Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 369
Filtrar
1.
Respir Res ; 20(1): 213, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31554510

RESUMO

BACKGROUND: The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and the clinical outcomes in HIV-negative patients with PCP who presented with hypoxemic respiratory failure. METHODS: A retrospective observational study was performed involving 51 HIV-negative patients with PCP who presented in respiratory failure and were admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between the time to anti-PCP treatment and in-hospital mortality. RESULTS: All patients were treated with appropriate anti-PCP treatment, primarily involving trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0-97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to confirmation of the microbiological diagnosis. However, the hospital mortality rates were not associated with increasing quartiles of time until anti-PCP treatment (P = 0.818, test for trend). In addition, hospital mortality of patients received early empiric treatment was not better than those of patients received definitive treatment after microbiologic diagnosis (48.4% vs. 40.0%, P = 0.765). In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01-1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34-72.65) were independently associated with increased mortality. CONCLUSIONS: There was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP who presented in hypoxemic respiratory failure.


Assuntos
Soronegatividade para HIV , Pneumonia por Pneumocystis/terapia , Insuficiência Respiratória/fisiopatologia , Adulto , Fatores Etários , Idoso , Antibacterianos/uso terapêutico , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/mortalidade , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
2.
Biomed Res Int ; 2019: 6057028, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30906778

RESUMO

We aimed to develop and validate a predictive model to evaluate in-hospital mortality risk in HIV/AIDS patients with PCP in China. 1001 HIV/AIDS patients with PCP admitted in the Beijing Ditan hospital from August 2009 to January 2018 were included in this study. Multivariate Cox proportional hazard model was used to identify independent risk factors of death, and a predictive model was devised based on risk factors. The overall in-hospital mortality was 17.3%. The patients were randomly assigned into derivation cohort (801cases) and validation cohort (200 cases) in 8:2 ratio, respectively, in which in derivation cohort we found that 7 predictors, including LDH >350U/L, HR>130 times/min, room air PaO2 <70mmHg, later admission to ICU, Anemia (HGB≤90g/L), CD4<50cells/ul, and development of a pneumothorax, were associated with poor prognosis in HIV/AIDS patients with PCP and were included in the predictive model. The model had excellent discrimination with AUC of 0.904 and 0.921 in derivation and validation cohort, respectively. The predicted scores were divided into two groups to assess the in-hospital mortality risk: low-risk group (0-11 points with mortality with 2.15-12.77%) and high-risk group (12-21 points with mortality with 38.78%-81.63%). The cumulative mortality rate also indicated significant difference between two groups with Kaplan-Meier curve (p<0.001). A predictive model to evaluate mortality in HIV/AIDS patients with PCP was constructed based on routine laboratory and clinical parameters, which may be a simple tool for physicians to assess the prognosis in HIV/AIDS patients with PCP in China.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Síndrome de Imunodeficiência Adquirida/mortalidade , HIV-1 , Mortalidade Hospitalar , Pneumonia por Pneumocystis/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/terapia , Síndrome de Imunodeficiência Adquirida/terapia , Adulto , China/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/terapia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
3.
Respir Investig ; 57(3): 213-219, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30824356

RESUMO

Pneumocystis pneumonia (PCP) is an opportunistic disease that mainly affects patients with a deficiency of cell-mediated immunity, especially acquired immunodeficiency syndrome (AIDS). The incidence of PCP in these patients has declined substantially owing to the widespread use of antiretroviral therapy and PCP prophylaxis. However, PCP is still a major AIDS-related opportunistic infection, particularly in patients with advanced immunosuppression in whom human immunodeficiency virus type 1 (HIV-1) infection remains undiagnosed or untreated. The clinical manifestations, diagnosis, treatment, and prevention of PCP in patients with HIV-1 infection are addressed in this review.


Assuntos
Infecções por HIV/complicações , HIV-1 , Infecções Oportunistas/complicações , Pneumonia por Pneumocystis/complicações , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Biomarcadores/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Infecções por HIV/terapia , Humanos , Imunidade Celular , L-Lactato Desidrogenase/sangue , Mucina-1/sangue , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/prevenção & controle , Infecções Oportunistas/terapia , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/prevenção & controle , Pneumonia por Pneumocystis/terapia , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos
4.
Tex Heart Inst J ; 45(4): 254-259, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30374241

RESUMO

The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been generally beneficial. However, because of various concerns, ECMO has rarely been used in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. We report our successful use of venovenous ECMO in a 29-year-old man who presented with severe respiratory distress secondary to Pneumocystis jirovecii pneumonia associated with undiagnosed infection with the human immunodeficiency virus and acquired immune deficiency syndrome. After highly active antiretroviral therapy was begun, acute immune reconstitution inflammatory syndrome developed. The patient's respiratory condition deteriorated rapidly; he was placed on venovenous ECMO for 19 days and remained intubated thereafter. After a 65-day hospital stay and inpatient pulmonary rehabilitation, he recovered fully. In addition to presenting this case, we review the few previous reports and note the multidisciplinary medical and surgical support necessary to treat similar patients.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Oxigenação por Membrana Extracorpórea/métodos , HIV , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Insuficiência Respiratória/terapia , Síndrome de Imunodeficiência Adquirida/virologia , Adulto , Ecocardiografia Transesofagiana , Fluoroscopia , Humanos , Masculino , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/terapia , Radiografia Torácica , Insuficiência Respiratória/etiologia
5.
J Assoc Physicians India ; 66(1): 28-31, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-30341841

RESUMO

Objectives: Pneumocystis jirovecii pneumonia (PCP) can differ in HIV and non HIV population due to degree of immunity. This study was undertaken with an aim to highlight the differences between the two groups. Methods: It was an observational study conducted in the department of Medicine of a tertiary care institution in North India. All cases tested positive for Pneumocystis jirovecii from January 2009 to December 2014 were included in the study. Demographic profile, clinical presentation, risk factors, treatment and course in hospital were noted and analyzed. Results: Among the 42 patients who had PCP, 13 (30.9%) patients were HIV positive and 29 (69%) were HIV negative.Cough was seen maximum in 10(79.3%) patients in HIV group compared to non HIV whereas fever and breathlessness predominated in the non HIV group. The outcome was better in the non HIV group compared to the HIV group which was 16 (55.2%) versus 6 (46.1%) patients respectively. Conclusion: Clinical presentation differed slightly in both these groups. Difference in the outcome was also noted, however, larger numbers may be required to show the difference. It may form the basis of further research. The study successfully compared the presentation and outcome of PCP in the two groups.


Assuntos
Pneumocystis carinii , Pneumonia por Pneumocystis/epidemiologia , Adulto , Coinfecção , Tosse/microbiologia , Dispneia/microbiologia , Feminino , Febre/microbiologia , Infecções por HIV/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/terapia , Fatores de Risco
6.
Neumol. pediátr. (En línea) ; 13(3): 122-124, sept. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-947642

RESUMO

We describe an unusual case of severe pneumonia due to Pneumocystis jirovecii in a previously healthy 2-month-old patient who had been hospitalized for RSV bronchiolitis.


Se describe un caso inusual de neumonía grave por Pneumocystis jirovecci en un paciente de 2 meses de vida previamente sano, quien había sido hospitalizado por una bronquiolitis por VRS.


Assuntos
Humanos , Masculino , Lactente , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/terapia , Pneumonia por Pneumocystis/microbiologia , Radiografia Torácica , Respiração com Pressão Positiva , Pneumocystis carinii/isolamento & purificação , Imunocompetência , Antibacterianos/uso terapêutico
7.
Am J Case Rep ; 19: 927-931, 2018 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-30087316

RESUMO

BACKGROUND Pneumocystis jiroveci pneumonia (PCP) - formerly known as Pneumocyctis carinii pneumonia - with newly diagnosed AIDS is an uncommon presentation in people over 50 years of age. A high level of suspicion is required for this diagnosis when an elderly patient with pneumonia is not responding to broad-spectrum antibiotic treatment. CASE REPORT We describe the case of a 63-year-old woman who presented with dyspnea, cough, and significant hypoxemia requiring high-flow oxygen supplement with bilateral lung infiltrates, treated with broad-spectrum antibiotics for a presumed diagnosis of pneumonia. The patient demonstrated slow clinical improvement. A diagnostic bronchoscopy with transbronchial biopsy was done, which revealed unexpected findings of Pneumocystis organisms on GMS stain. The patient tested positive for HIV and was found to have a low CD4 of 47. She was treated for Pneumocystis jiroveci pneumonia (PCP) and recovered accordingly. CONCLUSIONS It is essential to remember that HIV and the associated opportunistic infections can be very easily overlooked in the elderly. Taking a sexual history can be challenging, especially in the older population, but it should be performed. Keep in mind that aged people can get infected with HIV at an earlier stage in life and remain in latent phase for up to 15 years without specific symptoms.


Assuntos
Síndrome de Imunodeficiência Adquirida/diagnóstico , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Síndrome de Imunodeficiência Adquirida/terapia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Humanos , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/terapia , Pneumonia por Pneumocystis/terapia
8.
Clin Nutr ESPEN ; 25: 163-165, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29779813

RESUMO

It is generally acknowledged that malnutrition is a propensity factor for secondary infections in different clinical situations (malnutrition-associated infections in hospitalized patients and malnourished children in developing countries). However, it is not clear how malnutrition might facilitate the development of opportunistic infections in human immunodeficiency virus (HIV)-negative patients without a definite etiology (disease or treatment) of impaired cell-mediated immune response. We report here on a case of Pneumocystis jirovecii pneumonia in an HIV-negative patient suffering from anorexia nervosa with extreme malnutrition, which had a favorable outcome despite the severity of her respiratory failure. This report indicates the need for the early screening of nutritional status and rapid treatment initiation in patients with malnutrition, as well as the determination of opportunistic infections in the event of a low lymphocyte count.


Assuntos
Anorexia Nervosa/imunologia , Imunidade Celular , Hospedeiro Imunocomprometido , Estado Nutricional , Infecções Oportunistas/imunologia , Pneumocystis carinii/imunologia , Pneumonia por Pneumocystis/imunologia , Desnutrição Proteico-Calórica/imunologia , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/terapia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Pessoa de Meia-Idade , Avaliação Nutricional , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/terapia , Pneumocystis carinii/patogenicidade , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/terapia , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/fisiopatologia , Desnutrição Proteico-Calórica/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
J Health Care Poor Underserved ; 29(1): 107-158, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29503291

RESUMO

Globally, Pneumocystis pneumonia (PCP) remains a common and lethal infection in both HIV-positive and HIV-negative patients, particularly in developing countries where rates of PCP increases with rising GDP. Pneumocystis jirovecii cannot be cultured in routine clinical laboratories; thus diagnosis relies on microscopy, histology, serology and/or polymerase chain reaction (PCR) of the Pneumocystis DNA. Most of these methods are expensive and require training. Accessing lower respiratory tract specimens in young children is often challenging and only PCR testing of nasopharyngeal aspirates is useful. Early treatment with high-dose co-trimoxazole is effective therapy; however, adverse reactions are common along with reports of emerging resistance. Improved outcomes are associated with adding corticosteroid to treatment in those with moderate/severe PCP, although this has not been studied in resource-poor settings. This review compares the available diagnostic techniques in relation to their suitability for use in resource-poor settings. We also addressed the non-availability of the alternative medications in these regions.


Assuntos
Países em Desenvolvimento , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/terapia , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Medicine (Baltimore) ; 97(12): e0162, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29561424

RESUMO

RATIONALE: Cognitive dysfunction is a common presenting symptom in patients with HIV/AIDS. It is usually directly associated with HIV infection or due to opportunistic infection. Rapidly progressive dementia, however, is rarely observed in acute HIV infection or during immune reconstitution. Recently, a case of Creutzfeld-Jakob disease (CJD) has been reported in a patient with chronic HIV infection. The incidence of CJD is not known to be increased among immunocompromised patients. PATIENT CONCERNS: We here report the case of a 59-year-old male patient with a recent diagnosis of HIV/AIDS and Pneumocystis jiroveci pneumonia presenting with secondary behavioral changes and disorientation. Over the course of several weeks, progressive dementia developed characterized by apraxia, gait ataxia, and mutism. DIAGNOSES: After the exclusion of common HIV-associated neurologic conditions, the clinical course as well as findings on electroencephalogram (EEG), magnetic resonance imaging (MRI), and a positive 14-3-3 assay converged into a probable diagnosis of CJD. The diagnosis was later confirmed histopathologically. OUTCOMES: Palliative care was provided, and the patient passed away within 2 months of symptom onset. LESSONS: HIV/AIDS is an important stratifying condition during the work-up of many clinical syndromes including encephalopathy but may prematurely exclude important differential diagnoses. Non-opportunistic etiologies have to be considered as part of a secondary workup as this case of concomitant AIDS and CJD demonstrates. Rapidly progressive dementia should be distinguished from delirium as early as possible in order to be able to choose the correct diagnostic pathway. Despite the common occurrence of neurologic syndromes in the setting of immunodeficiency, an analytical diagnostic approach is advisable to minimize diagnostic bias.


Assuntos
Síndrome de Creutzfeldt-Jakob/etiologia , Infecções por HIV/complicações , Pneumocystis carinii , Pneumonia por Pneumocystis/complicações , Síndrome de Creutzfeldt-Jakob/diagnóstico por imagem , Síndrome de Creutzfeldt-Jakob/fisiopatologia , Síndrome de Creutzfeldt-Jakob/terapia , Evolução Fatal , Infecções por HIV/diagnóstico por imagem , Infecções por HIV/fisiopatologia , Infecções por HIV/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/fisiopatologia , Pneumonia por Pneumocystis/terapia
11.
J Artif Organs ; 21(3): 371-373, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29574652

RESUMO

Patients with immunosuppression from human immunodeficiency virus (HIV) have been traditionally considered poor candidates for extracorporeal membrane oxygenation (ECMO) because of high in-hospital mortality and poor long-term survival. Highly active antiretroviral therapy (HAART) has improved survival rates in compliant HIV patients and reversible severe respiratory failure may warrant ECMO in this group. Immune reconstitution inflammatory syndrome (IRIS) involves excessive inflammatory response to a pathogen with paradoxical clinical deterioration following HAART initiation and may present as severe respiratory failure. Patients with IRIS supported on ECMO have been infrequently reported in literature. We report two HIV-positive patients who developed acute respiratory distress syndrome from IRIS necessitating successful veno-venous ECMO as salvage therapy.


Assuntos
Oxigenação por Membrana Extracorpórea , Infecções por HIV/complicações , Reconstituição Imune , Pneumonia por Pneumocystis/terapia , Adulto , Infecções por HIV/imunologia , Humanos , Masculino , Pneumonia por Pneumocystis/etiologia , Pneumonia por Pneumocystis/imunologia , Insuficiência Respiratória , Resultado do Tratamento
12.
Perfusion ; 33(6): 433-437, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29528776

RESUMO

AIM: As experience with extracorporeal life support (ECLS) increases, indications for its use have expanded to diverse patient populations, including those with HIV infection. Pneumocystis jirovecii pneumonia (PJP) is a particularly devastating complication of HIV infections. The objective of this study was to review ECLS use in HIV-positive patients, with particular emphasis on those with concomitant PJP infection. METHODS: All patients were treated by the same ECLS team, consisting of an ECLS specialist intensivist, cardiothoracic surgeon and allied medical professionals at three healthcare institutions. The same ECLS protocol was utilized for all patients during the study period. A retrospective review was performed for all HIV-positive patients placed on ECLS from May 2011 to October 2014. Demographic, clinical, ECLS and complication data were reviewed to identify risk factors for death. RESULTS: A total of 22 HIV-positive patients received ECLS therapy during the study period. All patients were supported with venovenous ECLS and overall survival to hospital discharge was 68%. Survival amongst the PJP positive cohort was 60%. Non-survivors were more likely to require inotropic medications on ECLS (100% non-survivors vs. 46.7% survivors, p=0.022) and had a longer total duration of ECLS (13 days non-survivors vs. 7 days survivors, p=0.011). No difference was observed between PJP-positive and PJP-negative patients with regard to demographic data, complication rates or survival. CONCLUSION: ECLS is a viable treatment option in carefully selected HIV-positive patients, including those with severe disease as manifested by PJP infection.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Infecções por HIV/complicações , Infecções por HIV/terapia , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/terapia , Adulto , Feminino , HIV/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Análise de Sobrevida , Carga Viral
13.
J Infect Dev Ctries ; 12(10): 824-834, 2018 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-32004150

RESUMO

INTRODUCTION: Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients. METHODOLOGY: We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017. RESULTS: The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-ß-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial. CONCLUSIONS: Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Hospedeiro Imunocomprometido , Pneumocystis carinii , Pneumonia por Pneumocystis , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/terapia , Estudos de Casos e Controles , Diagnóstico Precoce , Humanos , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/imunologia , Pneumonia por Pneumocystis/mortalidade , Pneumonia por Pneumocystis/terapia , Taxa de Sobrevida
14.
Clin Chest Med ; 38(3): 465-477, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28797489

RESUMO

Many fungi cause pulmonary disease in patients with human immunodeficiency virus (HIV) infection. Pathogens include Pneumocystis jirovecii, Cryptococcus neoformans, Aspergillus spp, Histoplasma capsulatum, Coccidioides spp, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei, and Emmonsia spp. Because symptoms are frequently nonspecific, a high index of suspicion for fungal infection is required for diagnosis. Clinical manifestations of fungal infection in HIV-infected patients frequently depend on the degree of immunosuppression and the CD4+ helper T cell count. Establishing definitive diagnosis is important because treatments differ. Primary and secondary prophylaxes depend on CD4+ helper T cell counts, geographic location, and local prevalence of disease.


Assuntos
Infecções por HIV/complicações , Micoses/terapia , Pneumocystis/patogenicidade , Pneumonia por Pneumocystis/terapia , Humanos
15.
Biomed Res Int ; 2017: 7452604, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28567422

RESUMO

BACKGROUND: The risk factors for the mortality rate of Pneumocystis jirovecii pneumonia (PCP) who required mechanical ventilation (MV) remained unknown. METHODS: A retrospective chart review was performed of all PCP patients admitted to our intensive care unit and treated for acute hypoxemic respiratory failure to assess the risk factors for the high mortality. RESULTS: Twenty patients without human immunodeficiency virus infection required mechanical ventilation; 19 received noninvasive ventilation; and 11 were intubated. PEEP was incrementally increased and titrated to maintain FIO2 as low as possible. No mandatory ventilation was used. Sixteen patients (80%) survived. Pneumothorax developed in one patient with rheumatoid arthritis (RA). Median PEEP level in the first 5 days was 10.0 cmH2O and not associated with death. Multivariate analysis showed the association of incidence of interstitial lung disease and increase in serum KL-6 with 90-day mortality. CONCLUSIONS: We found MV strategies to prevent pneumothorax including liberal use of noninvasive ventilation, and PEEP titration and disuse of mandatory ventilation may improve mortality in this setting. Underlying disease of interstitial lung disease was a risk factor and KL-6 may be a useful predictor associated with mortality in patients with RA. These findings will need to be validated in larger studies.


Assuntos
Mucina-1/sangue , Pneumocystis carinii , Pneumonia por Pneumocystis/terapia , Respiração Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/sangue , Pneumonia por Pneumocystis/etiologia , Estudos Retrospectivos
17.
Arch Bronconeumol ; 53(2): 55-61, 2017 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27616706

RESUMO

INTRODUCTION: The clinical benefits of adjunctive corticosteroids for Pneumocystis jirovecii (P. jirovecii) pneumonia in patients not infected with the human immunodeficiency virus (HIV) has not been evaluated by meta-analysis. METHODS: We conducted a systematic review of published studies describing the effects of adjunctive corticosteroids on outcome in non-HIV P. jirovecii pneumonia patients. Two investigators independently searched the PubMed and Cochrane databases for eligible articles written in English. A meta-analysis was performed using a random-effects model for measuring mortality as the primary outcome, and the need for intubation or mechanical ventilation as the secondary outcome. RESULTS: Seven observational studies were eligible. In these studies, adjunctive corticosteroids did not affect mortality in non-HIV patients (odds ratio [OR] 1.26; 95% CI 0.60-2.67) and there was no beneficial effect in patients with severe hypoxemia (PaO2<70mmHg) (OR 0.90; 95% CI 0.44-1.83). No significant effect on the secondary outcome was observed (OR 1.34; 95% CI 0.44-4.11). CONCLUSIONS: Although the studies were observational, meta-analysis showed that adjunctive corticosteroids did not improve the outcome of P. jirovecii pneumonia in non-HIV patients. The results warrant a randomized controlled trial.


Assuntos
Pneumonia por Pneumocystis/tratamento farmacológico , Adolescente , Adulto , Soronegatividade para HIV , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Imunocompetência , Hospedeiro Imunocomprometido , Intubação Intratraqueal/estatística & dados numéricos , Estudos Observacionais como Assunto , Pneumonia por Pneumocystis/mortalidade , Pneumonia por Pneumocystis/terapia , Respiração Artificial/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
18.
Infect Immun ; 85(3)2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27993972

RESUMO

We explored differential polarization of macrophages during infection using a rat model of Pneumocystis pneumonia. We observed enhanced pulmonary M1 macrophage polarization in immunosuppressed (IS) hosts, but an M2 predominant response in immunocompetent (IC) hosts following Pneumocystis carinii challenge. Increased inflammation and inducible nitric oxide synthase (iNOS) levels characterized the M1 response. However, macrophage ability to produce nitric oxide was defective. In contrast, the lungs of IC animals revealed a prominent M2 gene signature, and these macrophages effectively elicited an oxidative burst associated with clearance of Pneumocystis In addition, during P. carinii infection the expression of Dectin-1, a critical receptor for recognition and clearance of P. carinii, was upregulated in macrophages of IC animals but suppressed in IS animals. In the absence of an appropriate cytokine milieu for M2 differentiation, Pneumocystis induced an M1 response both in vitro and in vivo The M1 response induced by P. carinii was plastic in nature and reversible with appropriate cytokine stimuli. Finally, we tested whether macrophage polarization can be modulated in vivo and used to help manage the pathogenesis of Pneumocystis pneumonia by adoptive transfer. Treatment with both M1 and M2 cells significantly improved survival of P. carinii-infected IS hosts. However, M2 treatment provided the best outcomes with efficient clearance of P. carinii and reduced inflammation.


Assuntos
Hospedeiro Imunocomprometido , Ativação de Macrófagos/imunologia , Macrófagos Alveolares/imunologia , Macrófagos Alveolares/microbiologia , Pneumocystis/imunologia , Transferência Adotiva , Animais , Modelos Animais de Doenças , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Lectinas Tipo C/genética , Lectinas Tipo C/metabolismo , Macrófagos Alveolares/metabolismo , Mortalidade , Pneumonia por Pneumocystis/imunologia , Pneumonia por Pneumocystis/metabolismo , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/terapia , Ratos
19.
Anticancer Res ; 36(12): 6673-6676, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27920001

RESUMO

We describe a 69-year-old woman with metastatic breast cancer who developed dyspnea on exertion, persistent cough, fever and fatigue while on everolimus and exemestane combination. The initial differentials included opportunistic infection such as pneumocystis jiroveci pneumonia (PJP) vs. pneumonitis. Bronchoalveolar lavage (BAL) from bronchoscopy revealed PJP. The patient recovered after appropriate treatment. We also correlated the progressive decrease in her absolute lymphocyte count with PJP infection and recovery. This is the second case that PJP has been described in patients with breast cancer receiving everolimus. Clinicians should be vigilant in their monitoring of patients on everolimus-based regimens and promptly institute appropriate therapy to reduce and prevent morbidity and mortality.


Assuntos
Neoplasias da Mama/complicações , Pneumonia por Pneumocystis/diagnóstico , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Metástase Neoplásica , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/terapia
20.
PLoS One ; 11(11): e0164320, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27824870

RESUMO

BACKGROUND: Pneumocystis jirovecii pneumonia (PCP) is a frequent opportunistic infection in immunocompromised patients. In literature, presentation and outcome of PCP differs between patients with human immunodeficiency virus (HIV) infection and renal transplant recipients (RTRs). METHODS: We conducted a cross-sectional study of patients with PCP based on the HIV and renal transplant registries at our institution. Radiological and clinical data from all confirmed PCP cases between 2005 and 2012 were compared. RESULTS: Forty patients were included: 16 with HIV and 24 RTRs. Radiologically, HIV patients had significantly more areas of diffuse lung affection (81% HIV vs. 25% RTR; p = 0.02), more ground glass nodules 5-10 mm (69% vs. 4%; p = <0.001) and enlarged hilar lymph nodes were found only in HIV patients (44%). Cough and dyspnea were the most common clinical signs (>80%) in both groups. Duration from illness onset to hospital presentation was longer in the HIV patients (median of 18 vs. 10 days (p = 0.02)), implying a less fulminant clinical course. Sixty percent of PCP cases in RTRs occurred >12 months after transplantation. Lengths of hospitalization, admission rates to the intensive care unit, and requirements for mechanical ventilation were similar. Outcome in both groups was favourable. CONCLUSIONS: While important differences in radiological presentation of PCP between HIV patients and RTRs were found, clinical presentation was similar. PCP only rarely presented with fulminant respiratory symptoms requiring ICU admission, with similar results and outcomes for HIV patients and RTRs. Early diagnosis and treatment is mandatory for clinical success.


Assuntos
Infecções por HIV/microbiologia , Transplante de Rim/efeitos adversos , Pneumocystis carinii/patogenicidade , Pneumonia por Pneumocystis/diagnóstico por imagem , Adulto , Idoso , Estudos Transversais , Feminino , Hospitalização , Humanos , Hospedeiro Imunocomprometido/fisiologia , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/terapia , Radiografia , Transplantados
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA