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Reacción en Cadena de la Polimerasa , Humanos , Reacciones Falso Negativas , Pneumocystis/genética , Pneumocystis/aislamiento & purificación , Pneumocystis/clasificación , Pneumocystis carinii/genética , Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/microbiología , Reacción en Cadena de la Polimerasa/métodosRESUMEN
BACKGROUND: PCR is more sensitive than immunofluorescence assay (IFA) for detection of Pneumocystis jirovecii. However, PCR cannot always distinguish infection from colonization. This study aimed to compare the performance of real-time PCR and IFA for diagnosis of P. jirovecii pneumonia (PJP) in a real-world clinical setting. METHODS: A retrospective cohort study was conducted at a 1,300-bed hospital between April 2017 and December 2018. Patients whose respiratory sample (bronchoalveolar lavage or sputum) were tested by both Pneumocystis PCR and IFA were included. Diagnosis of PJP was classified based on multicomponent criteria. Sensitivity, specificity, 95% confidence intervals (CI), and Cohen's kappa coefficient were calculated. RESULTS: There were 222 eligible patients. The sensitivity and specificity of PCR was 91.9% (95% CI, 84.0%-96.7%) and 89.7% (95% CI, 83.3%-94.3%), respectively. The sensitivity and specificity of IFA was 7.0% (95% CI, 2.6%-14.6%) and 99.2% (95% CI, 95.6%-100.0%), respectively. The percent agreement between PCR and IFA was 56.7% (Cohen's kappa -0.02). Among discordant PCR-positive and IFA-negative samples, 78% were collected after PJP treatment. Clinical management would have changed in 14% of patients using diagnostic information, mainly based on PCR results. CONCLUSIONS: PCR is highly sensitive compared with IFA for detection of PJP. Combining clinical, and radiological features with PCR is useful for diagnosis of PJP, particularly when respiratory specimens cannot be promptly collected before initiation of PJP treatment.
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Técnica del Anticuerpo Fluorescente/métodos , Técnicas de Diagnóstico Molecular/métodos , Neumonía por Pneumocystis/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Adulto , Anciano , Líquido del Lavado Bronquioalveolar/microbiología , Femenino , Técnica del Anticuerpo Fluorescente/normas , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Diagnóstico Molecular/normas , Pneumocystis/genética , Pneumocystis/aislamiento & purificación , Pneumocystis/patogenicidad , Neumonía por Pneumocystis/microbiología , Reacción en Cadena en Tiempo Real de la Polimerasa/normas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Esputo/microbiologíaRESUMEN
No disponible
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Humanos , Femenino , Adulto , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/virología , Infecciones por VIH/diagnóstico , Neumonía por Pneumocystis/diagnóstico , Diagnóstico Diferencial , Pandemias/estadística & datos numéricos , VIH/aislamiento & purificación , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo/aislamiento & purificación , Pneumocystis/aislamiento & purificaciónRESUMEN
AIM: Pneumocystis pneumonia (PCP) has a high mortality rate in HIV-negative immunocompromised patients, but is preventable with antimicrobial prophylaxis. We aimed to determine the incidence of PCP in three hospitals in Auckland, New Zealand that would have been potentially preventable if patients had been prescribed prophylaxis according to commonly proposed indications. METHODS: We conducted a retrospective study of HIV-negative adults with PCP who were admitted to Middlemore, North Shore or Waitakere Hospitals between January 2011 and June 2017. We classified their PCP as potentially preventable if they had not been prescribed prophylaxis despite having a commonly proposed indication for this. RESULTS: Of the 108 patients with PCP, 33/108 (30.6%) had potentially preventable infection. Of these, 14/33 (42.4%) died within 30 days of diagnosis of PCP. Most potentially preventable infections occurred in patients with solid organ or haematologic malignancies who were receiving high-dose corticosteroids for >4 weeks. We estimate that 28 cases of PCP and 12 deaths could have been prevented over the study duration if prophylaxis was prescribed to those with commonly proposed indications. CONCLUSION: There is a substantial incidence of potentially preventable PCP and PCP-related mortality in the Auckland region. This could be reduced by greater clinician familiarity with commonly proposed indications for PCP prophylaxis, particularly for clinicians prescribing prolonged corticosteroid courses to patients with malignancies.
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Corticoesteroides/efectos adversos , Infecciones por VIH/complicaciones , Neumonía por Pneumocystis/etiología , Neumonía por Pneumocystis/prevención & control , Adolescente , Corticoesteroides/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Hospitalización , Humanos , Huésped Inmunocomprometido/efectos de los fármacos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/epidemiología , Neumonía por Pneumocystis/mortalidad , Estudios Retrospectivos , Adulto JovenRESUMEN
Fungal organisms of the genus Pneumocystis may cause Pneumocystis pneumonia (PCP) in humans, but also domestic and wild mammals. Almost every animal species hosts its own genetically distinct Pneumocystis species, however information is sparse. In this study, 62 red foxes (Vulpes vulpes) and 37 raccoon dogs (Nyctereutes procyonoides) were collected in North-East Germany. The lung tissues of the animals were analysed by a new designed specific pan-Pneumocystis mtLSU rRNA gene PCR and sequencing. With this PCR, detection and discrimination of all known Pneumocystis spp. in a single step should be possible. This first detection of Pneumocystis spp. in 29/62 (46.8%) red foxes and 29/37 (78.4%) raccoon dogs indicated, that they harbour two dissimilar strains, as seen by specific single nucleotide position changes (SNPs). Nevertheless, five samples with contrary SNPs showed a probable inter-species transmission.
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Zorros , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/veterinaria , Perros Mapache , Animales , ADN de Hongos/aislamiento & purificación , Femenino , Pulmón/microbiología , Masculino , Filogenia , Pneumocystis/clasificación , Pneumocystis/genética , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/epidemiología , Reacción en Cadena de la Polimerasa/veterinaria , Estudios RetrospectivosAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Linfopenia/diagnóstico , Piperazinas/efectos adversos , Neumonía por Pneumocystis/inmunología , Piridinas/efectos adversos , Anciano , Androstadienos/efectos adversos , Neoplasias de la Mama/patología , Quinasa 4 Dependiente de la Ciclina/antagonistas & inhibidores , Quinasa 6 Dependiente de la Ciclina/antagonistas & inhibidores , Resultado Fatal , Femenino , Humanos , Huésped Inmunocomprometido , Recuento de Linfocitos , Linfopenia/inducido químicamente , Linfopenia/complicaciones , Linfopenia/inmunología , Pneumocystis/inmunología , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/microbiología , Índice de Severidad de la Enfermedad , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
BACKGROUND: Indoleamine 2, 3-dioxygenase (IDO) is a key enzyme in the degradation of tryptophan (Trp) to kynurenine (Kyn). We measured IDO activity as the Kyn to Trp ratio, and investigated whether IDO could be used to assess prognosis of acquired immune deficiency Sydrome (AIDS) patients with pneumocystis pneumonia (PCP). METHODS: The Kyn and Trp concentration were measured by UPLC-MS/MS in plasma samples. A total of 49 AIDS-PCP patients were included in the analysis. Clinical characteristics and Kyn/Trp ratio were compared between survivors and non-survivors. RESULTS: Kyn/Trp ratio was significantly lower after anti-PCP treatment in AIDS patients with PCP (P < 0.0001). Plasma Kyn/Trp ratio was higher in patients with PaO2/FiO2 ≤ 300 mmHg than in those with PaO2/FiO2 > 300 mmHg (P = 0.007). Kyn/Trp ratio, D-dimer and CRP showed much higher AUC for predicting death of AIDS-PCP patients. Kyn/Trp ratio was useful for predicting the mortality of AIDS-PCP due to a significantly higher Kyn/Trp ratio in the non-survivors (P = 0.002). And the high Kyn/Trp ratio group had higher mortality rate than low Kyn/Trp group (32.1% vs. 9.1%, respectively, p = 0.024). CONCLUSION: Activation of the kynurenine pathway is associated with the severity and fatal outcomes of AIDS patients with pneumocystis pneumonia.
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Infecciones por VIH/patología , Neumonía/diagnóstico , Adulto , Antifúngicos/uso terapéutico , Área Bajo la Curva , Biomarcadores/metabolismo , Cromatografía Líquida de Alta Presión , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Humanos , Indolamina-Pirrol 2,3,-Dioxigenasa/metabolismo , Quinurenina/análisis , Quinurenina/sangre , Masculino , Persona de Mediana Edad , Pneumocystis/aislamiento & purificación , Neumonía/complicaciones , Neumonía/tratamiento farmacológico , Neumonía/microbiología , Pronóstico , Curva ROC , Tasa de Supervivencia , Espectrometría de Masas en Tándem , Triptófano/análisis , Triptófano/sangreRESUMEN
The genus Pneumocystis comprises potential pathogens that reside normally in the lungs of a wide range of mammals. Although they generally behave as transient or permanent commensals, they can occasionally cause life-threatening pneumonia (Pneumocystis pneumonia; PCP) in immunosuppressed individuals. Several decades ago, the presence of Pneumocystis morphotypes (trophic forms and cysts) was described in the lungs of normal cats and cats with experimentally induced symptomatic PCP (after immunosuppression by corticosteroids); yet to date spontaneous or drug-induced PCP has not been described in the clinical feline literature, despite immunosuppression of cats by long-standing retrovirus infections or after kidney transplantation. In this study, we describe the presence of Pneumocystis DNA in the lungs of normal cats (that died of various unrelated causes; n = 84) using polymerase chain reactions (PCRs) targeting the mitochondrial small and large subunit ribosomal RNA gene (mtSSU rRNA and mtLSU rRNA). The presence of Pneumocystis DNA was confirmed by sequencing in 24/84 (29%) cats, with evidence of two different sequence types (or lineages). Phylogenetically, lineage1 (L1; 19 cats) and lineage 2 (L2; 5 cats) formed separate clades, clustering with Pneumocystis from domestic pigs (L1) and carnivores (L2), respectively. Results of the present study support the notion that cats can be colonized or subclinically infected by Pneumocystis, without histological evidence of damage to the pulmonary parenchyma referable to pneumocystosis. Pneumocystis seems most likely an innocuous pathogen of cats' lungs, but its possible role in the exacerbation of chronic pulmonary disorders or viral/bacterial coinfections should be considered further in a clinical setting.
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Enfermedades de los Gatos/diagnóstico , ADN de Hongos/aislamiento & purificación , Pulmón/microbiología , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/veterinaria , Animales , Enfermedades de los Gatos/microbiología , Gatos , Femenino , Masculino , Filogenia , Pneumocystis/genética , Neumonía por Pneumocystis/diagnóstico , ARN Mitocondrial/aislamiento & purificación , ARN Ribosómico/aislamiento & purificaciónRESUMEN
INTRODUCTION: Pulmonary infiltrates in immunosuppressed patients are common. Yields from bronchoscopy with bronchoalveolar lavage (BAL) has been reported to be between 31 and 65%. The clinical impact of pneumocystis and viral Polymerase chain reaction (PCR) testing on BAL has not been extensively evaluated in a mixed immunosuppressed patient population. METHODS: We performed a retrospective chart review of immunosuppressed adults with pulmonary infiltrates who underwent BAL at the University of Rochester Medical Center. Only one BAL per patient was included. We compared the rate of positive PCR testing to conventional testing. We then investigated factors associated with positive PCR testing. Finally, we assessed for changes in antimicrobial therapy after bronchoscopy. RESULTS: Three hundred and fifty-nine patients underwent BAL with 249 patients having pneumocystis PCR testing and 142 having viral PCR testing. Pneumocystis identification occurred in 43 patients and viral species identification occurred in 56 patients. PCR testing increased pneumocystis identification compared to microscopy, 14% vs. 5%, pâ¯=â¯0.01, and viral identification compared to culture, 25% vs. 6%, pâ¯=â¯0.0001. Of the patients with positive pneumocystis PCR testing 49% had antibiotics stopped, 66% were started on anti-pneumocystis therapy, and only 6% did not receive treatment. There was no difference in the number of patients with antibiotics stopped based on viral PCR testing results. DISCUSSION: PCR testing increases BAL yield in immunosuppressed patients compared to conventional testing. Pneumocystis identified by PCR only may cause a self-limited infection and may not require antimicrobial therapy. PCR testing should be included in the evaluation of pulmonary infiltrates in immunosuppressed patients.
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Líquido del Lavado Bronquioalveolar/microbiología , Huésped Inmunocomprometido , Infecciones por Pneumocystis/diagnóstico , Infecciones por Pneumocystis/microbiología , Pneumocystis/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antifúngicos/administración & dosificación , Antivirales/administración & dosificación , Líquido del Lavado Bronquioalveolar/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Pneumocystis/tratamiento farmacológico , Estudios Retrospectivos , Adulto JovenRESUMEN
We used a real-time PCR (rtPCR) targeting a 150-bp amplicon of the mitochondrial small subunit of ribosomal RNA (mtSSU rRNA) to screen for Pneumocystis DNA in lungs of wild squirrels ( Callosciurus finlaysonii, n = 85) and river rats ( Myocastor coypus, n = 43) in Italy. The rtPCR revealed Pneumocystis DNA in 20 of 85 (24%) squirrels and in 35 of 43 (81%) river rats, and was more sensitive than a nested PCR that targets a portion of the mtSSU rRNA and the mitochondrial large subunit of rRNA (mtLSU rRNA). Phylogenetic analysis based on mtSSU rRNA and mtLSU rRNA sequences showed distinct Pneumocystis sequence types in these rodents. The rtPCR assay should be reliable for screening large populations for this potential pathogen, thereby allowing cost-effective monitoring of the disease in wild animals.
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Especies Introducidas , Infecciones por Pneumocystis/veterinaria , Pneumocystis/aislamiento & purificación , Enfermedades de los Roedores/epidemiología , Roedores , Animales , ADN de Hongos/análisis , Italia/epidemiología , Pulmón/microbiología , Filogenia , Infecciones por Pneumocystis/epidemiología , Infecciones por Pneumocystis/microbiología , Prevalencia , ARN Ribosómico/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa , Enfermedades de los Roedores/microbiología , Sciuridae , Análisis de Secuencia de ARN/veterinariaRESUMEN
Pneumocystis jirovecii can cause severe potentially life-threatening pneumonia (PCP) in kidney transplant patients. Prophylaxis of patients against PCP in this setting is usually performed during 6 months after transplantation. The aim of this study is to describe the molecular epidemiology of a cluster of PCP in renal transplant recipients in Brazil. Renal transplant patients who developed PCP between May and December 2011 had their formalin-fixed paraffin-embedded (FFPE) lung biopsy samples analysed. Pneumocystis jirovecii 23S mitochondrial large subunit of ribosomal RNA (23S mtLSU-rRNA), 26S rRNA, and dihydropteroate synthase (DHPS) genes were amplified by polymerase chain reaction (PCR), sequenced, and analysed for genetic variation. During the study period, 17 patients developed PCP (only four infections were documented within the first year after transplantation) and six (35.3%) died. Thirty FFPE samples from 11 patients, including one external control HIV-infected patient, had fungal DNA successfully extracted for further amplification and sequencing for all three genes. A total of five genotypes were identified among the 10 infected patients. Of note, four patients were infected by more than one genotype and seven patients were infected by the same genotype. DNA extracted from FFPE samples can be used for genotyping; this approach allowed us to demonstrate that multiple P. jirovecii strains were responsible for this cluster, and one genotype was found infecting seven patients. The knowledge of the causative agents of PCP may help to develop new initiatives for control and prevention of PCP among patients undergoing renal transplant and improve routine PCP prophylaxis.
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Variación Genética , Trasplante de Riñón/efectos adversos , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/microbiología , Complicaciones Posoperatorias/microbiología , Adulto , Brasil , Estudios Transversales , ADN de Hongos/genética , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Filogenia , Pneumocystis/clasificación , Pneumocystis/genética , Neumonía por Pneumocystis/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Subunidades Ribosómicas Grandes/genética , Adulto JovenRESUMEN
Pneumocystis species are opportunistic mammalian pathogens that cause severe pneumonia in immunocompromised individuals. These fungi are highly host specific and uncultivable in vitro Human Pneumocystis infections present major challenges because of a limited therapeutic arsenal and the rise of drug resistance. To investigate the diversity and demographic history of natural populations of Pneumocystis infecting humans, rats, and mice, we performed whole-genome and large-scale multilocus sequencing of infected tissues collected in various geographic locations. Here, we detected reduced levels of recombination and variations in historical demography, which shape the global population structures. We report estimates of evolutionary rates, levels of genetic diversity, and population sizes. Molecular clock estimates indicate that Pneumocystis species diverged before their hosts, while the asynchronous timing of population declines suggests host shifts. Our results have uncovered complex patterns of genetic variation influenced by multiple factors that shaped the adaptation of Pneumocystis populations during their spread across mammals.IMPORTANCE Understanding how natural pathogen populations evolve and identifying the determinants of genetic variation are central issues in evolutionary biology. Pneumocystis, a fungal pathogen which infects mammals exclusively, provides opportunities to explore these issues. In humans, Pneumocystis can cause a life-threatening pneumonia in immunosuppressed individuals. In analysis of different Pneumocystis species infecting humans, rats, and mice, we found that there are high infection rates and that natural populations maintain a high level of genetic variation despite low levels of recombination. We found no evidence of population structuring by geography. Our comparisons of the times of divergence of these species to their respective hosts suggest that Pneumocystis may have undergone recent host shifts. The results demonstrate that Pneumocystis strains are widely disseminated geographically and provide a new understanding of the evolution of these pathogens.
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Pneumocystis/genética , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/microbiología , Neumonía por Pneumocystis/veterinaria , Enfermedades de los Roedores/microbiología , Animales , Variación Genética , Genómica , Humanos , Ratones , Filogenia , Pneumocystis/clasificación , Ratas , Ratas Sprague-Dawley , Recombinación GenéticaRESUMEN
A 67-year-old man was admitted to our hospital complaining of dry cough. Chest computed tomography showed diffuse infiltrates and ground-glass opacities in the bilateral lung fields. Transbronchial lung biopsy specimens showed alveoli filled with yeast-like fungi. With a diagnosis of pneumocystis pneumonia (PCP), he was given oral sulfamethoxazole/trimethoprim, to which he responded well. However, seven months later, PCP relapsed. Analyses revealed a low bronchoalveolar lavage fluid CD4/CD8 ratio of 0.04 and CD4+ lymphocytopenia (250/µL). Despite intensive work-up, we were unable to detect the underlying cause of CD4+ lymphocytopenia; therefore, a final diagnosis of idiopathic CD4+ T-lymphocytopenia was made.
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Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antibacterianos/uso terapéutico , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/tratamiento farmacológico , Linfocitopenia-T Idiopática CD4-Positiva/diagnóstico , Linfocitopenia-T Idiopática CD4-Positiva/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Anciano , Líquido del Lavado Bronquioalveolar/microbiología , Humanos , Pulmón/patología , Masculino , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/etiología , Linfocitopenia-T Idiopática CD4-Positiva/etiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
To understand the epidemiological significance of Pneumocystis detection in a lung tissue sample of non-immunosuppressed individuals, we examined sampling procedures, laboratory methodology, and patient characteristics of autopsy series reported in the literature. Number of tissue specimens, DNA-extraction procedures, age and underlying diagnosis highly influence yield and are critical to understand yield differences of Pneumocystis among reports of pulmonary colonization in immunocompetent individuals.
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Autopsia/métodos , Pulmón/microbiología , Técnicas Microbiológicas/métodos , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/diagnóstico , Manejo de Especímenes/métodos , Humanos , Neumonía por Pneumocystis/microbiologíaRESUMEN
Aim of this study was the retrospective investigation of viral (porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSV), torque teno sus virus type 1 and 2 (TTSuV1, TTSuV2)) and bacterial (Bordetella bronchiseptica (B. b.), Mycoplasma hyopneumoniae (M. h.), and Pasteurella multocida (P. m.)) co-infections in 110 Pneumocystis spp. positive lung samples of Austrian pigs with pneumonia. Fifty-one % were positive for PCV2, 7% for PRRSV, 22% for TTSuV1, 48% for TTSuV2, 6% for B. b., 29% for M. h., and 21% for P. m. In 38.2% only viral, in 3.6% only bacterial and in 40.0% both, viral and bacterial pathogens were detected. In 29.1% of the cases a co-infection with 1 pathogen, in 28.2% with 2, in 17.3% with 3, and in 7.3% with 4 different infectious agents were observed. The exposure to Pneumocystis significantly decreased the risk of a co-infection with PRRSV in weaning piglets; all other odds ratios were not significant. Four categories of results were compared: I = P. spp. + only viral co-infectants, II = P. spp. + both viral and bacterial co-infectants, III = P. spp. + only bacterial co-infectants, and IV = P. spp. single infection. The evaluation of all samples and the age class of the weaning piglets resulted in a predomination of the categories I and II. In contrast, the suckling piglets showed more samples of category I and IV. In the group of fattening pigs, category II predominated. Suckling piglets can be infected with P. spp. early in life. With increasing age this single infections can be complicated by co-infections with other respiratory diseases.
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Infecciones por Pneumocystis/veterinaria , Pneumocystis/aislamiento & purificación , Neumonía/veterinaria , Enfermedades de los Porcinos/microbiología , Enfermedades de los Porcinos/virología , Porcinos/microbiología , Porcinos/virología , Animales , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/veterinaria , Infecciones Bacterianas/virología , Coinfección , Femenino , Pulmón/microbiología , Pulmón/virología , Masculino , Infecciones por Pneumocystis/microbiología , Infecciones por Pneumocystis/virología , Neumonía/microbiología , Neumonía/virología , Estudios Retrospectivos , Virosis/microbiología , Virosis/veterinaria , Virosis/virologíaRESUMEN
BACKGROUND: Pneumocystis pneumonia (PCP) is one of the most devastating fungal diseases in patients with impaired immunity. Effective antiviral therapies have reduced the burden of PCP among AIDS patients, but an increase in the prevalence of this disease among persons receiving immunosuppressive therapies has been reported. METHODS: We retrospectively reviewed HIV and non-HIV PCP patients diagnosed in our department during a nine year period. Data were collected from the local database completed during the diagnosis procedure. For each patient, demographic, clinical, radiological, biological and therapeutic data were analyzed. RESULTS: A total of 21,274 bronchoalveolar samples were received from patients suspected of pneumocystosis during the study period, leading to a discharge diagnosis of PCP for 604 patients (143 HIV-positive and 461 HIV-negative). The ratio of non-HIV versus HIV patients presenting PCP increased from 1.7 to 5.6 during the study period. The mortality rate at day 14 was 16%, occurring mostly in non-HIV patients (20.6% compared to 1.4%, P<0.0001), while non-HIV patients were less symptomatic at diagnosis than AIDS patients. CONCLUSIONS: This study presents one of the higher number of HIV and non-HIV patients presenting with PCP in a single center. Pneumocystosis is now a crucial health challenge for patients receiving immunosuppressive therapy, with a high mortality rate. This study highlights the need for international guidelines for prophylaxis of PCP in non-HIV patients.
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Infecciones por VIH/epidemiología , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Francia/epidemiología , Infecciones por VIH/mortalidad , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pneumocystis/genética , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/mortalidad , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
Lung specimens (n = 216) from six wildlife species were examined for occurrence of Pneumocystis species in pulmonary tissues. Among small mammals the shrew Sorex antinorii (80 %) were most frequently colonized. In contrast, foxes and badgers did not yield positive amplification. Host-specificity was noted, at least at the level of the host genus. Phylogenetic trees based on partial mtLSU and mtSSU showed high diversity of species corresponding to animal host diversity. Nuclear rDNA ITS data confirmed unambiguous separation of species. In conclusion, ITS is an excellent marker to distinguish species of the genus Pneumocystis.
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Animales Salvajes/microbiología , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/veterinaria , Animales , Código de Barras del ADN Taxonómico , Pulmón/microbiología , Datos de Secuencia Molecular , Filogenia , Pneumocystis/clasificación , Pneumocystis/genética , Neumonía por Pneumocystis/microbiologíaRESUMEN
Las micosis son enfermedades graves y potencialmente letales. Con el desarrollo de terapias inmunosupresoras y técnicas de soporte vital, la inmunosupresión en sus diferentes grados es cada vez más prevalente. El deterioro de la respuesta inmune es el factor de riesgo principal para el desarrollo de las micosis oportunistas. El diagnóstico y tratamiento precoces son factores cruciales para mejorar el pronóstico de estas enfermedades. Sin embargo, los aislamientos mediante cultivos o las técnicas de detección antigénicas no son capaces de distinguir entre colonización e infección invasiva, y las biopsias rara vez se pueden realizar por la situación clínica. Ello sitúa al médico en una situación de incertidumbre en la que debe reconocer precozmente los signos clínicos y radiológicos e interpretar los resultados microbiológicos en su contexto. El objetivo de esta revisión es aportar una visión general del perfil de paciente que sufre estas infecciones, el papel de su sistema inmune, y de forma más detallada, los principales avances diagnósticos más reconocidos y recomendados por la comunidad científica
Mycoses are serious diseases with potentially fatal outcome. The introduction of immunosuppressive treatments and life support techniques has led to a growing prevalence of different degrees of immunosuppression. Compromised immune response is the primary risk factor for the development of opportunistic mycoses. Early diagnosis and treatment are crucial for improving prognosis. However, isolation in cultures or identification using antigen detection techniques cannot distinguish between colonization and invasive infection, and the clinical status of the patient often prevents biopsy sampling. Clinicians thus find themselves in an uncertain position, requiring them to quickly recognize clinical and radiological signs and interpret microbiological results in context. The aim of this review is to provide a general overview of the profile of patients susceptible to these infections, the role of the immune system and, in more detail, the major diagnostic developments that have gained most acceptance and recognition among the scientific community
Asunto(s)
Humanos , Masculino , Femenino , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/prevención & control , Aspergillus/aislamiento & purificación , Pneumocystis/aislamiento & purificación , Enfermedades Pulmonares Fúngicas/epidemiología , Enfermedades Pulmonares Fúngicas/prevención & control , Micosis/complicaciones , Micosis/diagnóstico , Micosis/epidemiología , Mucormicosis/complicaciones , Mucormicosis/epidemiología , Cryptococcus/aislamiento & purificación , Factores de Riesgo , Lavado Broncoalveolar/instrumentación , Lavado Broncoalveolar/métodos , Neumonía por Pneumocystis/epidemiología , Neumonía por Pneumocystis/prevención & controlRESUMEN
Norway (Rattus norvegicus) and black rats (Rattus rattus) are common peridomestic species, yet little is known about wild rat ecology, including their natural diseases. We describe gross and histological lesions in the respiratory tract of a sample of 711 wild urban rats. A subset was examined for 19 distinct categories of histological lesions in the respiratory tract. Testing for known respiratory pathogens included serology and polymerase chain reaction (PCR) of lung samples. Grossly evident lesions were rare (8/711; 1%). Upper respiratory tract inflammation was present in 93 of 107 (87%) rats and included rhinitis, submucosal and periglandular lymphoplasmacytic tracheitis, and/or tracheal intraluminal necrotic debris and was significantly associated (P < .05) with the presence of cilia-associated respiratory bacillus (CARB), Mycoplasma pulmonis, and increased body mass (odds ratio [OR] = 1.09; 95% confidence interval [CI] = 1.05-1.14 per 10 g). Within the lungs, peribronchiolar and/or perivascular lymphoplasmacytic cuffs were present in 152 of 199 rats (76%) and were also significantly associated (P ≤ .02) with CARB, M. pulmonis, and increased body mass (OR = 1.20; 95% CI = 1.14-1.27 per 10 g). Rats were frequently coinfected with M. pulmonis and CARB, and lesions associated with these pathogens were histologically indistinguishable. Pneumocystis sp was detected in 48 of 102 (47%) rats using PCR but was not significantly associated with lesions. This description of pathology in the respiratory system of wild rats demonstrates that respiratory disease is common. Although the impact of these lesions on individual and population health remains to be investigated, respiratory disease may be an important contributor to wild rat morbidity and mortality.
Asunto(s)
Enfermedades Pulmonares/veterinaria , Infecciones por Mycoplasma/veterinaria , Mycoplasma pulmonis/aislamiento & purificación , Infecciones por Pneumocystis/veterinaria , Pneumocystis/aislamiento & purificación , Enfermedades de los Roedores/epidemiología , Animales , Femenino , Pulmón/microbiología , Pulmón/patología , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/microbiología , Enfermedades Pulmonares/patología , Masculino , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/microbiología , Infecciones por Mycoplasma/patología , Mycoplasma pulmonis/genética , Mycoplasma pulmonis/inmunología , Noruega/epidemiología , Pneumocystis/genética , Pneumocystis/inmunología , Infecciones por Pneumocystis/epidemiología , Infecciones por Pneumocystis/microbiología , Infecciones por Pneumocystis/patología , Ratas , Enfermedades de los Roedores/microbiología , Enfermedades de los Roedores/patologíaRESUMEN
In order to standardize a polymerase chain reaction (PCR)-based method of Pneumocystis detection, we describe the development of an improved PCR method that targets the Pneumocystis mtLSUrRNA gene. Design of a new primer pair and PCR program with suitable parameters and optimization resulted in a simpler and faster single-round amplification assay. The sensitivity of the novel Pneumocystis genus-specific PCR proved comparable to the reference nested PCR. The improvement that this new PCR assay offers in the detection and epidemiological studies of Pneumocystis spp. infection in research laboratories is discussed.