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pneumocystis pneumonia

Henry Anyimadu, Chandra Pingili, Vel Sivapalan, Yael Hirsch-Moverman, Sharon Mannheimer
Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm3 or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considered for prophylaxis. Discordance between CD4 count and CD4% occurs in 16% to 25% of HIV-infected patients. Provider compliance with current PJP prophylaxis guidelines when such discordance is present was assessed. Electronic medical records of 429 HIV-infected individuals who had CD4 count and CD4% measured at our clinic were reviewed...
January 2018: Journal of the International Association of Providers of AIDS Care
Gildas Baulier, Nahema Issa, Frederic Gabriel, Isabelle Accoceberry, Fabrice Camou, Pierre Duffau
OBJECTIVES: Guidelines for preventing Pneumocystis pneumonia (PCP) in HIV patients are based on CD4 below 200/mm3. Such cut-off value is suggested to guide prophylaxis in non-HIV conditions (NHIV) especially in autoimmune and inflammatory diseases (AD). We aimed to determine if CD4 could be used to guide PCP prophylaxis in AD. METHODS: CD4 and lymphocyte-count were retrospectively studied in patients diagnosed with PCP between January 2013 and February 2016. RESULTS: 129 patients were included...
February 26, 2018: Clinical and Experimental Rheumatology
Gerry Capatos, Christopher R Burke, Mark T Ogino, Roberto R Lorusso, Thomas V Brogan, D Michael McMullan, Heidi J Dalton
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...
March 1, 2018: Perfusion
X Huang, L Weng, L Yi, M Li, Y Y Feng, Y Tian, J G Xia, Q Y Zhan, B Du
Objective: To investigate the clinical manifestations and prognostic factors of hospital death in connective tissue disease patients with acute respiratory failure caused by pneumocystis pneumonia (PCP) admitted to two medical intensive care units(MICU). Methods: A retrospective review was conducted for all connective tissue disease (CTD) patients with acute respiratory failure from PCP in MICU of 2 academic medical centers between 2010 and 2015. The patients were divided into survivors and non-survivors. Demographic and clinical data, including laboratory, radiological and microbiological findings, as well as therapy, clinical course, mortality and prognostic factors of hospital mortality were included in the analysis...
March 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
Vadim M Kemaykin, Nariman B Tabinbaev, Mahira S Khudaibergenova, Anastasia A Olifirovich, Layzzat M Abdrakhmanova, David W Denning, Nikolai Klimko
Our work aimed to generate a preliminary estimation of severe and chronic fungal diseases in the Republic of Kazakhstan with a model proposed by LIFE (Leading International Fungal Education). Calculations were carried out on data from 2015. Published results of studies of mycoses in Kazakhstan were identified; in the absence of national data from the scientific literature, the frequency of life-threatening and serious mycoses in defined groups of patients at risk from other countries were taken into account...
March 8, 2018: Journal of Fungi (Basel, Switzerland)
Giacomo Veronese, Enrico Ammirati, Maria Cristina Moioli, Rossella Baldan, Carlo Andrea Orcese, Gisele De Rezende, Silvio Veronese, Gabriella Masciocco, Enrico Perna, Giovanna Travi, Massimo Puoti, Manlio Cipriani, Simon Tiberi, Daniela Cirillo, Maria Frigerio
BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) outbreaks are described in solid organ transplant recipients. Few reports suggest interhuman transmission with important infection control implications. We described a large PJP outbreak in heart transplant (HTx) recipients. METHODS: Six cases of PJP occurred in HTx recipients within 10 months in our hospital. Demographics, clinical characteristics, treatment and outcomes were described. To identify contacts among individuals a review of all dates of out-patient visits and patient hospitalizations was performed...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Nathan Ford, Graeme Meintjes, Alexandra Calmy, Helen Bygrave, Chantal Migone, Marco Vitoria, Martina Penazzato, Lara Vojnov, Meg Doherty
In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. These guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia...
March 4, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
W A Werbel, M G Ison, M P Angarone, A Yang, V Stosor
BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) affected 5-15% of solid organ transplant (SOT) recipients prior to universal prophylaxis, classically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines generally recommend 6-12 months of prophylaxis post SOT, yet optimal duration and robust PJP risk stratification have not been established. METHODS: A retrospective, single-center, case-control study of PJP among SOT recipients from January 1998 to December 2013 was conducted...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
G Jutras, K Bélanger, N Letarte, J-P Adam, D Roberge, B Lemieux, É Lemieux-Blanchard, L Masucci, C Ménard, J P Bahary, R Moumdjian, F Berthelet, M Florescu
Background: Procarbazine, lomustine, and vincristine (pcv) significantly improve survival outcomes in lgg (low-grade gliomas). Administration of pcv to lgg patients increased tremendously over the past years as it went from 2 patients per year between 2005 and 2012 to 23 patients in 2015 only in our centre. However, serious hematological and non-hematological adverse events may occur. The purpose of this study was to evaluate the toxicity of pcv and its clinical relevance in our practice...
February 2018: Current Oncology
Rita O Oladele, Akaninyene A Otu, Malcolm D Richardson, David W Denning
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...
2018: Journal of Health Care for the Poor and Underserved
Mihai Mareș, Valentina Ruxandra Moroti-Constantinescu, David W Denning
OBJECTIVE: To estimate for the first time the burden of fungal infections in Romania. METHODS: Data derived from the World Health Organization (WHO), National Institute of Statistics, Romanian public health agencies and non-profit health organizations, and published annual reports on local epidemiology were used in the present study. When no data were available, specific at-risk populations were used to calculate frequencies of serious fungal diseases, using previously published epidemiological parameters...
March 1, 2018: Journal of Fungi (Basel, Switzerland)
Mengyan Wang, Biao Zhu
Pneumocystis jirovecii pneumonia is an opportunistic infection among immunocompromised people. Studies have found that the increased resistance to sulfa drugs of Pneumocystis jirovecii may be associated with the mutation of dihydropteroate synthase ( DHPS ) gene and dihydrofolate reductase ( DHFR ) genes, but the mechanism is still unclear. The mutation of DHPS and DHFR genes may be the result of sulfa drugs selection or spontaneous genetic polymorphism, and it can be acquired from person-to-person transmission...
May 25, 2017: Zhejiang da Xue Xue Bao. Yi Xue Ban, Journal of Zhejiang University. Medical Sciences
Daniela Fluxá, Jorge Segovia, Matías Florenzano, Jessica Salinas, Lilian Flores, Daniela Simian, Rodrigo Quera
There are no evidence-based guidelines about prophylaxis against Pneumocystis jiroveci pneumonia in inflammatory bowel disease. We report a case of P. jiroveci pneumonia in patient with Crohn's disease receiving infliximab and methotrexate. This case emphasizes the importance of considering the possibility of this infection in inflammatory bowel disease patients treated on biological therapy.
October 2017: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
Prithiv Prasad, Kevin Bryan Lo, Pradhum Ram
The highest risk of opportunistic infections is from 1 to 6 months post-transplant. We report a rare case of Pneumocystis jirovecii pneumonia in a renal transplant recipient only on maintenance immunosuppression eleven years after transplant without concomitant CMV infection or recent episodes of graft rejection.
June 2018: Medical Mycology Case Reports
V A Novikov, G M Galstyan, I An E G Gemdzh, I E Kostina, M K Gitis
PURPOSE: To compare the accuracy of bedside lung ultrasound (LUS) and chest computed tomography (CT) for the de- tection of lung lesions in patients with hematological malignancies and acute respiratory failure (ARF). MATERIALS AND METHODS: 39 patients with hematological malignancies and ARF were enrolled in prospective study. The investigation of the patients included LUS, chest C, extravascular lung water index (EVLW) by transpulmonary ther- modilution, and bronchoalveolar lavage (BAL)...
September 2017: Anesteziologiia i Reanimatologiia
S Richard, J M G C F Almeida, O H Cissé, A Luraschi, O Nielsen, M Pagni, P M Hauser
Fungi of the genus Pneumocystis are obligate parasites that colonize mammals' lungs and are host species specific. Pneumocystis jirovecii and Pneumocystis carinii infect, respectively, humans and rats. They can turn into opportunistic pathogens in immunosuppressed hosts, causing severe pneumonia. Their cell cycle is poorly known, mainly because of the absence of an established method of culture in vitro It is thought to include both asexual and sexual phases. Comparative genomic analysis suggested that their mode of sexual reproduction is primary homothallism involving a single mating type ( MAT ) locus encompassing plus and minus genes ( matMc , matMi , and matPi ; Almeida et al...
February 20, 2018: MBio
Mark Reinwald, Jose T Silva, Nicolas J Mueller, Jesús Fortún, Christian Garzoni, Johan W de Fijter, Mario Fernández-Ruiz, Paolo Grossi, Jose María Aguado
BACKGROUND: The present review is part of the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies. AIMS: To review, from an Infectious Diseases perspective, the safety profile of therapies targeting different intracellular signaling pathways and to suggest preventive recommendations. SOURCES: Computer-based MEDLINE searches with MeSH terms pertaining to each agent or therapeutic family...
February 15, 2018: Clinical Microbiology and Infection
Takahiro Makino, Ikuo Kamitsukasa, Shoichi Ito
A 72-year-old Japanese woman with rheumatoid arthritis whose activity decreased with previous treatments had recurrent thunderclap headaches during an atovaquone regimen for the treatment of pneumocystis pneumonia. The recurrent headaches disappeared after discontinuation of the drug. Brain magnetic resonance images showed multiple cerebral vasoconstrictions of cerebral arteries with vasogenic cerebral white matter edema, which diminished several weeks later. We diagnosed the patient's headaches as reversible cerebral vasoconstriction syndrome due to atovaquone...
September 2017: Case Reports in Neurology
Gensheng Zhang, Miaomiao Chen, Shufang Zhang, Hongwei Zhou, Xiaozhen Ji, Jiachang Cai, Tianzheng Lou, Wei Cui, Ning Zhang
Combined treatment with caspofungin and trimethoprim/sulfamethoxazole (TMP/SMZ) as salvage therapy in non-HIV positive patients with severe pneumocystis pneumonia (PCP) yields poor outcomes. It remains unknown whether the use of this combination strategy as a first-line therapy would improve patient outcomes. The present study aimed to assess the efficacy of caspofungin combined with TMP/SMZ as a first-line therapy in non-HIV positive patients with severe PCP. A retrospective cohort study was conducted between March 2016 and February 2017...
February 2018: Experimental and Therapeutic Medicine
Yuri Higashi, Keishi Nakamura, Atsushi Hirose, Seisho Sakai, Jun Kinoshita, Isamu Makino, Hironori Hayashi, Katsunobu Oyama, Masafumi Inokuchi, Tomoharu Miyashita, Hidehiro Tajima, Hiroyuki Takamura, Itasu Ninomiya, Sachio Fushida, Tetsuo Ohta
A 69-year-old man with multiple liver metastases from sigmoid colon cancer received mFOLFOX6 plus cetuximab(Cmab) chemotherapy. A partial response was observed; hence, we performed an extended left hepatectomy, 3 partial liver resections, and a sigmoidectomy. After 4 courses of CapeOX, a recurrent lesion occurred between S8 and S7 of the liver, and we changed the regimen to FOLFIRI plus bevacizumab(BV). Three months later, he had Grade 3 febrile neutropenia and CT scan findings showed ground glass opacity in the superior lobes of both lungs...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
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