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Hu J, Yao Y, Wang J, Fu X, Fu B. Non-small cell lung cancer with bone metastasis and pneumocystis pneumonia in a pregnant woman: a case report and literature review. BMC Infect Dis 2023; 23:792. [PMID: 37964211 PMCID: PMC10644424 DOI: 10.1186/s12879-023-08790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Cancer case during pregnancy is rare, but it is the second leading cause of maternal mortality. CASE PRESENTATION A-32-year old pregnant woman with a gestational age of 37 weeks was admitted to the hospital due to repeated coughing for 5 months. She received Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) treatment for severe hypoxemia after delivery. She was diagnosed with non-small cell lung cancer (NSCLC) with bone metastasis and pneumocystis pneumonia (PCP). She subsequently received anti-tumor therapy and anti-infective therapy. After treatment, her condition improved and she was weaned from ECMO. Two weeks after weaning ECMO, her condition worsened again. Her family chose palliative treatment, and she ultimately died. CONCLUSIONS NSCLC is rare during pregnancy. At present, there is still a lack of standardized methods to manage these cases. For theses cases, the clinician should be wary of opportunistic infections, such as pneumocystis jirovecii (P. jirovecii) and Elizabethkingia spp. Specialized medical teams with abundant experience and multidisciplinary discussions from the perspectives of the patient's clinical characteristics as well as preferences are crucial for developing individualized and the best approach.
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Affiliation(s)
- Jie Hu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Dalian road 149, Zunyi city, Guizhou province, China
| | - Yuantuan Yao
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Dalian road 149, Zunyi city, Guizhou province, China
| | - Jinjing Wang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi city, Guizhou province, China
| | - Xiaoyun Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Dalian road 149, Zunyi city, Guizhou province, China.
| | - Bao Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Dalian road 149, Zunyi city, Guizhou province, China.
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2
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Xue T, Kong X, Ma L. Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection. J Fungi (Basel) 2023; 9:812. [PMID: 37623583 PMCID: PMC10455156 DOI: 10.3390/jof9080812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/19/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
The increasing morbidity and mortality of life-threatening Pneumocystis pneumonia (PCP) in immunocompromised people poses a global concern, prompting the World Health Organization to list it as one of the 19 priority invasive fungal diseases, calling for increased research and public health action. In response to this initiative, we provide this review on the epidemiology of PCP in non-HIV patients with various immunodeficient conditions, including the use of immunosuppressive agents, cancer therapies, solid organ and stem cell transplantation, autoimmune and inflammatory diseases, inherited or primary immunodeficiencies, and COVID-19. Special attention is given to the molecular epidemiology of PCP outbreaks in solid organ transplant recipients; the risk of PCP associated with the increasing use of immunodepleting monoclonal antibodies and a wide range of genetic defects causing primary immunodeficiency; the trend of concurrent infection of PCP in COVID-19; the prevalence of colonization; and the rising evidence supporting de novo infection rather than reactivation of latent infection in the pathogenesis of PCP. Additionally, we provide a concise discussion of the varying effects of different immunodeficient conditions on distinct components of the immune system. The objective of this review is to increase awareness and knowledge of PCP in non-HIV patients, thereby improving the early identification and treatment of patients susceptible to PCP.
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Affiliation(s)
- Ting Xue
- NHC Key Laboratory of Pneumoconiosis, Key Laboratory of Prophylaxis and Treatment and Basic Research of Respiratory Diseases of Shanxi Province, Shanxi Province Key Laboratory of Respiratory, Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Xiaomei Kong
- NHC Key Laboratory of Pneumoconiosis, Key Laboratory of Prophylaxis and Treatment and Basic Research of Respiratory Diseases of Shanxi Province, Shanxi Province Key Laboratory of Respiratory, Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Liang Ma
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD 20892, USA
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3
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Friaza V, de Armas Y, Capó V, Morilla R, Plascencia-Hernández A, Pérez-Gómez HR, Iglesias E, Fonte L, de la Horra C, Calderón EJ. Multilocus Genotyping of Pneumocystis jirovecii from Deceased Cuban AIDS Patients Using Formalin-Fixed and Paraffin-Embedded Tissues. J Fungi (Basel) 2021; 7:jof7121042. [PMID: 34947024 PMCID: PMC8706017 DOI: 10.3390/jof7121042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
The results of the genotypic characterization of Pneumocystis jirovecii are described in lung tissue samples from 41 Cubans who died of AIDS with pneumocystosis between 1995 and 2008. Histological sections of the lung preserved as formalin-fixed and paraffin-embedded tissue were examined. PCR amplification and nucleotide sequencing of the two mitochondrial genes (large and small) of the pathogen allowed verification of a predominance of genotype 3 (85T/248C) of the large mitochondrial gene and genotype 3 (160A/196T) of the small mitochondrial gene over a period of 14 years (1995–2008). These results suggest that the 85T/248C//160A/196T genotype circulates with the highest frequency (81.3%) among AIDS patients in Cuba. Multilocus analysis indicates a limited circulation of pathogen genotypes on the island with the existence of a clonal genotype with an epidemic structure. Furthermore, it appears that circulating strains of P. jirovecii have not developed mutations related to sulfonamide resistance. Taken together, the data in this study revealed important elements about pneumocystosis in Cuban patients dying of AIDS and the usefulness of formalin-fixed and paraffin-embedded samples to carry out molecular epidemiology studies of P. jirovecii.
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Affiliation(s)
- Vicente Friaza
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Seville, Spain; (V.F.); (R.M.); (E.J.C.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Yaxsier de Armas
- Department of Clinical Microbiology Diagnostic, Hospital Center of Institute of Tropical Medicine “Pedro Kourí”, 11400 Havana, Cuba;
- Pathology Department, Hospital Center of Institute of Tropical Medicine “Pedro Kourí”, 11400 Havana, Cuba;
| | - Virginia Capó
- Pathology Department, Hospital Center of Institute of Tropical Medicine “Pedro Kourí”, 11400 Havana, Cuba;
| | - Rubén Morilla
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Seville, Spain; (V.F.); (R.M.); (E.J.C.)
| | - Arturo Plascencia-Hernández
- Centro Universitario de Ciencias para la Salud, Universidad de Guadalajara, 44100 Guadalajara, Mexico; (A.P.-H.); (H.R.P.-G.)
| | - Héctor R. Pérez-Gómez
- Centro Universitario de Ciencias para la Salud, Universidad de Guadalajara, 44100 Guadalajara, Mexico; (A.P.-H.); (H.R.P.-G.)
| | - Enrique Iglesias
- Centro de Ingeniería Genética y Biotecnología, Departamento de Vacunas, 10600 Havana, Cuba;
| | - Luis Fonte
- Parasitology Department, Institute of Tropical Medicine “Pedro Kourí”, 11400 Havana, Cuba;
| | - Carmen de la Horra
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Seville, Spain; (V.F.); (R.M.); (E.J.C.)
- Correspondence:
| | - Enrique J. Calderón
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Seville, Spain; (V.F.); (R.M.); (E.J.C.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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4
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Is It Possible to Differentiate Pneumocystis jirovecii Pneumonia and Colonization in the Immunocompromised Patients with Pneumonia? J Fungi (Basel) 2021; 7:jof7121036. [PMID: 34947017 PMCID: PMC8707387 DOI: 10.3390/jof7121036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Abstract
Although the incidence of Pneumocystis pneumonia (PCP) has decreased since the introduction of combination antiretroviral therapy, it remains an important cause of disease in both HIV-infected and non-HIV-infected immunosuppressed populations. The epidemiology of PCP has shifted over the course of the HIV epidemic both from changes in HIV and PCP treatment and prevention and from changes in critical care medicine. Although less common in non-HIV-infected immunosuppressed patients, PCP is now more frequently seen due to the increasing numbers of organ transplants and development of novel immunotherapies. New diagnostic and treatment modalities are under investigation. The immune response is critical in preventing this disease but also results in lung damage, and future work may offer potential areas for vaccine development or immunomodulatory therapy. Colonization with Pneumocystis is an area of increasing clinical and research interest and may be important in development of lung diseases such as chronic obstructive pulmonary disease. In this review, we discuss current clinical and research topics in the study of Pneumocystis and highlight areas for future research.
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Benamrouz S, Conseil V, Creusy C, Calderon E, Dei-Cas E, Certad G. Parasites and malignancies, a review, with emphasis on digestive cancer induced by Cryptosporidium parvum (Alveolata: Apicomplexa). Parasite 2012; 19:101-15. [PMID: 22348213 PMCID: PMC3671432 DOI: 10.1051/parasite/2012192101] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The International Agency for Research on Cancer (IARC) identifies ten infectious agents (viruses, bacteria, parasites) able to induce cancer disease in humans. Among parasites, a carcinogenic role is currently recognized to the digenetic trematodes Schistosoma haematobium, leading to bladder cancer, and to Clonorchis sinensis or Opisthorchis viverrini, which cause cholangiocarcinoma. Furthermore, several reports suspected the potential association of other parasitic infections (due to Protozoan or Metazoan parasites) with the development of neoplastic changes in the host tissues. The present work shortly reviewed available data on the involvement of parasites in neoplastic processes in humans or animals, and especially focused on the carcinogenic power of Cryptosporidium parvum infection. On the whole, infection seems to play a crucial role in the etiology of cancer.
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Affiliation(s)
- S Benamrouz
- Biologie & Diversité des Pathogènes Eucaryotes Émergents (BDEEP), Centre d'Infection et d'Immunité de Lille (CIIL), INSERM U1019, CNRS UMR8402, EA4547, Université Lille Nord-de-France, Institut Pasteur de Lille, France
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7
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Gutiérrez S, Respaldiza N, Campano E, Martínez-Risquez MT, Calderón EJ, De La Horra C. Pneumocystis jirovecii colonization in chronic pulmonary disease. Parasite 2011; 18:121-6. [PMID: 21678787 PMCID: PMC3671413 DOI: 10.1051/parasite/2011182121] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pneumocystis jirovecii causes pneumonia in immunosuppressed individuals. However, it has been reported the detection of low levels of Pneumocystis DNA in patients without signs and symptoms of pneumonia, which likely represents colonization. Several studies performed in animals models and in humans have demonstrated that Pneumocystis induces a local and a systemic response in the host. Since P. jirovecii colonization has been found in patients with chronic pulmonary diseases it has been suggested that P. jirovecii may play a role in the physiopathology and progression of those diseases. In this report we revise P. jirovecii colonization in different chronic pulmonary diseases such us, chronic obstructive pulmonary disease, interstitial lung diseases, cystic fibrosis and lung cancer.
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Affiliation(s)
- S Gutiérrez
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
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8
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Wiwatanadate P. Lung Cancer Related to Environmental and Occupational Hazards and Epidemiology in Chiang Mai, Thailand. Genes Environ 2011. [DOI: 10.3123/jemsge.33.120] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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9
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Smith CJ, Perfetti TA, King JA. Perspectives on Pulmonary Inflammation and Lung Cancer Risk in Cigarette Smokers. Inhal Toxicol 2008; 18:667-77. [PMID: 16864557 DOI: 10.1080/08958370600742821] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cigarette mainstream smoke (MSS) inhaled by smokers is a complex aerosol composed of minute liquid droplets suspended within a mixture of combustion gases (CO, CO2, NOx, etc.) and semivolatile compounds. The minute liquid droplets represent the particulate or "tar" phase, while the combustion gases and semivolatiles comprise the vapor phase. For historical and technical reasons, the vast majority of studies on the carcinogenicity of MSS have focused on the particulate phase. The particulate phase is mutagenic and cytotoxic in vitro, proinflammatory, and promotes tumor formation in animal models. In addition to cytotoxic compounds found in the particulate phase, the vapor phase of MSS contains a number of cytotoxic constituents including reactive aldehydes and carbonyls capable of damaging cells and inducing pulmonary inflammation. A large body of evidence suggests that smoking-induced pulmonary inflammation may play an important role in increasing lung cancer risk in smokers. Use of aspirin and nonsteroidal anti-inflammatory drugs is associated with reduced cancer development in animal models and lower lung cancer rates in smokers. A number of benign nonpulmonary and pulmonary diseases characterized by chronic inflammation increase the risk of cancer at the affected site in the absence of chemical exposure. Animal models displaying tumorigenic responses following exposure to either whole smoke or smoke fractions show elevated rates of cellular proliferation. A relationship between pulmonary inflammation and lung cancer is mechanistically plausible because inflammatory cells secrete activated oxygen species, inflammatory mediators, and proteolytic enzymes that can both damage DNA and lead to increases in reparative cell proliferation rates.
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Affiliation(s)
- Carr J Smith
- Department of Pathology, University of South Alabama College of Medicine, Mobile, Alabama, USA.
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10
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Morris A, Wei K, Afshar K, Huang L. Epidemiology and Clinical Significance ofPneumocystisColonization. J Infect Dis 2008; 197:10-7. [DOI: 10.1086/523814] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Chuang C, Zhanhong X, Yinyin G, Qingsi Z, Shuqing Z, Nanshan Z. Unsuspected Pneumocystis pneumonia in an HIV-seronegative patient with untreated lung cancer: circa case report. J Med Case Rep 2007; 1:115. [PMID: 17963527 PMCID: PMC2147019 DOI: 10.1186/1752-1947-1-115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 10/28/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with solid malignant tumours are at increased risk of Pneumocystis jiroveci infection from immunosuppression as a result of chemotherapy and/or radiotherapy, but active Pneumocystis pneumonia (PCP) in untreated lung cancer is uncommon. CASE PRESENTATION A 43-year-old woman presented with prolonged fever, progressive dyspnoea, diffuse alveolar and interstitial infiltrates. Malignant cells were found on sputum cytology, confirming the diagnosis of lung cancer. She had been treated with corticosteroids and antibiotics but did not receive chemotherapy or radiotherapy. Pneumocystis jiroveci was later found in the sputum but she proved to be HIV negative. CONCLUSION Unsuspected PCP can occur in chemotherapy and radiotherapy-naïve, HIV-seronegative patients with lung cancer. The complex clinicoradiological manifestations of PCP with underlying lung cancer can lead to delay in diagnosis and may worsen the prognosis.
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Affiliation(s)
- Cai Chuang
- Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510012, China, .
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Vidal S, de la Horra C, Martín J, Montes-Cano MA, Rodríguez E, Respaldiza N, Rodríguez F, Varela JM, Medrano FJ, Calderón EJ. Pneumocystis jirovecii colonisation in patients with interstitial lung disease. Clin Microbiol Infect 2006; 12:231-5. [PMID: 16451409 DOI: 10.1111/j.1469-0691.2005.01337.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A prospective study was conducted to determine the prevalence of colonisation by Pneumocystis jirovecii in 80 consecutive patients who required bronchoscopy and bronchoalveolar lavage (BAL) following suspicion of interstitial lung disease (ILD). The mtLSU rRNA gene of P. jirovecii was identified by nested PCR in BAL samples. Patients with ILDs were divided into three groups: group A comprised those with idiopathic interstitial pneumonias; group B comprised those with sarcoidosis; and group C comprised those with other ILDs. The overall prevalence of P. jirovecii carriage was 33.8%, with colonisation rates of 37.8%, 18.8% and 37% in groups A, B and C, respectively (p not significant). There were more smokers among the carriers, but there were no other significant differences between carriers and non-carriers. The high prevalence of P. jirovecii carriers found among immunocompetent patients with ILDs in Spain suggests a possible role of P. jirovecii in the natural history of these diseases.
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Affiliation(s)
- S Vidal
- Department of Pneumology, Virgen del Rocío University Hospital, Seville, Spain.
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Medrano FJ, Montes-Cano M, Conde M, de la Horra C, Respaldiza N, Gasch A, Perez-Lozano MJ, Varela JM, Calderon EJ. Pneumocystis jirovecii in general population. Emerg Infect Dis 2005; 11:245-50. [PMID: 15752442 PMCID: PMC3320436 DOI: 10.3201/eid1102.040487] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The possible presence of Pneumocystis among healthy adults was examined by detecting Pneumocystis jirovecii-specific DNA in prospectively obtained oropharyngeal wash samples from 50 persons without underlying lung disease or immunosuppression. Pneumocystis carriage, defined by detecting Pneumocystis DNA by nested polymerase chain reaction in 2 independent analyses plus successful mitochondrial large subunit ribosomal RNA typing by direct sequencing, was found in 20% of cases. All carriers were asymptomatic, anti-HIV negative, and had normal total lymphocyte and CD4+ cell counts. A second sample obtained in the 6-month follow-up was positive in 2 of 9 available carriers. Genotype analysis showed different polymorphisms; 85A/248C (40%) and 85C/248C (30%) were most frequently observed. This study provides the first evidence that P. jirovecii DNA can be frequently detected in the respiratory tract of immunocompetent adults, which agrees with the hypothesis that the general population could be a reservoir and source of this infection.
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Affiliation(s)
- Francisco J Medrano
- Department of Internal Medicine, Virgen del Rocío University Hospital, Avda Manuel Siurot s/n, 41013 Seville, Spain.
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