Pneumocystosis versus pulmonary Pneumocystis carinii colonization in HIV-negative and HIV-positive patients

Nevez, Gilles; Raccurt, C. P.; Jounieaux, Vincent; Dei‐Cas, Eduardo; Mazars, Edith

doi:10.1097/00002030-199903110-00020

Cited by 80 publications

(51 citation statements)

References 5 publications

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“…The prevalence of pulmonary P. carinii colonisation among HIV-positive and HIV-negative patients was investigated previously and was reported to be not significant (11.4% versus 15.9%, respectively; Fisher's test, p ¼ 0:59) [13]. In the present study, P. carinii colonisation was observed among HIV-infected individuals significantly more frequently than among immunocompromised patients without HIV infection (26.9% versus 8.9%, p ¼ 0.048).…”

Section: Discussionmentioning

confidence: 96%

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

Takahashi¹,

Goto²,

Endo³

et al. 2002

Journal of Medical Microbiology

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Eighty-one bronchoalveolar lavage (BAL) specimens obtained from 26 HIV-infected, 45 non-HIV immunosuppressed and 10 immunocompetent patients with primary pulmonary diseases were analysed for the presence of Pneumocystis carinii by staining and by P. carinii 5S rDNA determined by PCR. P. carinii was observed by staining of BAL specimens from HIV-infected patients significantly more frequently than those from immunocompromised hosts without HIV infection (57.7% versus 20.0%, respectively). P. carinii 5S rDNA was detected by PCR assay in seven (26.9%) HIV-infected individuals, which was significantly more frequent than for four (8.9%) immunosuppressed patients without HIV infection, for whom staining was negative. None of these patients developed P. carinii pneumonia (PCP) within the follow-up period. BAL specimens from 10 immunocompetent patients with pulmonary disorders were negative for PCP by both staining and PCR assay.

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Section: Discussionmentioning

confidence: 96%

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

Takahashi¹,

Goto²,

Endo³

et al. 2002

Journal of Medical Microbiology

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“…[12][13][14] Alternatively, acute GVHD and high-dose steroids and cyclosporine in these patients could have triggered PCP despite the use of prophylaxis, maybe because of low intestinal absorption of the prophylactic regimen or resistance of P. jiroveci to sulfonamides through the selection of mutations in the dihydropteroate synthase gene. 15,16 The 10 other patients developed a late onset PCP, a median of 14.5 months after engraftment.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study

Castro

Neuville

Sarfati

et al. 2005

Bone Marrow Transplant

123

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Summary:Pneumocystis jiroveci pneumonia (PCP) has become a rare opportunistic infection due to the efficacy of prophylactic regimens. We conducted a 6-year retrospective study at our institution. A total of 13 cases of PCP were diagnosed among 519 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (2.5%). In three patients, PCP occurred within the first 5 months following HSCT. These severely immunocompromised patients were receiving prophylaxis and had concomitant aspergillosis that caused rapid death in two of them. In 10 other patients, PCP occurred a median of 14.5 months after HSCT. In all these patients, PCP prophylaxis had been discontinued, mainly because of the suspected bone-marrow toxicity of the prophylactic regimen. Median CD4 þ T cell count was 131/ll at diagnosis. Seven of these 10 patients were receiving immunosuppressive therapy for chronic graft versus host disease and three had a relapse of their hematological malignancy. One patient died from PCP despite high doses of cotrimoxazole. We conclude that PCP is still occurring after allogeneic HSCT, mainly as a late complication in patients in whom PCP prophylaxis had been prematurely discontinued. Long-term PCP prophylaxis should be maintained in patients receiving immunosuppressive drugs, and in those with low CD4 þ T cell counts or a relapse of their hematological malignancy. Pneumocystis jiroveci is an atypical fungus causing severe pneumonia in immunocompromised patients, particularly among allogeneic hematopoietic stem cell transplant (HSCT) recipients. 1 Before the use of prophylaxis, 5-16% of patients who received allogeneic marrow transplants developed P. jiroveci pneumonia (PCP) with a median onset at 9 weeks post-transplantation and a mortality rate of up to 76%. 2,3 Since the use of effective prophylaxis with trimethoprim-sulfamethoxazole, less than 5% of HSCT recipients still develop PCP. 2,4,5 However, recent studies have reported the occurrence of late onset PCP in patients discontinuing prophylaxis after the first 6 months posttransplant. 4,6 These reports gave rise to the recommendation of prescribing PCP prophylaxis throughout all periods of immunocompromise after engraftment. 7 These recommendations, however, do not clearly define parameters that could be used to determine the best time for discontinuing prophylaxis in HSCT recipients, as recent studies have shown a long-lasting defect in CD4 þ T cells in these patients. 8,9 Following the occurrence of PCP among three HSCT recipients in our center in 2002, we decided to undertake a retrospective study of all cases of PCP diagnosed among HSCT recipients within the last 6 years. Patients and methodsIn order to describe the clinical characteristics of recent cases of PCP, we retrospectively reviewed the charts of all patients who underwent an allogeneic HSCT and who developed PCP between January 1997 and December 2002 at our institution. Patients were identified through the computerized records of the laboratory of parasitology, by the identification of P...

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“…Indeed, several populations have been identified as being colonized by the fungus. Low burden of P. jirovecii organisms have been detected using PCR assays in patients with various levels of immunodeficiency (Nevez et al, 1999a;Nevez et al, 1999b), with acute or chronic pulmonary diseases (Calderon et al, 1996;Armbruster et al, 1997;Sing et al, 1999b;Nevez et al, 2002), immunonaive infants with P. jirovecii primary infection (Nevez et al, 2001a, Vargas et al, 2001, pregnant women with physiological immunity changes (Vargas et al, 2003), and health care workers in contact with patients with PCP (Miller et al, 2001, Durand-Joly et al, 2003, reviewed in Peterson et al, 2005. In fact, Pneumocystis infections can have a large spectrum of presentations, of which PCP in immunocompromised patients may represent only a part, while mild infections such as colonization may constitute the major part.…”

Section: Colonized Subjects As Potential Sources Of P Jiroveciimentioning

confidence: 99%

NosocomialPneumocystis jiroveciiinfections

et al. 2008

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Summary :Airborne transmission of Pneumocystis sp. from host to host has been demonstrated in rodent models and several observations suggest that interindividual transmission occurs in humans. Moreover, it is accepted that the Pneumocystis organisms infecting each mammalian species are host specific and that the hypothesis of an animal reservoir for Pneumocystis jirovecii (P. jirovecii), the human-specific Pneumocystis species, can be excluded. An exosaprophytic form of the fungus cannot be strictly ruled out. However, these data point toward the potential for the specific host to serve as its own reservoir and for Pneumocystis infection in humans as an anthroponosis with humans as a reservoir for P. jirovecii. This review highlights the main data on host-to-host transmission of Pneumocystis in rodent models and in humans by the airborne route and provides a rationale for considering the occurrence of nosocomial infections and measures for their prevention KEY WORDS : Pneumocystis jirovecii, nosocomial infections, genotyping.

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Pneumocystosis versus pulmonary Pneumocystis carinii colonization in HIV-negative and HIV-positive patients

Cited by 80 publications

References 5 publications

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study

NosocomialPneumocystis jiroveciiinfections

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