Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 921
Filtrar
2.
Diagn Cytopathol ; 47(11): 1194-1196, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31322837

RESUMO

Liver transplant recipients are prone to several infections, including lung infections, which can lead to substantial morbidity and mortality. Bronchoalveolar lavage (BAL) cytology is a rapid and sensitive diagnostic tool to identify the etiologic agents. We report a rare case of a 24-year-old male, post Live donor liver transplantation for autoimmune chronic liver disease, who presented with cough, fever, weight loss, and cavitatory lesion in lung. BAL cytology revealed Leishmania donovani (LD) and Pneumocystis jirovecii/carinii (PCP). Cytomegalovirus deoxyribonucleic acid polymerase chain reaction (CMV DNA PCR) test showed markedly raised levels. Patient was put on treatment for these multiple infections and showed significant improvement. Thus, rapid diagnosis of infections through BAL cytology is crucial in transplant recipients to institute timely therapy and avoid undesirable empirical treatments. Moreover, this case highlights a rare finding of LD bodies along with PCP in BAL cytology.


Assuntos
Líquido da Lavagem Broncoalveolar , Lavagem Broncoalveolar , Infecções por Citomegalovirus , Leishmania donovani/genética , Leishmaniose Visceral , Transplante de Fígado , Pneumocystis carinii/genética , Pneumonia por Pneumocystis , Reação em Cadeia da Polimerase , Adulto , Líquido da Lavagem Broncoalveolar/microbiologia , Líquido da Lavagem Broncoalveolar/parasitologia , Líquido da Lavagem Broncoalveolar/virologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/genética , Infecções por Citomegalovirus/patologia , Humanos , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/genética , Leishmaniose Visceral/patologia , Doadores Vivos , Masculino , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/genética , Pneumonia por Pneumocystis/patologia
3.
BMC Infect Dis ; 19(1): 525, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200652

RESUMO

BACKGROUND: As technology progresses, several highly sensitive human immunodeficiency virus (HIV) screening kits are being researched and developed to quickly and efficiently identify serum HIV antibodies within the non-window period. In individuals who are HIV-seronegative, HIV infections that are not within a window period are rare. In such cases, all antibody detection methods will fail, and misdiagnosing these patients will have catastrophic consequences. CASE PRESENTATION: A 22-year-old male Chinese patient with diffuse exudative lesions in both lungs and initial symptoms of cough and dyspnoea was diagnosed with Pneumocystis jirovecii pneumonia (PJP) by aetiological examination, and the patient's plasma CD4+ T-cell count was extremely low. In China, PJP is prevalent in HIV-infected individuals. Pneumocystis jirovecii (P. jirovecii) has a high colonisation rate in patients with HIV infections. This patient was naturally suspected of being an HIV patient; however, serum HIV antibody tests were negative using both an enzyme-linked immunosorbent assay (ELISA) and a latex agglutination assay, and HIV was not detected by western blotting. Subsequently, the plasma HIV viral load was found to be extremely high on two repeated plasma HIV RNA tests, thus confirming HIV-seronegative acquired immunodeficiency syndrome (AIDS) in this patient. With administration of effective anti-P. jirovecii treatment and highly active antiretroviral therapy (HAART) after diagnosis, the patient's disease condition was rapidly controlled. CONCLUSION: This is the second reported case in China of an HIV-seronegative AIDS patient. Such cases are also rare worldwide. Although HIV-seronegative HIV infections are rare, AIDS should be considered in immunodeficient patients with opportunistic infections, even if the test results are HIV-seronegative. Plasma HIV RNA testing is important for such patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/sangue , Síndrome de Imunodeficiência Adquirida/sangue , Pneumonia por Pneumocystis/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/patologia , Síndrome de Imunodeficiência Adquirida/virologia , Antibacterianos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Humanos , Masculino , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/sangue , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/patologia , RNA Viral/sangue , Resultado do Tratamento , Adulto Jovem
4.
Mycopathologia ; 184(3): 457-458, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30955129

RESUMO

Pneumocystis jiroveci pneumonia in non-HIV patients is infrequent and characterized by atypical presentations and increased severity. Although hematogenous dissemination from the lungs can lead to extrapulmonary infections, isolation of oocysts from blood in human subjects has not been documented. We report a case of P. jiroveci pneumonia with persistent isolation of oocysts from blood and positivity of P. jiroveci polymerase chain reaction. The patient presented with bilateral diffuse pulmonary nodules and received prolonged treatment with trimethoprim/sulfamethoxazole.


Assuntos
Sangue/microbiologia , Fungemia/microbiologia , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Antifúngicos/administração & dosagem , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/patologia , Reação em Cadeia da Polimerase , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem
5.
Microb Pathog ; 132: 59-65, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31002962

RESUMO

The present study was aimed to synthesize and evaluate tetrazoles of baicalin against Pneumocystis carinii pneumonia in the rat model. Among the seven synthesized baicalin tetrazoles, one with trifloromethyl group in the aromatic ring was found to be most potent during the initial study. The mechanism of preventive effect of most potent compound 4c against Pneumocystis carinii pneumonia was investigated in detail. The compound 4c decreased the parasitic load by almost 99% in the rats. It significantly (P < 0.05) decreased mortality rate of the rats, prevented pulmonary tissue damage and aggregation of inflammatory cytokines. In Pneumocystis carinii infected rats compound 4c treatment inhibited production of interleukin-18, interleukin-1ß and TNF-α significantly (P < 0.05) in the BALF and pulmonary tissues. Treatment of the pneumocystis carinii-infected rats with compound 4c inhibited up-regulation of mRNA expression corresponding NLRP3, ASC and caspase-1. The compound 4c treatment of the pneumocystis carinii-infected rats significantly (P < 0.02) suppressed the level of NLRP3 and ASC proteins. Moreover, the enhancement of caspase-1 activation by pneumocystis carinii-infection in rats was also suppressed by compound 4c. The results from present study demonstrate that compound 4c protects pneumocystis carinii induced pneumonia through suppression of inflammatory cytokines and NLRP3 activation. Therefore, compound 4c can be of therapeutic importance for the treatment of pneumocystis carinii induced pneumonia.


Assuntos
Antifúngicos/farmacologia , Flavonoides/farmacologia , Hospedeiro Imunocomprometido , Pneumocystis carinii/efeitos dos fármacos , Pneumonia por Pneumocystis/prevenção & controle , Tetrazóis/farmacologia , Animais , Anti-Inflamatórios/farmacologia , Antifúngicos/química , Líquido da Lavagem Broncoalveolar/química , Proteínas Adaptadoras de Sinalização CARD/metabolismo , Caspase 1/metabolismo , Citocinas , Modelos Animais de Doenças , Flavonoides/síntese química , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Pulmão/patologia , Mortalidade , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Pneumonia por Pneumocystis/patologia , RNA Mensageiro/metabolismo , Ratos , Tetrazóis/síntese química , Fator de Necrose Tumoral alfa/metabolismo
6.
Jpn J Infect Dis ; 72(4): 270-273, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-30918147

RESUMO

Subsequent to the increasing use of immunosuppressant therapy, Pneumocystis jirovecii pneumonia (PcP) has emerged as a life-threatening condition in human immunodeficiency virus (HIV)-negative patients. We investigated changes in epidemiological and clinical characteristics among PcP cases with and without HIV infections. Data of 424 patients diagnosed with PcP in a 2,700-bed Korean tertiary care hospital between February 2003 and April 2017 were retrospectively analyzed. The study included patients with compatible clinical findings in whom PcP was confirmed via direct immunofluorescence assay. The annual average number of cases increased from 12.2 (initial 5-year period) to 42.2 (recent 5-year period). In HIV-negative patients, hematologic malignancy (34.8%) and solid organ transplantation (32.9%) were the most frequent major underlying conditions, and immunosuppressive therapies including corticosteroids (342/362, 94.5%) and chemotherapy (122/362, 33.7%) were significantly associated with PcP infection (p < 0.001 for both). The incidence of PcP has continued to increase among non-HIV-infected immunocompromised patients in recent years.


Assuntos
Hospedeiro Imunocomprometido , Pneumocystis carinii/fisiologia , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/patologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/microbiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Risco , Centros de Atenção Terciária/estatística & dados numéricos
9.
Am J Physiol Lung Cell Mol Physiol ; 316(1): L291-L301, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30284926

RESUMO

Pneumocystis pneumonia (PCP) is a common opportunistic infectious disease that is prevalent in immunosuppressed hosts. Accumulating evidence shows that B cells play an important role in infectious diseases. In the present study, the immune regulatory role of mature B cells in host defense to Pneumocystis was evaluated. Pneumocystis infection resulted in a decrease in B cells in patients and mice, and the Pneumocystis burden in B cell-deficient mice also progressively increased from weeks 1 to 7 after infection. The clearance of Pneumocystis was delayed in B cell-activating factor receptor (BAFF-R)-deficient mice (BAFF-R-/- mice), which had few B cells and Pneumocystis-specific IgG and IgM antibodies, compared with clearance in wild-type (WT) mice. There were fewer effector CD4+ T cells and higher percentages of T helper (Th)1/Th17 cells in BAFF-R-/- mice than in WT mice. Adoptive transfer of naive B cells, mRNA sequencing, and IL-1ß neutralization experiments indicated that IL-1ß is a likely determinant of the IL-10-producing B cell-mediated suppression of Th1/Th17-cell immune responses in BAFF-R-/- PCP mice. Our data indicated that B cells play a vital role in the regulation of Th cells in response to Pneumocystis infection.


Assuntos
Linfócitos B/imunologia , Interleucina-10/imunologia , Pneumocystis/imunologia , Pneumonia por Pneumocystis/imunologia , Células Th1/imunologia , Células Th2/imunologia , Adulto , Animais , Anticorpos Antifúngicos/imunologia , Receptor do Fator Ativador de Células B/genética , Receptor do Fator Ativador de Células B/imunologia , Linfócitos B/patologia , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Interleucina-10/genética , Interleucina-1beta/genética , Interleucina-1beta/imunologia , Masculino , Camundongos , Camundongos Knockout , Pneumonia por Pneumocystis/genética , Pneumonia por Pneumocystis/patologia , Células Th1/patologia , Células Th2/patologia
11.
Saudi J Kidney Dis Transpl ; 29(4): 993-996, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30152442

RESUMO

We describe a patient who had developed hypercalcemic crisis, with altered mental status and renal failure, one year following aggressive corticosteroid-therapy for lupus nephritis. Her disease relapsed after successful live-related kidney transplantation 11 years ago. She had normal parathyroid hormone and 25-hydroxyvitamin D yet high 1,25 dihydroxyvitamin D. Four weeks later, she developed severe dyspnea and hypoxia with a reticulonodular pattern on chest computed tomography. Bacteriological and serological tests were negative for pathogens. However, bronchoalveolar lavage established the diagnosis of Pneumocystis jiroviceii pneumonia (PJP). Her pneumonia and hypercalcemia improved with Co-trimoxazole. The case indicates that severe hypercalcemia can herald PJP.


Assuntos
Hipercalcemia , Pneumonia por Pneumocystis , Corticosteroides/uso terapêutico , Adulto , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/fisiopatologia , Hospedeiro Imunocomprometido , Transplante de Rim , Pulmão/diagnóstico por imagem , Pulmão/patologia , Nefrite Lúpica/tratamento farmacológico , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/patologia , Radiografia Torácica , Tomografia Computadorizada por Raios X
12.
BMC Infect Dis ; 18(1): 399, 2018 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107791

RESUMO

BACKGROUND: Tuberculosis, bacterial community-acquired pneumonia (CAP), and Pneumocystis jirovecii pneumonia (PJP) are the three commonest causes of hospitalisation in HIV-infected adults. Prompt diagnosis and treatment initiation are important to reduce morbidity and mortality, but are hampered by limited diagnostic resources in resource poor settings. C-reactive protein (CRP) and procalcitonin have shown diagnostic utility for respiratory tract infections, however few studies have focussed on their ability to distinguish between tuberculosis, CAP, and PJP in HIV-infected inpatients. METHODS: We evaluated the diagnostic accuracy of CRP and procalcitonin, compared with composite reference standards, to discriminate between the three target infections in adult HIV-infected inpatients in two district level hospitals in Cape Town, South Africa. Participants were admitted with current cough and danger signs in accordance with the WHO algorithm for tuberculosis in seriously ill HIV-infected patients. Study clinicians were blinded to CRP and procalcitonin results. RESULTS: Two hundred forty-eight participants met study case definitions: 133 with tuberculosis, 61 with CAP, 16 with PJP, and 38 with mixed infection. In the 210 particpants with single infections the differences in median CRP and procalcitonin concentrations between the three infections were statistically significant, but distributions overlapped considerably. CRP and procalcitonin concentrations were highest in the CAP group and lowest in the PJP group. CRP and procalcitonin cut-offs with sensitivities of ≥90% were found for all three target infection pairs, but corresponding specificities were low. Highest receiver operating characteristic areas under the curve for CRP and procalcitonin were for PJP versus tuberculosis and PJP versus CAP (0.68 and 0.71, and 0.74 and 0.69 respectively). CONCLUSIONS: CRP and procalcitonin showed limited value in discriminating between the three target infections due to widely overlapping distributions, but diagnostic accuracy was higher for discriminating PJP from CAP or tuberculosis. Our findings show limitations for CRP and procalcitonin, particularly for discriminiation of tuberculosis form CAP, however they may have greater diagnostic utility as part of a panel of biomarkers or in clinical prediction rules.


Assuntos
Proteína C-Reativa/análise , Infecções por HIV/patologia , Pneumonia Bacteriana/diagnóstico , Pneumonia por Pneumocystis/diagnóstico , Pró-Calcitonina/análise , Tuberculose/diagnóstico , Adulto , Idoso , Antirretrovirais/uso terapêutico , Área Sob a Curva , Biomarcadores/análise , Análise Discriminante , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/patologia , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/patologia , Estudos Prospectivos , Curva ROC , Índice de Gravidade de Doença , África do Sul , Tuberculose/complicações , Tuberculose/patologia
13.
Ann Hematol ; 97(12): 2373-2380, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30030570

RESUMO

Patients with non-Hodgkin's lymphoma (NHL) receiving rituximab-containing chemotherapy are at risk of developing respiratory complications, but comprehensive information on these complications and their impact on survival is lacking. We performed a retrospective cohort analysis on 123 NHL patients who received rituximab-containing chemotherapy between 2009 and 2016 in order to describe the incidence, etiologies and effect on survival of respiratory complications defined by new or worsening respiratory symptoms requiring diagnostic work-up or hospitalization. Thirty patients (24%) developed respiratory complications during a follow-up time of 825 (555-1338) days after chemotherapy. They had a higher prevalence of congestive heart failure and lung or pleural involvement at diagnosis as compared to patients who did not develop complications. Overall, 58 episodes of pulmonary complications were observed after median (interquartile) times from the first and last rituximab doses of 205 (75-580) days and 27 (14-163) days respectively. Infectious etiologies accounted for 75% of the respiratory complications, followed by heart failure exacerbation, lymphomatous involvement, and ARDS. Two Pneumocystis jirovecii pneumonias were observed, and no complication was ascribed to rituximab toxicity. Respiratory complications required ICU admission in 19 cases (33%) and invasive mechanical ventilation in 14 cases (24%). Using a time-dependent Cox regression analysis, we observed that the occurrence of respiratory complications was associated with a 170% increase in death hazard (hazard ratio 2.65, 95% CI 1.60-4.40, p = 0.001). In conclusion, respiratory complications in NHL patients receiving chemotherapy are relatively frequent, severe, and mostly infectious and are associated with increased mortality.


Assuntos
Linfoma não Hodgkin/tratamento farmacológico , Pneumocystis carinii , Pneumonia por Pneumocystis/induzido quimicamente , Rituximab/efeitos adversos , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/mortalidade , Pneumonia por Pneumocystis/patologia , Pneumonia por Pneumocystis/fisiopatologia , Estudos Retrospectivos , Rituximab/administração & dosagem , Taxa de Sobrevida
14.
Front Immunol ; 9: 1118, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29887863

RESUMO

Introduction: Pneumocystis pneumonia (PCP) remains a severe complication with high mortality in immunocompromised patients. It has been well accepted that CD4+ T cells play a major role in controlling Pneumocystis infection. Th9 cells were the main source of IL-9 with multifaced roles depending on specific diseases. It is unclear whether IL-9/Th9 contributes to the immune response against PCP. The current study aims to explore the role of IL-9 and the effect of IL-9 on Th17 cells in murine model of PCP. Materials and methods: Mice were intratracheally injected with 1 × 106Pneumocystis organisms to establish the murine model of Pneumocystis infection. Pneumocystis burden was detected by TaqMan real-time PCR. Using IL-9-deficient (IL-9-/-) mice, flow cytometry, real-time PCR and enzyme-linked immunosorbent assay (ELISA) were conducted to investigate the immune function related to Th17 response in defense against Pneumocystis infection. Results: Reduced Pneumocystis burden was observed in lungs in IL-9-/- mice compared with WT mice at 3-week postinfection. IL-9-/-mice exhibited stronger Th17 immune responses than WT PCP mice through flow cytometer and real-time PCR. ELISA revealed higher levels of IL-17 and IL-23 in bronchoalveolar lavage fluid from IL-9-/- mice than WT mice. And IL-9 deficiency promoted Th17 differentiation from CD4+ naive T cells. IL-17A neutralization increased Pneumocystis burden in IL-9-/- mice. Conclusion: Although similar basic clearance of Pneumocystis organisms was achieved in both WT and IL-9-/- PCP mice, IL-9 deficiency could lower Pneumocystis organism burden and promote pulmonary Th17 cells response in the early stage of infection.


Assuntos
Suscetibilidade a Doenças , Interleucina-9/deficiência , Pneumocystis/imunologia , Pneumonia por Pneumocystis/etiologia , Células Th17/imunologia , Células Th17/metabolismo , Animais , Apoptose , Biomarcadores , Líquido da Lavagem Broncoalveolar/citologia , Líquido da Lavagem Broncoalveolar/imunologia , Diferenciação Celular/genética , Diferenciação Celular/imunologia , Modelos Animais de Doenças , Imunofenotipagem , Interleucina-17/metabolismo , Masculino , Camundongos , Camundongos Knockout , Neutrófilos/imunologia , Neutrófilos/metabolismo , Pneumocystis/genética , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/patologia
15.
Clin Transplant ; 32(8): e13339, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29956379

RESUMO

A growing number of publications have reported the outbreaks of post-transplant pneumocystis pneumonia (PJP). In most studies, the onset of PJP was beyond 6-12 months of prophylaxis. Cytomegalovirus (CMV) infection and allograft rejection have been repeatedly reported as probable risk factors for post-transplant PJP. In this systematic review and meta-analysis, we determined the pooled effect estimates of these 2 variables as risk factors. Data sources included PUBMED, MEDLINE-OVID, EMBASE-OVID, Cochrane Library, Networked Digital Library of Theses and Dissertations, World Health Organization, and Web of Science. We excluded publications related to hematopoietic stem cell transplantation (HSCT) or Human Immunodeficiency Virus (HIV) patients. Eventually, 15 studies remained for the final stage of screening. Cytomegalovirus infection (OR: 3.30, CI 95%: 2.07-5.26, I2 : 57%, P = 0.006) and allograft rejection (OR:2.36, CI95%: 1.54-3.62, I2: 45.5%, P = 0.05) significantly increased the risk of post-transplant PJP. Extended prophylaxis targeting recipients with allograft rejection or CMV infection may reduce the risk of PJP.


Assuntos
Infecções por Citomegalovirus/microbiologia , Citomegalovirus/isolamento & purificação , Rejeição de Enxerto/etiologia , Transplante de Órgãos/efeitos adversos , Pneumonia por Pneumocystis/etiologia , Infecções por Citomegalovirus/complicações , Rejeição de Enxerto/patologia , Humanos , Pneumonia por Pneumocystis/patologia , Fatores de Risco , Transplantados
16.
Rev Fac Cien Med Univ Nac Cordoba ; 75(4): 299-302, 2018 12 11.
Artigo em Espanhol | MEDLINE | ID: mdl-30734710

RESUMO

Introduction: The incidence of breast tuberculosis in the world is very low. This pathology can be primary and, more commonly, secondary. It is presented as an extrapulmonary focus due to Mycobacterium tuberculosis invasion in the mammary gland. Methods: Method: we present the clinical case of a 29-year-old in AIDS woman a breast tumor. At the time of the consultation, rales were also heard in both pulmonary fields. A chest x-ray, blood analysis, and computed tomography of breast tumor and armpit, were performed. One month after admission to the hospital, the tumor fistulized and drained purulent secretion spontaneously. A sample was taken and sent to anatomopathological and microbiological analysis A tuberculin skin test (PPD) was also performed. ouch. Results: the chest X-ray showed a diffuse interstitial infiltrate, suggestive of Pneumocystis Jirovecci pneumonia. Computed tomography of the breast and armpit tumors reported the presence of multiple adenopathies. The PPD value reported was 5 millimeters; this rate is considered as a positive reaction in HIV patients. The result of the pathological anatomy for neoplasic cells was negative. The microbiological results were: Mycobacterium tuberculosis, sensitive to Isoniacid, Streptomycin, Pyrazinamide, Ethambutol and Rifampicin. Conclusion: Based on the results of the laboratory report, the diagnosis was pulmonary and mammary tuberculosis. The pulmonary tuberculosis in AIDS patients, can give non-characteristic radiographic images. This case proved how the diagnosis could be confused with pneumonia by Peumocystis jirovecci in a first appr


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Doenças Mamárias/diagnóstico , Doenças Mamárias/microbiologia , Tuberculose/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Doenças Mamárias/patologia , Feminino , Humanos , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/patologia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Teste Tuberculínico , Tuberculose/patologia
17.
Am J Pathol ; 188(2): 417-431, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29169991

RESUMO

Subclinical primary Pneumocystis infection is the most common pulmonary infection in early infancy, making it important to determine whether it damages the lung. Pneumocystis peaks at 2 to 5 months of age, when respiratory morbidity coincidently increases. We have documented that Pneumocystis increases mucus production in infant lungs, and animal models reveal lung lesions that warrant characterization. Herein, immunocompetent rats infected at birth with Pneumocystis by cohabitation, to resemble community-acquired infection, underwent lung assessments at 45, 60, and 75 days of age. Lungs fixed by vascular perfusion to prevent collapse during necropsy were used for morphometry evaluations of mucus production, airway epithelial thickening, perivascular and peribronchiolar inflammation, and structural airway remodeling. Changes in these histologic features indicate lung disease. Selected immune markers were assessed in parallel using fresh-frozen lung tissue from sibling rats of the same cages. Sequential activation of NF-κB and an increased Gata3/T-bet mRNA level ratio, consistent with a type 2 helper T-cell-type inflammatory response, and subacute fibrosis were recognized. Therefore, documenting subclinical Pneumocystis infection induces lung disease in the immunocompetent host. Taken together with the peak age of primary Pneumocystis infection, results warrant investigating the clinical impact of this often subclinical infection on the severity of respiratory diseases in early infancy. This model can also be used to assess the effects of airway insults, including coinfections by recognized respiratory pathogens.


Assuntos
Pneumonia por Pneumocystis/imunologia , Células Th2/imunologia , Animais , Bronquíolos/patologia , Modelos Animais de Doenças , Progressão da Doença , Matriz Extracelular/patologia , Feminino , Regulação da Expressão Gênica/fisiologia , Imunocompetência , Mediadores da Inflamação/metabolismo , Muco/metabolismo , NF-kappa B/metabolismo , Pneumonia por Pneumocystis/patologia , RNA Mensageiro/genética , Ratos Sprague-Dawley , Mucosa Respiratória/patologia , Transdução de Sinais/fisiologia
18.
Am J Respir Cell Mol Biol ; 58(2): 232-240, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28886250

RESUMO

Pneumocystis is an important fungal pathogen that causes life-threatening pneumonia in patients with AIDS and malignancy. Lung fungal pathogens are recognized by C-type lectin receptors (CLRs), which bind specific ligands and stimulate innate immune responses. The CLR Dectin-1 was previously shown to mediate immune responses to Pneumocystis spp. For this reason, we investigated a potential role for Dectin-2. Rats with Pneumocystis pneumonia (PCP) exhibited elevated Dectin-2 mRNA levels. Soluble Dectin-2 carbohydrate-recognition domain fusion protein showed binding to intact Pneumocystis carinii (Pc) and to native Pneumocystis major surface glycoprotein/glycoprotein A (Msg/gpA). RAW macrophage cells expressing V5-tagged Dectin-2 displayed enhanced binding to Pc and increased protein tyrosine phosphorylation. Furthermore, the binding of Pc to Dectin-2 resulted in Fc receptor-γ-mediated intracellular signaling. Alveolar macrophages from Dectin-2-deficient mice (Dectin-2-/-) showed significant decreases in phospho-Syk activation after challenge with Pc cell wall components. Stimulation of Dectin-2-/- alveolar macrophages with Pc components showed significant decreases in the proinflammatory cytokines IL-6 and TNF-α. Finally, during infection with Pneumocystis murina, Dectin-2-/- mice displayed downregulated mRNA expression profiles of other CLRs implicated in fungal immunity. Although Dectin-2-/- alveolar macrophages had reduced proinflammatory cytokine release in vitro, Dectin-2-/- deficiency did not reduce the overall resistance of these mice in the PCP model, and organism burdens were statistically similar in the long-term immunocompromised and short-term immunocompetent PCP models. These results suggest that Dectin-2 participates in the initial innate immune signaling response to Pneumocystis, but its deficiency does not impair resistance to the organism.


Assuntos
Imunidade Inata/imunologia , Lectinas Tipo C/imunologia , Macrófagos Alveolares/imunologia , Pneumocystis carinii/imunologia , Pneumonia por Pneumocystis/imunologia , Animais , Linhagem Celular , Glicoproteínas/metabolismo , Inflamação/imunologia , Inflamação/patologia , Interleucina-6/metabolismo , Lectinas Tipo C/genética , Camundongos , Camundongos Knockout , Fosforilação , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/patologia , RNA Mensageiro/genética , Ratos , Fator de Necrose Tumoral alfa/metabolismo
19.
BMJ Case Rep ; 20172017 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-29066657

RESUMO

Pneumocystis pneumonia (PCP) is an opportunistic fungal infection that is usually seen in immunocompromised patients, especially those with HIV, malignancies, organ transplants and on drug therapies like chemotherapy and steroids. PCP has subacute presentation in patients with AIDS which if left untreated gets worse and is a significant cause of morbidity and mortality. Here we present a case of PCP went undiagnosed, partially due to the patient being unaware of his HIV positive status and partially because no organism could be found under the microscope.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico , Biópsia , Diagnóstico Diferencial , Infecções por HIV/sangue , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA