Outbreak-Causing Fungi: Pneumocystis jirovecii

Mycopathologia - Pneumocystis jirovecii pneumonia (PCP) is an important cause of morbidity in immunocompromised patients, with a higher mortality in non-HIV than in HIV patients. P. jirovecii is...     

Epidemiology of Pneumocystis jirovecii Pneumonia in Venezuela

Current Fungal Infection Reports - The aim of this work is to contribute to the knowledge of the epidemiology of pneumocystosis or Pneumocystis jirovecii pneumonia (PCP) in Venezuela, by an updated...     

耶氏肺孢子菌与宿主免疫防御相互作用

肺孢子菌肺炎(Pneumocystis pneumonia,PCP)是由酵母样真菌耶氏肺孢子菌(Pneumocystis jirovecii,Pj)引起的肺炎,是免疫缺陷患者重要的致死原因。Pj一般不导致系统性感染,仅在肺部繁殖,引发严重损害肺换气功能的间质性肺炎。Pj通过主要表面糖蛋白(major surface glycoprotein,MSG)的抗原转换,逃避宿主免疫系统清除,而宿主利用dectin-1识别β-(1,3)-D-葡聚糖(beta-1,3-D-glucan,BG)、甘露糖受体识别MSG,启动天然免疫反应,继而CD4+T细胞聚集活化,调控细胞免疫和体液免疫。分泌干扰素γ的细胞毒型CD8+Tc1细胞有助于控制Pj感染,特异性抗体有助于调理加强吞噬细胞清除Pj,而聚集的中性粒细胞和非Tc1CD8+T细胞与肺损伤有关。血浆BG水平可以辅助诊断PCP,而支气管肺泡灌洗液中白介素8的水平与肺损伤及死亡预后有关。     

Evidence for the Presence of "Metabolic Sterols" in Pneumocystis: Identification and Initial Characterization of Pneumocystis carinii Sterols

Mixed life cycle stages of rat-derived Pneumocystis carinii were isolated from host lungs and their sterols were compared with those present in lungs from normal and immunosuppressed uninfected rats. Gas-liquid chromatography consistently detected, resolved, and quantified 9, 10, and 20 sterol components in the total nonsaponifiable neutral lipid fraction of lungs from normal rats, lungs from immunosuppressed uninfected rats, and P. carinii preparations, respectively. In all samples, cholesterol was the most abundant sterol present, comprising 97%, 93%, and 78% of total sterols in lungs from normal rats, lungs from immunosuppressed uninfected rats, and P. carinii , respectively. Tentative identifications of several rat lung and P. carinii minor sterols were made based on gas-liquid chromatogram retention times and fragmentation patterns from mass spectral analyses. Campesterol (ergost-5-en-3-ol), cholest-5-en-3-one, and β -sitosterol (stigmast-5-en-3-ol) were among the minor components present in both types of lung controls, and were also components of P. carinii sterols. In contrast to lung controls, the sterols of P. carinii were enriched in C₂₈ and C₂₉ sterols with one or two double bonds, and a hydroxyl group at C-3 (ergost-5-en-3-ol, ergost-7-en-3-ol, ergosta-dien-3-ol, stigmast-5-en-3-ol, stigmast-7-en-3-ol and stigmasta-dien-3-ol). Steryl esters of P. carinii , probably stored in cytoplasmic lipid droplets, were dominated by those present in the host lung. In separate studies. 3-hydroxy-3-methylglutaryl coenzyme A activity, a key enzyme in the regulation of sterol biosynthesis, was detected in purified P. carinii preparations and incorporation of radiolabeled squalene and mevalonate was observed. Together, these results suggest that the parasite readily takes up and incorporates host sterols, and that the organism synthesizes some of its own "metabolic sterols"     

Diagnosis,Burden and Mortality of Pneumocystis jirovecii Pneumonia in Venezuela

Current Fungal Infection Reports - The aim of this work is to contribute to the knowledge of diagnosis, burden, and mortality of pneumocystosis or Pneumocystis jirovecii pneumonia (PCP) in...     

A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole

A 50-year-old male visited the outpatient clinic and complained of fever, poor oral intake, and weight loss. A chest X-ray demonstrated streaky and fibrotic lesions in both lungs, and chest CT revealed multifocal peribronchial patchy ground-glass opacities with septated cystic lesions in both lungs. Cell counts in the bronchoalveolar lavage fluid revealed lymphocyte-dominant leukocytosis, and further analysis of lymphocyte subsets showed a predominance of cytotoxic T cells and few T helper cells. Video-assisted wedge resection of the left upper lobe was performed, and the histologic examination was indicative of a Pneumocystis jirovecii infection. Trimethoprim-sulfamethoxazole (TMP-SMX) was orally administered for 3 weeks; however, the patient complained of cough, and the pneumonia was aggravated in the follow-up chest X-ray and chest CT. Molecular studies demonstrated mutations at codons 55 and 57 of the dihydropteroate synthase (DHPS) gene, which is associated with the resistance to TMP-SMX. Clindamycin-primaquine was subsequently administered for 3 weeks replacing the TMP-SMX. A follow-up chest X-ray showed that the pneumonia was resolving, and the cough was also alleviated. A positive result of HIV immunoassay and elevated titer of HCV RNA indicated HIV infection as an underlying condition. This case highlights the importance of careful monitoring of patients with P. jirovecii pneumonia (PCP) during the course of treatment, and the molecular study of DHPS mutations. Additionally, altering the anti-PCP drug utilized as treatment must be considered when infection with drug-resistant P. jirovecii is suspected. To the best of our knowledge, this is the first case of TMP-SMX-resistant PCP described in Korea.     

耶氏肺孢子菌肺炎临床特点及KL-6诊断价值

目的分析本地区耶氏孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)患者的流行趋势、临床特征、血清学标志物,为PJP患者的早预防、早诊断提供理论依据。方法回顾性分析江西省3所综合性医院2016年1月至2019年12月诊断为PJP的49例住院患者,收集患者临床资料,包括基本信息、危险因素、临床表现、实验室结果、影像学报告、预后等。结果49例PJP患者绝大多数HIV阴性(89.8%),且以中年男性为主。AIDS、肾脏疾病(47.7%)和结缔组织疾病(29.6%)为PJP患者主要危险因素,临床表现以干咳(83.7%)、白色黏痰,发热(79.6%)为主,其次为呼吸困难。PJP患者以低剂量/短时间(<3个月)使用糖皮质激素或免疫抑制剂为特征。85%以上PJP患者实验室指标超过参考范围的有中性粒细胞百分比、C反应蛋白、氧分压、乳酸脱氢酶和涎液化糖链抗原-6(KL-6)。结论HIV阴性患者感染PJ逐渐增多,肾脏疾病和结缔组织疾病是其主要危险因素,LDH、BG和KL-6可作为PJP患者的重要辅助检查。     

Accuracy of a routine real-time PCR assay for the diagnosis of Pneumocystis jirovecii pneumonia

Pneumocystis jirovecii is a common cause of life-threatening pneumonia among immunocompromised patients. Using 400 fresh bronchoalveolar lavage samples, we compared prospectively routine direct immunofluorescence assay (DFA) and a real-time PCR assay, performed on a LightCycler system, for the detection of P. jirovecii. Among the 66 PCR positive samples, 31 were positive by DFA. No patient was found as having the pattern "PCR--ve/DFA+ve". The semi-quantification of the P. jirovecii DNA was represented by the cycle threshold (Ct). Using DFA as the gold standard, the sensitivity of the PCR was 100% for Ct>/=28 and the specificity was 100% for Ct<22. Between these two points, the results could be discrepant. The patients of the "22/=28" group, and presented less frequently with HIV-infection and elevated lactate dehydrogenase (LDH) assay than in the "Ct<22" group. A negative PCR allowed us to exclude the P. jirovecii pneumonia. The real-time PCR assay seems to be an accurate diagnosis method and could replace the DFA. The semi-quantitative results should be helpful to distinguish colonized, subclinically infected and P. jirovecii pneumonia patients.