Granulomatous Pneumocystis carinii pneumonia in three patients with the acquired immune deficiency syndrome (original) (raw)
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Pneumocystis carinii antigenemia in adults with malignancy, infection, or pulmonary disease
Journal of clinical microbiology, 1984
A counterimmunoelectrophoresis test for Pneumocystis carinii antigenemia was employed to assess the extent of subclinical infection or colonization with this agent in adults with infection, pulmonary disease, or malignancy and in healthy homosexual men. Antigenemia was detected in 6 of 208 (3%) of normal controls, 3 of 28 (11%) of patients with pulmonary infection, 3 of 33 (9%) of those with chronic lung disease, 1 of 36 (3%) of patients with lung cancer, 7 of 271 (3%) of afebrile subjects with malignancy, 6 of 19 (32%) of febrile patients with malignancy, 2 of 22 (9%) of those with nonpulmonary infection, and 0 of 21 (0%) of healthy young homosexual men. These data suggest that P. carinii is a common commensal or saprophyte that becomes clinically significant only when host defenses are impaired. Antigenemia may occur intermittently during various disease states in the absence of positive clinical signs and should alert the physician to subacute infection or colonization. Treatment...
Internal Medicine, 2008
Objective To elucidate the clinical and radiological features of Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA), compared with methotrexate (MTX) pneumonitis in RA and Pneumocystis pneumonia in acquired immunodeficiency syndrome (AIDS). Subjects and Methods Retrospective analysis of 14 PCP cases in RA (RA-PCP), 10 MTX pneumonitis cases in RA (MTX-P) and 11 PCP cases in AIDS (AIDS-PCP) from 9 centers in the Kanto area in the last 6 years. Results Compared with AIDS-PCP, both RA-PCP and MTX-P developed more rapidly, showing higher serum CRP and lower plasma β-D-glucan levels, and more severe oxygenation impairment. In most of the RA-PCP cases, a high dose of corticosteroid was administered as adjunctive therapy, resulting in a favorable outcome. The mortality was 14% in RA-PCP, 0% in AIDS-PCP and 0% in MTX-P cases. In RA-PCP patients the CD4 cell count showed only mild suppression, not reaching the predisposing level for PCP in HIV infection, suggesting that there are risk factors for RA-PCP other than immunosuppression. Radiologic analysis revealed some characteristic patterns of each disease. In MTX-P, diffuse homogeneous ground glass opacity (GGO) with sharp demarcation by interlobular septa (type A GGO) was found in 70%, while in AIDS-PCP diffuse, homogeneous or nonhomogeneous GGO without interlobular septal boundaries (type B GGO) was predominant (91%). In RA-PCP, type A GGO was found in 6 cases and type B GGO in 5 cases, showing the complex nature of this disease. Conclusion RA-PCP differed considerably from AIDS-PCP clinically and radiologically. Clinically it occurred without severe immunosuppression, and showed characteristic aspects, with more intense inflammation and less parasite burden. Radiologically it mimicked MTX-P in some cases sharing the conspicuous CT features of MTX-P, rendering the distinction of these two disorders difficult.
Radiology Case Reports
Although pneumocystis jiroveci pneumonia was historically associated with HIV/AID patients, there is a recent shift in demographics with increasing incidence in patients with hematologic malignancies and transplants. A granulomatous response to pneumocytis jiroveci infection is uncommon and most commonly presents as multiple randomly distributed nodules on chest imaging. Granulomatous pneumocytis jiroveci pneumonia presents with similar clinical manifestations as typical pneumocytis pneumonia but is usually not detected by bronchoalveolar lavage and may require biopsy for a definitive diagnosis. For this reason, the radiologist may be the first provider to suggest this diagnosis and guide management.
Biology and Medicine, 2018
Background: Pneumocystis pneumonia (PCP) is the most common opportunistic infection, and it is difficult to diagnose as PCP. The aim of this study was to assess whether CT findings or clinical characteristics contribute to early diagnosis of PCP. Method: Twenty-six patients with AIDS and PCP received medical treatment at the Kurume University Hospital between 1999 and 2018. None of the patients with AIDS had been diagnosed as HIV positive until the episode of PCP. In this study, the correlation between computed tomography (CT) findings and clinical characteristics were analyzed in patients with AIDS and PCP. The number of patients with PCP is not that high in Japan; therefore, it is difficult to diagnose patients with PCP in the clinic. Results: This study included 24 men and 2 women, and the mean age was 47.8 years. The mean CD4 cell count was 65.7 cells/μl, HIV-viral load was 680 × 10 4 copy, β-D-glucan (βDG) level was 234 pg/ml, and mean time till diagnosis was 41.3 days; 14 patients had hypoxemia. Twelve patients had PCP, 10 had cytomegalovirus (CMV) infection, 2 had Cryptococcus infection, 1 had Entamoeba histolytica infection, 1 had non-tuberculous mycobacteria infection, and 1 had Toxoplasma infection. CT images of the patients showed 10 cases with ground-glass opacity (GGO), 13 with consolidation, 1 with small nodules, 2 with a cavity, and 1 with cyst formation. Nine cases revealed peripheral distribution with peripheral sparing, 1 had pleural fluid, and 6 had lymph node enlargement. The mean time till diagnosis and cough were significantly correlated with lymphadenopathy. Patients with consolidation were more likely to be infected with CMV. Conclusion: GGO, combined with peripheral distribution and peripheral sparing, was the most common CT finding. When consolidation was present in PCP patients as shown in CT images, the patients were more likely to be infected with CMV.
Rheumatology (Oxford, England), 1999
white blood cell count (12 100 × 109/l with 73% PMN ) to treat this patient with IVIg. IVIg, alone or in combination with short-pulse high-dose steroids, resulted in and platelet (547 000 × 109/l ) counts. AST was N × 1.5-fold and ALT was N × 1.7-fold. Serum complete remission of ASD with excellent safety for the mother and the baby. IVIg might be considered a rheumatoid factor and antinuclear antibody were negative. Blood cultures and an exhaustive serological investi-potential alternative to NSAIDs and steroids in pregnant women with ASD. gation for bacterial, viral and parasitic aetiologies of ASD-like syndromes yielded repeatedly negative results.
Pneumocystis carinii Pneumonia in HIV-negative patients with haematologic disease
Infection, 1997
Pneumocystis carinii pneumonia (PCP) was diagnosed in 15 adult HIV-negative haematologic patients in our hospital. None of them had received PCP prophylaxis. All except one had been treated with prednisone.: Symptoms usually started after stopping or tapering. In six patients the diagnosis of PCP was delayed because of confounding bacterial isolates from blood, sputum or urine leading to unsuccessful antibiotic treatment. PCP was diagnosed by demonstrating pneumocysts in bronchoaiveolar lavage fluid. In four patients additional fungal or viral pathogens were identified. The infections were not clustered. The patients were treated with co-trimoxazole and, in case of a pO 2 < 60 mmHg, with prednisone. Three patients died (20%); they all had a coinfection with cytomegalovirus and/or aspergillus. The others recovered completely. There were no relapses. Primary PCP prophylaxis should be considered in patients with lympho-proliferative disease and exposure to prednisone.