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.

Activity of propolis in an experimental model of pneumocystosis

To investigate the anti Pneumocystis effects of propolis on Pneumocystis carinii P. carinii in rat model. Rats were obtained, and the study was taken in to place in Erciyes University Clinical and Experimental Research Center, Kayseri, Turkey, in June 2007. In order to obtain spontaneous pneumonia, rats were remained on immunosuppression therapy with dexamethasone throughout the study. Propolis administered orally at doses of 30, 50, and 100 mg/kg/day. Trimethoprim-sulfamethoxazole [TMP-SMX, 50/250 mg/kg/day] was used as positive control and untreated animals as negative control in the study. There were 6 animals in each group. Untreated animals showed P. carinii infection level with a mean +/= standard deviation log number of cysts per gram of lung tissue of 4.6 +/= 1.6 at the end of the experiment. Trimethoprim-sulfamethoxazole 50/250 mg/kg/day has significantly reduced the log number of cysts per gram to 1.8 +/= 1.6 [p<0.001]. There was no reduction found in the number of cysts in infected animals treated with 30, 50, and 100 mg of propolis/kg/day, and so the results were not statistically significant [p>0.05] compared with the control group. In our rat model of pneumocystosis the efficacy of propolis, this was used in folk medicine since ancient times, found completely ineffective

Pneumocystis pneumonia: an update.

Pneumocystis pneumonia is a major cause of illness and death in immunocompromised hosts. The numbers of pneumocystis pneumonia cases in Thailand have increased each year from 1992 to 2000 and peaked in 2000 at 6,255 cases. The microbe that causes pneumocystis pneumonia in humans is called Pneumocystis jirovecii. Pneumocystis sp. was discovered nearly a century ago, but the knowledge of Pneumocystis sp. remained poorly understood, until the molecular biology techniques help scientists verify it fungus nature. In the past, Pneumocystis sp. was misclassified as protozoan due to its morphologic features. Later, it was reclassified as fungus due to DNA analysis. Cotrimaxazole, the combination of trimethoprim-sulfamethoxazole, is the drug of choice for treatment and prophylaxis of pneumocystis pneumonia. However, increasing evidence of mutations in the enzyme dihydropteroate synthase (DHPS), the target of sulfa drugs represent emergence of sulfa resistance.

Hipersensibilidade a drogas em paciente com SIDA: relato de caso / Drug hipersensibility and HIV infected patients: case report

A alergia a drogas e frequente em pacientes portadores de HIV, com incidencia maior que na populacao geral. Os autores descrevem uma crianca com SIDA e reacoes adversas a drogas utilizadas na profilaxia do Pneumocystis carinii (Sulfametoxazol-trimetoprim/Pentamidina) e outros antibioticos, entre eles a cefalexina e o cloranfenicol. Sao discutidos os provaveis mecanismos fisiopatologicos das reacoes, drogas alternativas para profilaxia do Pneumocystis carinii e dessensibilizacao para o sulfametoxazol-trimetoprim

Nuevos medicamentos antiprotozoarios y antiartrópodos / New antiprozoan and anti arthropod drugs

Few developments have taqken place in this area, except for the use of trumetroprim and sulfamethoxazole for isospporosis and spiramycin for cryptosporidiosis in immune suppressed patients. For parasitic arthropods, crotamiton and piretoids have been helpful in treating scabies and pediculosis, respectively