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Description

Pneumocystis pneumonia, is a form of pneumonia caused by the fungus Pneumocystis jirovecii.[1][2]Pneumocystis specimens are commonly found in the lungs of healthy people although it is usually not a cause for disease.[3] However, they are a source of opportunistic infection and can cause lung infections in people with a weak immune system or other predisposing health conditions.[4]Antipneumocystic medication is used with concomitant steroids to avoid inflammation. The most commonly used medication is trimethoprim/sulfamethoxazole.[5][6]

Presentation

Signs and symptoms may develop over several days or weeks[4] and may include: shortness of breath and/or difficulty breathing (of gradual onset), fever, dry/non-productive cough, weight loss, and night sweats.[7]

Complication

In terms of further issues, pneumothorax is a well-known complication of Pneumocystis pneumonia.[8]

Associated conditions

Since the start of the AIDS epidemic, PCP has been closely associated with AIDS. Because it only occurs in an immunocompromised host, it may be the first clue to a new AIDS diagnosis if the individual has no other reason to be immunocompromised. An unusual rise in the number of PCP cases in North America, noticed when physicians began requesting large quantities of the rarely used antibiotic pentamidine, was the first clue to the existence of AIDS in the early 1980s.[9][10][11][12]

Cause

Pneumocystis jirovecii (previously P. carinii) is a yeast-like fungus of the genus Pneumocystis; it is the causative organism of Pneumocystis pneumonia.[13]

Mechanism

The risk of PCP increases when CD4-positive T-cell levels are less than 400 cells per micro liter. In these immunosuppressed individuals, the manifestations of the infection are highly variable.[14]The disease attacks the interstitial, fibrous tissue of the lungs, with marked thickening of the alveolar septa and alveoli, leading to significant hypoxia, which can be fatal if not treated aggressively. In this situation, lactate dehydrogenase levels increase and gas exchange is compromised. Oxygen is less able to diffuse into the blood, leading to hypoxia, which along with high arterial carbon dioxide levels, stimulates hyperventilatory effort, thereby causing dyspnea .[15][16][13]

Diagnosis

The diagnosis can be confirmed by the characteristic appearance of the chest X-ray and an arterial oxygen level that is strikingly lower than would be expected from symptoms. Gallium 67 scans are also useful in the diagnosis. [17][18]

Differential diagnosis

Other conditions that may appear similar to Pneumocystis pneumonia include: viral pneumonia, bacterial pneumonia, Acute respiratory distress syndrome, Tuberculosis, COVID-19 pneumonia and Legionella pneumonia.[13]

Treatment

Antipneumocystic medication is used with concomitant steroids to avoid inflammation. By far, the most commonly used medication is trimethoprim/sulfamethoxazole, though some individuals are unable to tolerate this treatment due to allergies.[13][19][20]

Epidemiology

The disease PCP is relatively rare in people with normal immune systems, but common among people with weakened immune systems, such as premature or severely malnourished children, the elderly, and especially persons living with HIV/AIDS (in whom it is most commonly observed).[1][21] PCP can also develop in patients who are taking immunosuppressive medications. It can occur in patients who have undergone solid organ transplantation or bone marrow transplantation and after surgery.[22]

History

Pneumocystis pneumonia, was first described in humans by Czech parasitologist Otto Jirovec in 1952. However, the organism responsible for the disease, Pneumocystis jirovecii, was initially discovered by Carlos Chagas in 1909, who mistakenly thought it was part of the lifecycle of Trypanosoma cruzi.[23][24]

References

  1. ↑ 1.0 1.1 Aliouat-Denis CM, Chabé M, Demanche C, Aliouat EM, Viscogliosi E, Guillot J, et al. (September 2008). "Pneumocystis species, co-evolution and pathogenic power". Infection, Genetics and Evolution. 8 (5): 708–726. doi:10.1016/j.meegid.2008.05.001. PMID 18565802.
  2. ↑ Bennett NJ, Gilroy SA (2017-08-08). "Pneumocystis jiroveci Pneumonia (PJP) Overview of Pneumocystis jiroveci Pneumonia". Medscape. Archived from the original on 2022-12-21. Retrieved 2023-01-29.
  3. ↑ Ponce CA, Gallo M, Bustamante R, Vargas SL (February 2010). "Pneumocystis colonization is highly prevalent in the autopsied lungs of the general population". Clinical Infectious Diseases. 50 (3): 347–353. doi:10.1086/649868. PMID 20047487.
  4. ↑ 4.0 4.1 "Pneumocystis pneumonia | Fungal Diseases | CDC". www.cdc.gov. 2020-07-27. Archived from the original on 2021-07-26. Retrieved 2020-08-10.
  5. ↑ "Pneumocystis jirovecii pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice US". bestpractice.bmj.com. Archived from the original on 3 June 2023. Retrieved 24 August 2024.
  6. ↑ "Pentamidine". LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases. 2012. Archived from the original on 1 September 2024. Retrieved 30 August 2024.
  7. ↑ "Pneumocystis Pneumonia". NORD (National Organization for Rare Disorders). Archived from the original on 2020-11-01. Retrieved 2020-08-10.
  8. ↑ Kanne JP, Yandow DR, Meyer CA (June 2012). "Pneumocystis jiroveci pneumonia: high-resolution CT findings in patients with and without HIV infection". AJR. American Journal of Roentgenology. 198 (6): W555 – W561. doi:10.2214/AJR.11.7329. PMID 22623570. S2CID 7041746.
  9. ↑ Fannin S, Gottlieb MS, Weisman JD, et al. (1982). "A Cluster of Kaposi's Sarcoma and Pneumocystis carinii pneumonia among homosexual male residents of Los Angeles and Range Counties, California". MMWR Weekly. 31 (32): 305–7. Archived from the original on 2008-02-24. Retrieved 2023-01-29.
  10. ↑ Masur H, Michelis MA, Greene JB, Onorato I, Stouwe RA, Holzman RS, et al. (December 1981). "An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction". The New England Journal of Medicine. 305 (24): 1431–1438. doi:10.1056/NEJM198112103052402. PMID 6975437.
  11. ↑ "Co-trimoxazole Monograph for Professionals - Drugs.com". web.archive.org. 6 September 2015. Archived from the original on 6 September 2015. Retrieved 27 August 2024.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  12. ↑ Hsu, Hao-Chen; Huang, Po-Wei; Cho, Yung-Tsu; Chu, Chia-Yu (1 July 2023). "Cotrimoxazole as a Preventative Intervention for Pneumocystis Pneumonia in Pemphigus Patients Treated with Rituximab: A Retrospective Study". Dermatology and Therapy. 13 (7): 1561–1576. doi:10.1007/s13555-023-00953-9. ISSN 2190-9172. Archived from the original on 30 August 2024. Retrieved 27 August 2024.
  13. ↑ 13.0 13.1 13.2 13.3 Truong, Justina; Ashurst, John V. (2024). "Pneumocystis jirovecii Pneumonia". StatPearls. StatPearls Publishing.
  14. ↑ Riedel S, Hobden JA, Miller S, Morse SA, Mietzner TA, Detrick B (2019). Jawetz, Melnick & Adelberg's Medical Microbiology (28th ed.). New York, NY. ISBN 9781260012026. OCLC 1101189928.{{cite book}}: CS1 maint: location missing publisher (link)
  15. ↑ Apostolopoulou A, Fishman JA. The Pathogenesis and Diagnosis of Pneumocystis jiroveci Pneumonia. J Fungi (Basel). 2022 Nov 5;8(11):1167. doi: 10.3390/jof8111167. PMID: 36354934; PMCID: PMC9696632.
  16. ↑ Thomas, Charles F.; Limper, Andrew H. (April 2007). "Current insights into the biology and pathogenesis of Pneumocystis pneumonia". Nature Reviews Microbiology. 5 (4): 298–308. doi:10.1038/nrmicro1621. ISSN 1740-1534. Archived from the original on 30 August 2024. Retrieved 29 August 2024.
  17. ↑ Bateman, Marjorie; Oladele, Rita; Kolls, Jay K (13 May 2020). "Diagnosing Pneumocystis jirovecii pneumonia: A review of current methods and novel approaches". Medical Mycology. 58 (8): 1015–1028. doi:10.1093/mmy/myaa024. ISSN 1369-3786. Archived from the original on 30 August 2024. Retrieved 29 August 2024.
  18. ↑ Crans, Charles A.; Boiselle, Phillip M. (January 1999). "Imaging Features of Pneumocystis carinii Pneumonia". Critical Reviews in Diagnostic Imaging. 40 (4): 251–284. doi:10.3109/10408379991249194. ISSN 1040-8371. Archived from the original on 2022-06-16. Retrieved 2024-08-31.
  19. ↑ "Pneumocystis jirovecii pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice US". bestpractice.bmj.com. Archived from the original on 3 June 2023. Retrieved 24 August 2024.
  20. ↑ "Pentamidine". LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases. 2012. Archived from the original on 1 September 2024. Retrieved 30 August 2024.
  21. ↑ Ryan KJ, Ray CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 978-0-8385-8529-0.
  22. ↑ Puzio J, Kucewicz E, Sioła M, Dworniczak A, Wojarski J, Zegleń S, et al. (2009). "[Atypical and opportunistic pulmonary infections after cardiac surgery]". Anestezjologia Intensywna Terapia (in polski). 41 (1): 41–45. PMID 19517677.
  23. ↑ Stringer, James R.; Beard, Charles B.; Miller, Robert F.; Wakefield, Ann E. "A New Name for Pneumocystis from Humans and New Perspectives on the Host-Pathogen Relationship - Volume 8, Number 9—September 2002 - Emerging Infectious Diseases journal - CDC". Emerging infectious diseases. doi:10.3201/eid0809.020096.
  24. ↑ Weisbroth, Steven H. (October 2006). "Pneumocystis: newer knowledge about the biology of this group of organisms in laboratory rats and mice". Lab Animal. 35 (9): 55–61. doi:10.1038/laban1006-55. ISSN 1548-4475.
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