Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases / 中华血液学杂志

Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.

Neumonía por Pneumocystis jirovecii posterior a COVID-19 en un paciente sin infección por VIH / Pneumonia by Pneumocystis jirovecii after COVID-19 in non-HIV patient

Resumen La neumonía oportunista por Pneumocystis jirovecii en pacientes con una infección respiratoria grave por SARS-CoV-2 es una entidad recién reconocida, asociada a la terapia con corticoesteroides junto a otros factores de riesgo predisponentes. Supone un reto diagnóstico y, tras el tratamiento, el pronóstico es favorable. Presentamos el caso de un varón con neumonía grave por SARS-CoV-2 que recibió tratamiento corticoidal, desarrollando posteriormente una neumonía por P. jirovecii.

Abstract Infection by Pneumocystis jirovecii in patients with severe respiratory infection caused by SARS-CoV-2 is a situation that we must take into account today. Corticotherapy along with other risk factors predisposes to it. It is a diagnostic challenge and, after treatment, the prognosis is favorable. We report the case of a male with severe pneumonia due to SARS-CoV-2 who received corticosteroid treatment, later developing pneumonia due to P. jiroveci.

Pneumocystis jirovecii Pneumonia in Patients with Lung Cancer: A Review / 中国肺癌杂志

In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency virus (HIV) patients, such as those with malignancies, post-transplantation and autoimmune diseases. Although the risk factors and management of PJP have been extensively studied in the hematologic tumor and post-transplant populations, the research on real tumor cases is insufficient. Lung cancer has been the most common tumor with the highest number of incidence and death worldwide, and the prognosis of lung cancer patients infected with PJP is poor in clinical practice. By reviewing the previous studies, this paper summarized the epidemiology and clinical manifestations of PJP in lung cancer patients, the risk factors and possible mechanisms of PJP infection in lung cancer patients, diagnosis and prevention, and other research progresses to provide reference for clinical application.
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Neumonía por Pneumocystis Jirovecii en paciente adolescente inmunosuprimido no VIH positivo: Un reporte de caso / Pneumocystis Jirovecii pneumonia in a non-HIV immunosuppressed adolescent patient: A case report

Resumen La neumonía en el paciente inmunocomprometido es un reto diagnóstico al cual el clínico se enfrenta cada vez con más frecuencia , al momento de hablar de infiltrados en vidrio esmerilado es menester tener siempre en cuenta la posibilidad de neumonía por Pneumocystis Jirovecii, que por mucho tiempo se pensó como una enfermedad propia del huésped inmunosuprimido con VIH, a través del tiempo se ha manifestado en pacientes con trasplantes de órgano sólido y de precursores hematopoyéticos, asociado a autoinmunidad, al uso crónico de corticoesteroides y más recientemente al uso de terapia biológicas. La descripción de esta enfermedad y sus métodos diagnósticos en huéspedes inmunosuprimidos no VIH no es del todo claro, sabemos que el tratamiento de elección en estos casos es el trimetropin-sulfametoxazol (TMP-SMX) el cual no cuenta con evidencia de alta calidad al momento de plantear una dosis ni un tiempo de duración establecidos. Presentamos el caso de un paciente con diagnóstico de glomerulonefritis por enfermedad de cambios mínimos corticodependiente y quien desarrolló neumonía por Pneumocystis Jirovecii confirmada por histopatología quien recibió tratamiento y tuvo un desenlace positivo.

Abstract The pneumonia in the immunocompromised patient is a diagnostic challenge that the clinician faces more and more frequently, every time we talk about ground glass infiltrates it is necessary to always take into account the possibility of pneumonia due to Neumocystis Jirovecii, which for a long time was thought as a disease of the immunosuppressed host with HIV, but that across the time it has manifested itself in patients with solid organ transplants and hematopoietic precursors, associated with autoimmunity, the chronic use of corticosteroids and more recently the use of biological therapy. The description of this disease and the diagnostic methods in non-HIV immunosuppressed hosts is not entirely clear, we know that the treatment of choice in these cases is trimethropin-sulfamethoxazole (TMP-SMX), which does not have high-quality evidence at the time of a dose or a time of established duration. We present the case of a patient diagnosed with glomerulonephritis due to corticodependent minimal change disease and who suffers from pneumocystis Jirovecii pneumonia confirmed by histopathology, which received treatment and had a positive outcome

Neumonía atípica vs COVID-19 en tratamiento de linfoma de Hodgkin / Atypical pneumonia vs COVID-19 in treating Hodgkin's lymphoma

Introducción: En tiempos de pandemia por COVID-19 toda sintomatología respiratoria o síndrome febril lleva a descartar dicha infección, pero hay que tener en cuenta, sobre todo en pacientes onco-hematológicos, como diagnóstico diferencial la neumonía atípica por Pneumocystis Jirovecii (PCP). Objetivo: Describir el caso de neumonía atípica vs COVID-19 en un paciente con linfoma de Hodgkin. Caso clínico: Paciente mujer de 30 años con diagnóstico de linfoma de Hodgkin tipo clásico estadio clínico III (ECIII), que inicia tratamiento sistémico con quimioterapia esquema R-ABVD (plan de 6 cursos con partes A y B). Recibe 3 cursos R-ABVD con respuesta completa según tomografía. Al programar 4to curso parte B presenta persistencia febril hasta 39,8°C asociado a diaforesis nocturna, que se agudiza en la última semana, por lo que se decide hospitalizarla. Se realiza tomografía contrastada (TEM c/c) de tórax: opacidades en patrón de vidrio deslustrado intercalados con lesiones fibrosas en ambos pulmones, no adenopatías; deshidrogenasa láctica (DHL): 656 UI/L. Sin clínica respiratoria, ni examen físico respiratorio alterado. A descartar PCP vs neumonía COVID-19. Sin leucocitosis, reacción en cadena de polimerasa (PCR) COVID-19 negativa. Se define como neumonía no asociada a coronavirus, por lo que recibe 12 días de antibiótico con Sulfametoxazol + Trimetoprim. A la evolución clínica: mejoría de malestar general y afebril. Finaliza 6 cursos de R-ABVD, con respuesta completa en reevaluación tomográfica, asintomática y presentando prueba rápida para COVID-19 no reactiva. Conclusiones: En el contexto de pandemia por COVID-19 el diagnóstico diferencial debe ser oportuno(AU)

Introduction: In times of COVID-19 pandemic, all respiratory symptoms or febrile syndrome leads to ruling out said infection, but atypical Pneumocystis Jirovecii pneumonia (PCP) must be taken into account, especially in onco-hematological patients, as differential diagnosis. Objective: To describe the case of atypical pneumonia vs. COVID-19 in a patient with Hodgkin's lymphoma. Clinical case report: The case of a 30-year-old female patient with diagnosis of clinical stage III Hodgkin lymphoma (IBD) is reported. She began systemic treatment with R-ABVD chemotherapy scheme (6-course plan with parts A and B). She received 3 R-ABVD courses with complete response according to tomography. When scheduling 4th course, part B, she had feverish persistence up to 39.8 ° C associated with nocturnal diaphoresis, worsening in the last week, so hospitalization was decided. A contrast tomography (TEM c / c) of the thorax was performed: ground-glass opacities interspersed with fibrous lesions in both lungs, no adenopathy; lactic dehydrogenase (DHL): 656 IU / L. No respiratory symptoms, or altered respiratory physical examination, to rule out PCP vs. COVID-19 pneumonia. No leukocytosis, negative COVID-19 polymerase chain reaction (PCR). It is defined as non-coronavirus associated pneumonia, so she received 2 days of Sulfamethoxazole + Trimethoprim antibiotics. On the clinical course, she exhibited improvement of general malaise and she was afebrile. She completed 6 courses of R-ABVD, with complete response in tomographic re-evaluation, she was asymptomatic and had non-reactive rapid test for COVID-19. Conclusions: In the context of COVID-19 pandemic, the differential diagnosis must be timely(AU)

[T1 ESP]Pneumocystis jirovecii y SARS-CoV-2; COVID-19 / [T1 ENG]Pneumocystis jirovecii and SARS-CoV-2; COVID-19

Resumen Pneumocystis jirovecii, es un agente fúngico oportunista causante de neumonía (pneumocistosis) que puede ser mortal en personas con condición de inmunocompromiso, incluyendo pacientes VIH con recuento de linfocitos T CD4+ < 200 céls/mm3 y en pacientes inmunocomprometidos por otras etiologías como trasplantes de órgano sólido y cáncer, entre otras. Muchas personas pueden ser portadoras sanas de este agente etiológico y actuar como reservorio y fuente de infección. Artículos relacionados con coinfección entre SARS-CoV-2 y los de carácter oportunistas como P. jirovecii y Aspergillus fumigatus empiezan a publicarse, donde se argumenta que esta infección viral tiene un alto riesgo de coinfección y se manifiesta la importancia de no excluir los patógenos respiratorios, como P. jirovecii, entre otros. La coinfección con P. jirovecii puede no ser detectada en pacientes con infección grave por SARS-CoV-2, dado que pueden compartir características clínicas comunes como infiltrados multifocales bilaterales e hipoxemia profunda entre otras. Por lo tanto, es necesario realizar pruebas diagnósticas adicionales para P. jirovecii en pacientes con infección por SARS-CoV-2, especialmente cuando se presenten otras características clínicas que pueden apoyar la coinfección, como hallazgos quísticos en la TC torácica y niveles elevados en sangre de 1,3-D-glucano, incluso en ausencia de factores de riesgo clásicos para P. jirovecii, para el diagnóstico de neumonía por Pneumocystis en pacientes con sospecha de infección por SARS-CoV-2.

Abstract Pneumocystis jirovecii, is an opportunistic fungal agent that causes pneumonia (pneumocistosis) that can be fatal in people with immunocomprome status, including HIV patients with CD4+ T lymphocyte count < 200 cels/mm3 and in patients immunocompromised by other aetiologies such as solid organ transplants and cancer, among others. Many people may be healthy carriers of this etiological agent and act as a reservoir and source of infection. Articles related to co-infection between SARS-CoV-2 and opportunistic articles such as P. jirovecii and Aspergillus fumigatus begin publication, where it is argued that this viral infection has a high risk of co-infection, expressing the importance of not excluding respiratory pathogens, such as P. jirovecii, among others. Co-infection with P. jirovecii, may not be detected in patients with severe SARS-CoV-2 infection as they may share common clinical characteristics such as bilateral multifocal infiltrates and deep hypoxemia among others. Therefore, additional diagnostic tests for P. jirovecii, are necessary in patients with SARS-CoV-2 infection, especially when other clinical characteristics that may support co-infection are present such as cystic findings in thoracic CT and elevated blood levels of 1.3-D-glucan, including in the absence of classic risk factors for P. jirovecii, for the diagnosis of Pneumocystis pneumonia in patients with suspected SARS-CoV-2 infection.

Diagnóstico simultáneo y evolución favorable de infección por Pneumocystis jirovecii, SARS-CoV-2 Y HIV avanzada / Simultaneous diagnosis and favorable evolution of infection with Pneumocystis jirovecii, SARS-CoV-2 and advanced HIV

Resumen El SARS-CoV-2 es el virus causante de la enfermedad COVID-19, desconocida antes del brote que ocurrió en diciembre de 2019 en Wuhan, China, y desencadenó la actual pandemia. Las manifestaciones de la infección por SARS-CoV-2 son muy variables entre los pacientes. Los peores desenlaces se suelen asociar a edad avanzada y factores de riesgo reconocidos. Entre estos sería razonable considerar los distintos tipos de inmunodeficiencia, en particular la producida por HIV. Sin embargo, no existen hasta el momento, estudios que demuestren que la infección HIV empeore la evolución y el pronóstico de COVID-19. La neumonía por el hongo Pneumocystis jirovecii (antes denominado P. carinii) afecta con mayor frecuencia a inmunodeprimidos y puede tener desenlace fatal. Exponemos el caso de una mujer de mediana edad con síndrome de Raynaud que ingresó con neumonía y durante la internación se le diagnosticó infección simultánea por HIV, SARS-CoV-2 y P. jirovecci. Evolucionó de forma favorable con tratamiento empírico sin requerir maniobras invasivas ni soporte ventilatorio, logrando el alta y seguimiento de forma ambulatoria.

Abstract SARS-CoV-2 causes the disease named COVID-19, which emerged in Wuhan, China, in December 2019 and developed into the current pandemic. The manifestations of SARS-CoV-2 infection are highly variable. The worst outcomes are usually associated with advanced age and known risk factors. Among these, it would be reasonable to consider conditions compromising the immune system, particularly the immunodeficiency associated to HIV. To date, however, there is no evidence of HIV infection worsening the evolution and prognosis of COVID-19. Pneumocystis jirovecii (previously-P. carinii) pneumonia, is a fungal disease that most commonly affects immunocompromised persons and can be life-threatening. Typically, patients at risk are those with any underlying condition altering host immunity. We present the case of a middle-aged woman with Raynaud's syndrome who was admitted with pneumonia. During hospitalization she was simultaneously diagnosed with infection by HIV, COVID-19 and P. jirovecci. The patient evolved favorably upon empirical treatment without requiring invasive maneuvers or ventilatory support. Outpatient follow-up after hospital discharge was uneventful.

Hallazgos radiológicos de la neumonía por Pneumocystis jirovecii en fallecidos cubanos con VIH/sida / Radiological findings of Pneumocystis jirovecii pneumonia in Cuban deceased HIV / AIDS patients

Introducción: La neumonía por Pneumocystis jirovecii (PcP) es una de las enfermedades más frecuentes en los pacientes con VIH/sida y provoca una alta morbilidad y mortalidad. La radiología juega un papel fundamental para su diagnóstico presuntivo. Objetivo: Describir los hallazgos radiológicos de neumonía por Pneumocystis jirovecii en una serie de casos de fallecidos cubanos por VIH/sida, y relacionarlos con el estado inmunológico de los pacientes. Métodos: Se realizó el estudio de una serie de 69 fallecidos por sida con PcP en el Instituto de Medicina Tropical Pedro Kourí desde enero de 1996 a enero de 2014. El diagnóstico de la PcP se confirmó por estudios anatomopatológicos mediante la observación de estructuras compatibles con el hongo. Resultados: De los 69 casos del estudio, 57 (82,6 por ciento) presentaron alteraciones en la radiografía de tórax. De ellos, 44 (77,2 por ciento) y 13 (22,8 por ciento) presentaron un patrón radiológico típico y atípico de la PcP, respectivamente. En 12 (17,4 por ciento) fallecidos la radiografía de tórax fue normal. En 76,8 por ciento de los casos se detectó niveles de linfocitos T CD4+ inferior a 200 cél/ 956;L. La relación entre el patrón radiológico y el estado inmunológico de los fallecidos analizados no fue significativa. Conclusiones: Los hallazgos radiológicos descritos en los fallecidos cubanos por sida con PcP son similares a los informados en la literatura internacional. Sin embargo, el diagnóstico de la PcP no debe excluirse en pacientes con radiografías de tórax normales o con patrones atípicos que presenten un cuadro clínico sugestivo de la enfermedad(AU)

Introduction: Pneumocystis jirovecii pneumonia (PcP) is one of the most common diseases among HIV / AIDS patients, causing great morbidity and mortality. Radiology plays a fundamental role in its presumptive diagnosis. Objective: Describe the radiological findings of Pneumocystis jirovecii pneumonia in a series of Cuban deceased HIV / AIDS patients and relate them to the patients' immune status. Methods: A study was conducted of a series of 69 deceased AIDS patients with PcP at Pedro Kourí Tropical Medicine Institute from January 1996 to January 2014. PcP diagnosis was confirmed through anatomopathological studies based on observation of structures compatible with the fungus. Results: Of the 69 study cases, 57 (82.6 percent) presented alterations in their chest radiographs. Of these, 44 (77.2 percent) and 13 (22.8 percent) followed a typical and atypical radiological pattern, respectively. In 12 deceased patients (17.4 percent) chest radiography was normal. In 76.8 percent of the cases, levels of T CD4+ lymphocytes were below 200 cell/ml. The relationship between the radiological pattern and the immune status of the deceased patients analyzed was not significant. Conclusions: The radiological findings described for Cuban deceased AIDS patients with PcP are similar to those reported in the international literature. However, PcP diagnosis should not be excluded in patients with normal chest radiographs or atypical patterns who present a clinical status suggestive of the disease(AU)

A school-aged boy with nephrotic syndrome with cough for one month and shortness of breath for half a month / 中国当代儿科杂志

A boy, aged 6 years and 11 months, was admitted due to nephrotic syndrome for 2 years, cough for 1 month, and shortness of breath for 15 days. The boy had a history of treatment with hormone and immunosuppressant. Chest CT after the onset of cough and shortness of breath showed diffuse ground-glass opacities in both lungs. Serum (1, 3)-beta-D glucan was tested positive, and the nucleic acid of cytomegalovirus was detected in respiratory secretions. After the anti-fungal and anti-viral treatment, the child improved temporarily but worsened again within a short period of time.

La era de los inhibidores de integrasa en el tratamiento del VIH/Sida: [Editorial] / The new era of Integrase Strand Transfer Inhibitors: [Editorial]

La era del VIH empezó oficialmente el 5 de junio de 1981, cuando el CDC (Center for Disease Control and Prevention) de Estados Unidos convocó una conferencia de prensa donde describieron cinco casos de pacientes adultos que cursaban con neumonía por Pneumocystis carinii, asociado a una disminución marcada de linfocitos CD4 circulantes. Desde ese instante el mundo enfrenta una de las epidemias mas largas, mortales y de difícil control que persiste a pesar de los esfuerzos de la ciencia, la industria farmacéutica, la sociedad y los diferentes entes gubernamentales. Al recorrer los casi 40 años del VIH dentro de la humanidad, hemos vivido múltiples etapas: la presencia de una sociedad señaladora, con capacidad de juzgar desde el desconocimiento; la desafortunada participación de una población infantil afectada, que está padeciendo una enfermedad que no se merece, una economía alrededor de una enfermedad que sigue avanzando de forma arrolladora con estadísticas que revelan que desde su inicio 76.1 millones de personas han adquirido la enfermedad, y aproximadamente 35 millones de personas han muerto por su causa. Por último, los avances científicos agigantados en medicamentos antiretrovirales que intentan ir más adelante que la enfermedad misma.

The era of HIV officially began on June 5, 1981, when the CDC (Center for Disease Control and Prevention) of the United States convened a press conference where they described five cases of adult patients with Pneumocystis carinii pneumonia, associated with a marked decrease in circulating CD4 lymphocytes. Since then, the world has been facing one of the longest, deadliest and most difficult to control epidemics that persists despite the efforts of science, the pharmaceutical industry, society and the different governmental bodies. As we have gone through almost 40 years of HIV within humanity, we have lived through multiple stages: the presence of a society that points fingers, with the ability to judge from ignorance; the unfortunate participation of an affected child population, who are suffering from a disease that they do not deserve; an economy around a disease that continues to advance in a sweeping manner with statistics that reveal that since its inception 76.1 million people have acquired the disease, and approximately 35 million people have died from it. Finally, the scientific breakthroughs in antiretroviral drugs that attempt to outpace the disease itself.

Clinical and pathological findings of Rhodococcus equi infection in foals / Achados clínicos e patológicos da infecção por Rhodococcus equi em potros

Infection by Rhodococcus equi is considered one of the major health concerns for foals worldwide. In order to better understand the disease's clinical and pathological features, we studied twenty cases of natural infection by R. equi in foals. These cases are characterized according to their clinical and pathological findings and immunohistochemical aspects. Necropsy, histologic examination, bacterial culture, R. equi and Pneumocystis spp. immunohistochemistry were performed. The foals had a mean age of 60 days and presented respiratory signs (11/20), hyperthermia (10/20), articular swelling (6/20), prostration (4/20), locomotor impairment (3/20) and diarrhea (3/20), among others. The main lesions were of pyogranulomatous pneumonia, seen in 19 foals, accompanied or not by pyogranulomatous lymphadenitis (10/20) and pyogranulomatous and ulcerative enterocolitis (5/20). Pyogranulomatous osteomyelitis was seen in 3 foals, one of which did not have pulmonary involvement. There was lymphoplasmacytic (4/20), lymphoplasmacytic and neutrophilic (1/20) or pyogranulomatous arthritis (1/20), affecting multiple or singular joints. Immunohistochemistry revealed to be a valuable tool for the detection of R. equi, confirming the diagnosis in all cases. Furthermore, pulmonary immunostaining for Pneumocystis spp. demonstrates that a coinfection with R. equi and this fungal agent is a common event in foals, seen in 13 cases.(AU)

Infecção por Rhodococcus equi é considerado um dos maiores problemas sanitários para potros em todo o mundo. Para melhor compreender a apresentação clínica e patológica da enfermidade, foram avaliados vinte casos de infecção natural por R. equi em potros. Os casos são caracterizados de acordo com seus achados clínicos e patológicos e aspectos imuno-histoquímicos. Foram realizados exames de necropsia, histologia, bacteriologia e imuno-histoquímica para R. equi e Pneumocystis spp. Os potros tinham idade media de 60 dias e apresentaram sinais respiratórios (11/20), hipertermia (10/20), aumento de volume articular (6/20), prostração (4/20), distúrbios locomotores (3/20) e diarreia (3/20), entre outros. As lesões mais importantes eram pneumonia piogranulomatosa, vista em 19 potros, acompanhada ou não por linfadenite piogranulomatosa (10/20) e enterocolite ulcerativa (5/20). Osteomielite piogranulomatosa foi constatada em três potros, um dos quais não apresentava envolvimento pulmonar. Artrites afetando uma ou múltiplas articulações eram caracterizadas por infiltrado linfoplasmocítico (4/20), linfoplasmocítico e neutrofílico (1/20) e piogranulomatoso (1/20). A imuno-histoquímica demonstrou ser uma ferramenta valiosa na detecção de R. equi, permitindo confirmar o diagnóstico em todos os casos avaliados. Além disso, a imuno-histoquímica para Pneumocystis spp. demonstra que a coinfecção por R. equi e o agente fúngico é um evento frequente em potros, constatado em 13 casos.(AU)

A multivariate prognostic score for predicting mortality of acquired immunodeficiency syndrome patients with Hypoxemic Respiratory Failure and Pneumocystis Jiroveci Pneumonia

Background Severe hypoxemic respiratory failure (SHRF) due to Pneumocystis jiroveci pneumonia (PJP) in AIDS patients represents the main cause of admission and mortality in respiratory intensive care units (RICUs) in low- and middle-income countries. Objective The objective of this study was to develop a predictive scoring system to estimate the risk of mortality in HIV/AIDS patients with PJP and SHRF. Methods We analyzed data of patients admitted to the RICU between January 2013 and January 2018 with a diagnosis of HIV infection and PJP. Multivariate logistic regression and Kaplan–Meier method were used in data analysis. The RICU and inhospital mortality were 25% and 26%, respectively. Multivariate analysis identified four independent predictors: body mass index, albumin, time to ICU admission, and days of vasopressor support. A predictive scoring system was derived and validated internally. The discrimination was 0.869 (95% confidence interval: 0.821-0.917) and calibration intercept (α) and slope (β) were 0.03 and 0.99, respectively. The sensitivity was 47.2%, specificity was 84.6%, positive predictive value was 89.2%, and negative predictive value was 82.6%. Conclusions This scoring system is a potentially useful tool to assist clinicians, in low- and medium-income countries, in estimating the RICU and inhospital mortality risk in patients with HIV/AIDS and SHRF caused by PJP.

Detección y genotipificación de Pneumocystis jirovecii en muestras de pacientes mexicanos VIH positivos y negativos / Detection and genotyping of Pneumocystis jirovecii in samples from HIV positive and negative Mexican patients

Resumen Introducción: Pneumocystis jirovecii es un hongo atípico detectado particularmente en pacientes VIH-positivos o con trasplante. Objetivo: Detectar y genotipificar Pneumocystis jirovecii en muestras de pacientes de dos hospitales de la ciudad de México. Método: Fueron procesadas 89 muestras respiratorias, correspondientes a 53 pacientes (30 VIH positivos y 23 VIH negativos) con sintomatología respiratoria y 11 personas sanas incluidas como control negativo. El DNA fue extraído y amplificado por PCR anidada de la región del espaciador transcrito interno, obteniendo un fragmento en cada ronda (de 693 y 550 pb). Los genotipos y su relación filogenética fueron determinados por secuenciación del fragmento de 550 pb. Resultados: Cuarenta y ocho muestras de 30 pacientes VIH-positivos provenían de un solo hospital, de las cuales 11 (36.6 %) fueron positivas a Pneumocystis jirovecii. Ninguna fue positiva en pacientes VIH-negativos o personas sanas. Los haplotipos detectados con mayor frecuencia fueron Eg y Em. Conclusiones: La frecuencia de infección por Pneumocystis jirovecii fue alta en la población mexicana estudiada. El genotipo más frecuente fue diferente a los reportados en otros países. Es necesario encauzar este problema de salud hacia la detección temprana de esta infección.

Abstract Introduction: Pneumocystis jirovecii is an atypical fungus particularly detected in HIV-positive or transplant patients. Objective: To detect and genotype Pneumocystis jirovecii in patient samples from two hospitals in Mexico City. Method: Eighty-nine respiratory tract samples, corresponding to 53 patients (30 HIV-positive and 23 HIV-negative) with respiratory symptoms and to 11 healthy individuals included as negative control, were processed. DNA was extracted from the ITS region and amplified by nested polymerase chain reaction from the internal transcribed spacer, with one fragment being obtained at each round (693 and 550 bp). Genotypes and their phylogenetic relationship were determined by sequencing the 550 bp fragment. Results: Forty-eight samples from 30 HIV-positive patients were received from a single hospital, out of which 11 (36.6 %) were positive for Pneumocystis jirovecii. No sample was positive in HIV-negative patients or healthy subjects. The most frequently detected haplotypes were Eg and Em. Conclusions: The frequency of Pneumocystis jirovecii infection was high in the studied Mexican population. The most common genotype was different from those reported in other countries. It is necessary to address this health problem through early detection of this infection.

A Case of Severe Pneumocystis Pneumonia in a Thyroid Cancer Patient Receiving Lenvatinib

Lenvatinib is a multitargeted tyrosine kinase inhibitor approved for use in patients with iodine-131–refractory thyroid cancer. The common adverse events of lenvatinib include hypertension, proteinuria, fatigue, and diarrhea. To date, no report on Pneumocystis pneumonia (PCP) in patients receiving lenvatinib has been published. Here, we present a case of severe PCP that led to the death of a 79-year-old woman who was diagnosed with poorly differentiated thyroid cancer and received lenvatinib. The development of PCP should be considered when patients taking lenvatinib show clinical symptoms of pneumonia, and regular chest X-ray follow-up is needed for patients receiving lenvatinib.

Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study / 한국역학회지

OBJECTIVES: To manage evidence-based diseases, it is important to identify the characteristics of patients in each country.METHODS: The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016).RESULTS: Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%).CONCLUSIONS: Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.

A Stepwise Diagnostic Approach to Cystic Lung Diseases for Radiologists

Lung cysts are commonly seen on computed tomography (CT), and cystic lung diseases show a wide disease spectrum. Thus, correct diagnosis of cystic lung diseases is a challenge for radiologists. As the first diagnostic step, cysts should be distinguished from cavities, bullae, pneumatocele, emphysema, honeycombing, and cystic bronchiectasis. Second, cysts can be categorized as single/localized versus multiple/diffuse. Solitary/localized cysts include incidental cysts and congenital cystic diseases. Multiple/diffuse cysts can be further categorized according to the presence or absence of associated radiologic findings. Multiple/diffuse cysts without associated findings include lymphangioleiomyomatosis and Birt-Hogg-Dubé syndrome. Multiple/diffuse cysts may be associated with ground-glass opacity or small nodules. Multiple/diffuse cysts with nodules include Langerhans cell histiocytosis, cystic metastasis, and amyloidosis. Multiple/diffuse cysts with ground-glass opacity include pneumocystis pneumonia, desquamative interstitial pneumonia, and lymphocytic interstitial pneumonia. This stepwise radiologic diagnostic approach can be helpful in reaching a correct diagnosis for various cystic lung diseases.

Optimización y validación de un método de PCR en tiempo real para el diagnóstico de Pneumocystis jirovecii en muestras respiratorias de pacientes pediátricos / Optimization and validation of a real-time PCR method for the diagnosis of Pneumocystis jirovecii in respiratory samples of pediatric patients

Pneumocystis jirovecii (PCP) es un hongo oportunista, que causa neumonía en pacientes con un sistema inmunitario seriamente comprometido. La prevalencia de la enfermedad disminuyó dramáticamente con la introducción de la terapia antirretroviral combinada (HAART) y actualmente las infecciones ocurren en aquellos pacientes que no reciben adecuada profilaxis o no la completan. Es una enfermedad grave con elevada tasa de mortalidad (30-60%) en pacientes oncohematológicos y receptores de trasplante de células progenitoras hematopoyéticas (HSCT), pero prevenible con profilaxis adecuada, por lo que el reconocimiento temprano de los pacientes en riesgo es crítico. El diagnóstico de certeza es de laboratorio ya que los hallazgos clínicos son inespecíficos y las imágenes no son patognomónicas de este agente. Actualmente las técnicas moleculares como la PCR en tiempo real son las metodologías recomendadas ya que poseen elevada sensibilidad, especificidad, rapidez y eficiencia. En el presente estudio se optimizó un método de PCR en tiempo real con iniciadores dirigidos al gen del ARNr de la subunidad grande mitocondrial, en formato dúplex junto con el gen constitutivo RNAsa P. El método demostró ser muy sensible y rápido para el diagnóstico clínico de PCP, con una concordancia қ: 0,789 con el método convencional de PCR anidada que emplea como target a la región espaciadora transcrita interna (ITS) del gen del ARNr de PCP, a la vez de ser mucho menos laborioso y con menor riesgo de contaminación, lo que permite el manejo de un alto número de muestras clínicas (AU)

Pneumocystis jirovecii (PCP) is an opportunistic fungus causing pneumonia in severely immunocompromised patients. Prevalence of the disease has dramatically decreased after the introduction of combined antiretroviral therapy (HAART) and currently these infections occur in patients who do not receive adequate prophylaxis or do not complete treatment. PCP is a severe disease with a high mortality rate (30-60%) in oncology-hematology patients and hematopoietic stem-cell transplantation (HSCT) recipients, but is preventable with adequate prophylaxis. Therefore, early recognition of at-risk patients is essential. Laboratory studies are the gold standard for the diagnosis as clinical findings are unspecific and imaging studies are not pathognomonic for this agent. Currently, molecular techniques, such as real-time PCR, are the methodology of choice because of their high sensitivity, specificity, speed, and efficiency. In this study, a real-time PCR method was optimized with primers targeting the gene of the mitochondrial large subunit rRNA in a duplex format together with the constitutive gene RNAsa P. The method showed to be very sensitive and fast for the clinical diagnosis of PCP, with a concordance of қ: 0.789 with the conventional nested PCR method targeting the internal transcribed spacer (ITS) region of the rRNA gene of PCP, and is much easier to perform with a lower contamination risk allowing a high through-put of clinical samples (AU)

Neumonia por Pneumocystis jirovecii en niño inmunocompetente: revisión de un caso / Pneumocystis jirovecii in immunocompetent children: a case report

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.