Pneumocystis jirovecii pneumonia in patients with or without AIDS, France.

Pneumocystis jirovecii pneumonia (PCP) in patients without AIDS is increasingly common. We conducted a prospective cohort study of consecutive patients with proven PCP; of 544 patients, 223 (41%) had AIDS (AIDS patients) and 321 (59%) had other immunosuppressive disorders (non-AIDS patients). Fewer AIDS than non-AIDS patients required intensive care or ventilation, and the rate of hospital deaths--17.4% overall--was significantly lower for AIDS versus non-AIDS patients (4% vs. 27%; p<0.0001). Multivariable analysis showed the odds of hospital death increased with older age, receipt of allogeneic bone marrow transplant, immediate use of oxygen, need for mechanical ventilation, and longer time to treatment; HIV-positive status or receipt of a solid organ transplant decreased odds for death. PCP is more often fatal in non-AIDS patients, but time to diagnosis affects survival and is longer for non-AIDS patients. Clinicians must maintain a high index of suspicion for PCP in immunocompromised patients who do not have AIDS.

Candidal abscess of the parotid gland due to Candida glabrata: report of a case and literature review.

We report the case of an immunocompetent woman who developed a Candida glabrata abscess of the parotid gland and present a review of similar cases from the literature. Diagnosis was based on the isolation of C. glabrata in pure culture from the abscess pus. Examination of stained smears of the same material demonstrated small sized yeast cells, some being intra-macrophagic. Combination of a local drainage and oral fluconazole proved to be an efficient therapeutic strategy. Candidal abscesses are rare in immunocompetent patients and salivary gland localization has only been reported in five cases.

Problemáticas bioéticas en ingeniería / Bioethical problems in Engineering

Entre las competencias profesionales de los ingenieros se encuentran el diseño y mantenimiento de dispositivos utilizados en medicina. Es importante y necesario que los estudiantes y graduados en Ingeniería cuenten con conocimientos básicos de los conceptos y problemáticas planteados por la bioética. Los objetivos del presente trabajo consisten en analizar en qué medida la bioética está incorporada en los currículos de Ingeniería de las universidades públicas y privadas de la Argentina, indagar qué posturas, opiniones e ideas sostienen estudiantes, docentes y graduados respecto de los problemas centrales planteados por la bioética y contrastar los métodos y estrategias más adecuados para incorporar y llevar a la práctica la enseñanza dela bioética en carreras de Ingeniería, a través de un curso sobre Ingeniería y Bioética. Concluimos que, dentro de los valores característicos de la bioética debe incluirse la ética de la tecnología, caracterizada como una ética de la responsabilidad. Del estudio también surgió la necesidad de articular un lenguaje comprensible entre ingenieros y médicos. La realización de actividades conjuntas, tales como simposios, congresos y jornadas que impliquen el intercambio entre ingenieros y médicos, puede contribuir a la construcción del referido lenguaje y a la generación de una actitud bioética común

Among the professional competences of engineers are the design and maintenance of devices employed in medicine, it is important and necessary that students and graduates in engineering have a basic knowledge of the concepts and problems raised by bioethics. The objectives of this paper are to analyze the extent to which bioethics is incorporated into the Engineering curricula of public and private universities in Argentina; inquire which are the opinions and ideas that are held by students, teachers and engineering graduates regarding the central problems posed by bioethics and contrast through a course on Engineering and Bioethics, which are the most appropriate methods and strategies to incorporate and put into practice the teaching of bioethics in engineering careers. We conclude that, within the characteristic values of bioethics, the ethics of technology should be included, characterized as an ethic of responsibility. From the study also arose the need to articulate an understandable language among engineers and doctors. In this sense, the realization of joint activities, such as symposiums, congresses and lectures involving the exchange between them, can contribute to the construction of the aforementioned language, and to the generation of a common bioethical attitude.

Dado que entre as competências profissionais dos engenheiros estão o desenho e manutenção dos equipamentos usados em medicina, é importante e necessário que os estudantes e graduados em Engenharia possuam uma compreensão básica dos conceitos e questões levantadas pela Bioética. O alvo deste estudo é analisar a medida em que a Bioética é incorporada nos currículos de engenharia das universidades públicas e privadas da Argentina; pesquisar que posicionamentos, opiniões e ideias sustentam alunos, professores e graduados de Engenharia respeito dos problemas centrais da bioética e conferir, através de um curso em Engenharia e Bioética, quais são os métodos e estratégias mais apropriados para incorporar e pôr em prática no ensino de Bioética em carreiras de Engenharia. Conclui-se que, que dentro dos valores característicos da Bioética, deve-se incluir a ética da tecnologia, caracterizada como uma ética da responsabilidade. A partir do estudo também surgiu a necessidade de articular uma linguagem compreensível entre engenheiros e médicos. A realização de atividades conjuntas de intercâmbio, como simpósios, congressos e jornadas entre engenheiros e médicos, pode contribuir para a construção da linguagem referida e a geração de uma atitude bioética comum.

Genotypes at the internal transcribed spacers of the nuclear rRNA operon of Pneumocystis jiroveci in nonimmunosuppressed infants without severe pneumonia.

The frequency of Pneumocystis jiroveci (human-derived Pneumocystis) in immunocompetent infants developing acute respiratory syndromes has recently been evaluated and has been shown to be close to 25%. Until now, there have been no data on the genomic characteristics of the fungus in these patients, while molecular typing of P. jiroveci organisms was mostly performed with samples from immunosuppressed patients with pneumocystosis (Pneumocystis carinii pneumonia [PCP]). The present report describes the genotypes of P. jiroveci organisms in 26 nonimmunosuppressed infants developing a mild Pneumocystis infection contemporaneously with an episode of bronchioloalveolitis. The typing was based on sequence analysis of internal transcribed spacers (ITSs) 1 and 2 of the rRNA operon, followed by the use of two typing scores. By use of the first score, 11 P. jiroveci ITS types were identified: 10 were previously reported in immunosuppressed patients with PCP, while 1 was newly described. By use of the second score, 13 types were identified, of which 2 were newly described. The most frequent type was identified as type B(1)a(3) (first score), which corresponds to type Eg (second score). Mixed infections were diagnosed in three infants. The occurrence of such diversity of P. jiroveci ITS types, an identical main type, and mixed infections has previously been reported in immunosuppressed patients with PCP. Thus, the P. jiroveci ITS genotypes detected in immunocompetent infants and immunosuppressed patients developing different forms of Pneumocystis infection share characteristics, suggesting that both groups of individuals make up a common human reservoir for the fungus. Finally, the frequency of P. jiroveci in nonimmunosuppressed infants with acute respiratory syndromes and the genotyping results provide evidence that this infant population is an important reservoir for the fungus.

Similar genotypes of Pneumocystis jirovecii in different forms of Pneumocystis infection.

This study describes the genotyping of Pneumocystis jirovecii organisms isolated from three groups of patients that developed diverse forms of P. jirovecii infection; the patients were monitored in the same French hospital. Forty archival specimens from 13 adults with Pneumocystis pneumonia, eight adults colonized by P. jirovecii and 19 immunocompetent infants infected with the fungus contemporaneously with a bronchiolitis episode were analysed retrospectively. Genotyping was performed by analysis of sequences of the internal transcribed spacer (ITS)1 and ITS2 regions, and of the dihydropteroate synthase (DHPS) locus. At the ITS regions, a high diversity of genotypes, identical main genotypes (B(1)a(3) and B(2)a(1)) and the occurrence of mixed infections (more than one genotype) were observed in the three patient groups. At the DHPS locus, the results indicated the presence of mutants in the two adult groups, as well as in the infant group. Consequently, at these two independent genomic regions, P. jirovecii isolates from patients who developed different forms of infection and who lived in the same geographical region presented common characteristics. These results suggest that patients infected with P. jirovecii, whatever the form of infection they present, are part of a common human reservoir for P. jirovecii.

Strain typing methods and molecular epidemiology of Pneumocystis pneumonia.

Pneumocystis pneumonia (PCP) caused by the opportunistic fungal agent Pneumocystis jirovecii (formerly P. carinii) continues to cause illness and death in HIV-infected patients. In the absence of a culture system to isolate and maintain live organisms, efforts to type and characterize the organism have relied on polymerase chain reaction-based approaches. Studies using these methods have improved understanding of PCP epidemiology, shedding light on sources of infection, transmission patterns, and potential emergence of antimicrobial resistance. One concern, however, is the lack of guidance regarding the appropriateness of different methods and standardization of these methods, which would facilitate comparing results reported by different laboratories.

Pneumocystis jirovecii dihydropteroate synthase genotypes in immunocompetent infants and immunosuppressed adults, Amiens, France.

To date, investigations of Pneumocystis jirovecii circulation in the human reservoir through the dihydropteroate synthase (DHPS) locus analysis have only been conducted by examining P. jirovecii isolates from immunosuppressed patients with Pneumocystis pneumonia (PCP). Our study identifies P. jirovecii genotypes at this locus in 33 immunocompetent infants colonized with P. jirovecii contemporaneously with a bronchiolitis episode and in 13 adults with PCP; both groups of patients were monitored in Amiens, France. The results have pointed out identical features of P. jirovecii DHPS genotypes in the two groups, suggesting that in these groups, transmission cycles of P. jirovecii infections are linked. If these two groups represent sentinel populations for P. jirovecii infections, our results suggest that all persons parasitized by P. jirovecii, whatever their risk factor for infection and the form of parasitism they have, act as interwoven circulation networks of P. jirovecii.

Immunocompetent infants as a human reservoir for Pneumocystis jirovecii: rapid screening by non-invasive sampling and real-time PCR at the mitochondrial large subunit rRNA gene.

We tested a real-time PCR assay targeting the Pneumocystis jirovecii mitochondrial large subunit rRNA gene on 240 archival nasopharyngeal aspirates from non-immunosuppressed infants. The sensitivity of this assay appeared close to that of a conventional nested-PCR assay targeting the same locus. Because of its one-step procedure, and its sensitivity and rapidity, the real-time PCR assay is particularly suitable for screening individuals parasitized by P. jirovecii within large populations.

Multilocus genotyping of Pneumocystis jirovecii in patients developing diverse forms of parasitism: implication for a wide human reservoir for the fungus.

Pneumocystis jirovecii ITS and DHPS genotypes were identified in 3 patient groups developing diverse forms of P. jirovecii infections: 13 patients with Pneumocystis pneumonia, 8 patients merely colonized by the fungus, and 19 immunocompetent infants with bronchiolitis developing mild P. jirovecii infection. Common P. jirovecii genotypes were found in the 3 patient groups, suggesting that common sources of P. jirovecii were involved in the fungus acquisition, and that transmission cycles of P. jirovecii infections in these patient groups are not independent. Parasitized patients, whatever the form of parasitism they present, may be part of a common reservoir for P. jirovecii.

Les maladies inflammatoires de l'enfant / The inflammatory diseases of the child

Le chapitre des maladies inflammatoires de l'enfant est un sujet dont l'interet est grandissant et auquel, de plus en plus souvent, nous devons faire face dans nos consultations pediatriques de ville. Il est... (AU)