerant patients, intravenous and aerosolized pentamidine, dapsone, and atovaquone are effective alternatives. Ιntravenous cotrimoxazole is the treatment of choice, but PJP has a high mortality even with appropriate therapy.

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 Is It Possible to Differentiate Pneumocystis jirovecii Pneumonia and Colonization in the Immunocompromised Patients with Pneumonia?

2021 ◽  
Vol 7 (12) ◽  
pp. 1036
Author(s):  
Yudy A. Aguilar ◽  
Zulma Vanessa Rueda ◽  
María Angélica Maya ◽  
Cristian Vera ◽  
Jenniffer Rodiño ◽  
...  
Keyword(s):  
Qpcr Assay ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Rrna Gene ◽  
Immunocompromised Patients ◽  
Lung Cancer Patients ◽  
Molecular Tests ◽  
Cancer Group ◽  
Diagnostic Characteristics ◽  
Immunosuppressed Patients

Respiratory sample staining is a standard tool used to diagnose Pneumocystis jirovecii pneumonia (PjP). Although molecular tests are more sensitive, their interpretation can be difficult due to the potential of colonization. We aimed to validate a Pneumocystis jirovecii (Pj) real-time PCR (qPCR) assay in bronchoscopic bronchoalveolar lavage (BAL) and oropharyngeal washes (OW). We included 158 immunosuppressed patients with pneumonia, 35 lung cancer patients who underwent BAL, and 20 healthy individuals. We used a SYBR green qPCR assay to look for a 103 bp fragment of the Pj mtLSU rRNA gene in BAL and OW. We calculated the qPCR cut-off as well as the analytical and diagnostic characteristics. The qPCR was positive in 67.8% of BAL samples from the immunocompromised patients. The established cut-off for discriminating between disease and colonization was Ct 24.53 for BAL samples. In the immunosuppressed group, qPCR detected all 25 microscopy-positive PjP cases, plus three additional cases. Pj colonization in the immunocompromised group was 66.2%, while in the cancer group, colonization rates were 48%. qPCR was ineffective at diagnosing PjP in the OW samples. This new qPCR allowed for reliable diagnosis of PjP, and differentiation between PjP disease and colonization in BAL of immunocompromised patients with pneumonia.

scholarly journals Diagnosing Pneumocystis jirovecii pneumonia: A review of current methods and novel approaches

2020 ◽  
Vol 58 (8) ◽  
pp. 1015-1028 ◽  
Author(s):  
Marjorie Bateman ◽  
Rita Oladele ◽  
Jay K Kolls
Keyword(s):  
Point Of Care ◽  
Diagnostic Testing ◽  
Life Forms ◽  
Diagnostic Methods ◽  
Host Factors ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Clinical Implementation ◽  
Geographic Variations ◽  
The Impact

Abstract Pneumocystis jirovecii can cause life-threatening pneumonia in immunocompromised patients. Traditional diagnostic testing has relied on staining and direct visualization of the life-forms in bronchoalveolar lavage fluid. This method has proven insensitive, and invasive procedures may be needed to obtain adequate samples. Molecular methods of detection such as polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), and antibody-antigen assays have been developed in an effort to solve these problems. These techniques are very sensitive and have the potential to detect Pneumocystis life-forms in noninvasive samples such as sputum, oral washes, nasopharyngeal aspirates, and serum. This review evaluates 100 studies that compare use of various diagnostic tests for Pneumocystis jirovecii pneumonia (PCP) in patient samples. Novel diagnostic methods have been widely used in the research setting but have faced barriers to clinical implementation including: interpretation of low fungal burdens, standardization of techniques, integration into resource-poor settings, poor understanding of the impact of host factors, geographic variations in the organism, heterogeneity of studies, and limited clinician recognition of PCP. Addressing these barriers will require identification of phenotypes that progress to PCP and diagnostic cut-offs for colonization, generation of life-form specific markers, comparison of commercial PCR assays, investigation of cost-effective point of care options, evaluation of host factors such as HIV status that may impact diagnosis, and identification of markers of genetic diversity that may be useful in diagnostic panels. Performing high-quality studies and educating physicians will be crucial to improve the rates of diagnosis of PCP and ultimately to improve patient outcomes.

scholarly journals Pneumocystis jirovecii pneumonia in AIDS and non-AIDS immunocompromised patients – an update

2018 ◽  
Vol 12 (10) ◽  
pp. 824-834 ◽  
Author(s):  
Yuan-Ti Lee ◽  
Ming-Lung Chuang
Keyword(s):  
Mortality Rate ◽  
Clinical Manifestations ◽  
Lactic Dehydrogenase ◽  
Diagnosis And Treatment ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Aids Patients ◽  
Chain Reactions ◽  
Increased Risk

Introduction: Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients. Methodology: We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017. Results: The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial. Conclusions: Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.

scholarly journals Development of a Droplet Digital Polymerase Chain Reaction for Sensitive Detection of Pneumocystis jirovecii in Respiratory Tract Specimens

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Yi ◽  
Nan Wang ◽  
Jie Wu ◽  
Yueming Tang ◽  
Jingjia Zhang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Digital Pcr ◽  
Absolute Quantification ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii ◽  
Immunocompromised Patients ◽  
Balf Sample ◽  
Bronchoalveolar Fluid ◽  
Life Threatening ◽  
Digital Polymerase Chain Reaction

Background:Pneumocystis jirovecii is a human-specific opportunistic fungus that causes Pneumocystis pneumonia (PCP), a life-threatening opportunistic lung infection that affects immunocompromised patients. P. jirovecii colonization may be linked to the transmission of the infection. The detection of P. jirovecii in immunocompromised patients is thus especially important. The low fungal load and the presence of PCR inhibitors limit the usefulness of quantitative PCR (qPCR) for accurate absolute quantification of P. jirovecii in specimens. Droplet digital PCR (ddPCR), however, presents a methodology that allows higher sensitivity and accuracy. Here, we developed a ddPCR method for detecting P. jirovecii DNA in respiratory specimens, and evaluated its sensitivity against qPCR.Materials and Methods: One bronchoalveolar fluid (BALF) sample each was collected from 82 patients with potential PCP to test the presence of P. jirovecii DNA using both ddPCR and qPCR, and samples with inconsistent results between the two methods were further tested by metagenomic next generation sequencing (mNGS). In addition, 37 sputum samples from 16 patients diagnosed with PCP, as well as continuous respiratory tract specimens from nine patients with PCP and treated with sulfonamides, were also collected for P. jirovecii DNA testing using both ddPCR and qPCR.Results: ddPCR and qPCR gave the same results for 95.12% (78/82) of the BALF samples. The remaining four specimens tested positive using ddPCR but negative using qPCR, and they were found to be positive by mNGS. Detection results of 78.37% (29/37) sputum samples were consistent between ddPCR and qPCR, while the other eight samples tested positive using ddPCR but negative using qPCR. The P. jirovecii load of patients with PCP decreased to undetectable levels after treatment according to qPCR, but P. jirovecii was still detectable using ddPCR.Conclusions: ddPCR was more sensitive than qPCR, especially at detecting low-pathogen-load P. jirovecii. Thus, ddPCR represents a useful, viable, and reliable alternative to qPCR in P. jirovecii testing in patients with immunodeficiency.

scholarly journals Prevalence and Genotyping of Pneumocystis jirovecii Pneumonia in Patients with Previously Untreated Acute Myeloid Leukemia

2021 ◽  
Vol 5 (1) ◽  
pp. 3
Author(s):  
Valentina Del Prete ◽  
Giovangiacinto Paterno ◽  
David Di Cave ◽  
Luca Guarnera ◽  
Raffaele Palmieri ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Bronchoalveolar Lavage ◽  
Myeloid Leukemia ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Genotype 1 ◽  
Genotype 3 ◽  
Acute Myeloid

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection affecting immunocompromised patients. Patients with acute myeloid leukemia (AML) are not considered at high risk of PJP, thus, prophylaxis is not recommended. Between 2010 and 2020 we retrospectively analyzed 251 AML patients. We performed molecular diagnosis and genotyping of Pneumocystis jirovecii in 67 bronchoalveolar lavage samples. Eleven cases of PJP were diagnosed, with a prevalence of 4.3%. Our study confirms that the most widespread genotype in Europe is genotype 1; in our patients, 70% presented with genotype 1 and 30% the genotype 3.

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