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1.
BMC Cancer ; 21(1): 987, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479519

RESUMO

BACKGROUND: Pneumocystis jirovecii pneumonia (PCP)-related risk factors among patients with solid tumors are not completely defined. Thus, we aimed to characterize PCP cases with underlying solid tumors, to highlight the factors contributing to its development besides the prolonged use of moderate-to-high dose corticosteroids. METHODS: We retrospectively reviewed the medical records of patients with solid tumors diagnosed with PCP between 2006 and 2018 at a cancer center in Tokyo, Japan. Demographic and clinical data were collected, which included malignancy types, total lymphocyte count, coexisting pulmonary disease, chemotherapy, radiation therapy, corticosteroid use, and PCP-attributable mortality. RESULTS: Twenty cases of PCP with solid tumors were documented in 151,718 patients and 788,914 patient-years. Lung cancer (n = 6, 30%) was the most common underlying tumor, followed by breast cancer (n = 3, 15%). Only six (30%) patients were taking a dosage of ≥20 mg prednisone equivalents daily for ≥4 weeks from the onset of PCP. Among the remaining 14 patients, seven (50%) had coexisting pulmonary diseases, 10 (71%) had received chemotherapy within 90 days prior to PCP diagnosis, seven (50%) had undergone chest radiation therapy before PCP diagnosis, seven (50%) had received only intermittent corticosteroids, and one (7%) received no corticosteroids. Mortality attributable to PCP was 40%. CONCLUSIONS: More than half of the patients were not taking a dosage of ≥20 mg prednisone equivalents daily for ≥4 weeks. Multiple other factors (e.g., lymphocytopenia, radiation to chest) may have potentially contributed to PCP in patients with solid tumors in a composite manner. We need to establish a method for estimating the likelihood of PCP taking multiple factors into account in this patient population.


Assuntos
Prontuários Médicos/estatística & dados numéricos , Neoplasias/complicações , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/isolamento & purificação , Corticosteroides/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Pneumocystis/tratamento farmacológico , Infecções por Pneumocystis/microbiologia , Infecções por Pneumocystis/patologia , Pneumocystis carinii/efeitos dos fármacos , Prognóstico , Estudos Retrospectivos , Fatores de Risco
2.
Infect Genet Evol ; 93: 104978, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34175480

RESUMO

Pneumocystis fungi are opportunistic parasites of mammalian lungs whose evolution, ecology and host specificity in natural host populations remain poorly understood and controversial. Using an extensive collection of 731 lung samples from 27 rodent species sampled in five Southeast Asian countries, and nested PCR amplification of mitochondrial and nuclear genes, we investigated the host specificity and genetic structure of Pneumocystis lineages infecting wild rodents. We also identified the rodent species playing a central role in the transmission of these parasites using network analysis and centrality measurement and we characterized the environmental conditions allowing Pneumocystis infection in Southeast Asia using generalized linear mixed models. Building upon an unprecedented Pneumocystis sampling from numerous rodent species belonging to closely related genera, our findings provide compelling evidence that the host specificity of Pneumocystis lineages infecting rodents is not restricted to a single host species or genus as often presented in the literature but it encompasses much higher taxonomic levels and more distantly related rodent host species. The phylogenetic species status at both mitochondrial and nuclear genetic markers of at least three new Pneumocystis lineages, highly divergent from Pneumocystis species currently described, is also suggested by our data. Our models show that the probability of Pneumocystis infection in rodent hosts is positively correlated to environmental variables reflecting habitat fragmentation and landscape patchiness. Synanthropic and habitat-generalist rodents belonging to the Rattus, Sundamys and Bandicota genera played a role of bridge host species for Pneumocystis spreading in these heterogeneous habitats, where they can reach high population densities. These are critical findings improving our understanding of the ecology of these enigmatic parasites and the role played by cospeciation and host switches in their evolution. Our results also confirmed the role of land-use change and habitat fragmentation in parasite amplification and spillover in rodents.


Assuntos
Murinae , Infecções por Pneumocystis/veterinária , Pneumocystis/fisiologia , Doenças dos Roedores/epidemiologia , Doenças dos Roedores/transmissão , Animais , Animais Selvagens , Camboja/epidemiologia , Especificidade de Hospedeiro , Laos/epidemiologia , Filipinas/epidemiologia , Infecções por Pneumocystis/epidemiologia , Infecções por Pneumocystis/microbiologia , Infecções por Pneumocystis/transmissão , Doenças dos Roedores/microbiologia , Taiwan/epidemiologia , Tailândia/epidemiologia
3.
Med. infant ; 28(1): 23-26, Marzo 2021. ilus, Tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1282888

RESUMO

Pneumocystis jirovecii es un hongo oportunista, causante de neumonía en huéspedes inmunocomprometidos. Es una infección grave con elevada tasa de mortalidad en pacientes oncohematológicos y receptores de trasplante de células progenitoras hematopoyéticas. La administración de corticosteroides es el principal factor de riesgo para adquirir esta infección. Actualmente las infecciones ocurren en aquellos pacientes que no reciben adecuada profilaxis. Las técnicas de diagnóstico molecular son las recomendadas por su elevada sensibilidad, especificidad y rapidez. La frecuencia global de P. jirovecii en pacientes inmunocomprometidos de nuestro hospital, durante el período evaluado fue de 4,8%, con una mortalidad global del 20%. Como factores de mal pronóstico se reportan la presencia de coinfecciones y la necesidad de asistencia respiratoria mecánica. Es importante la sospecha precoz en pacientes de riesgo, confirmada con un diagnóstico preciso mediante métodos moleculares para una intervención adecuada y oportuna (AU)


Pneumocystis jirovecii is an opportunistic fungus, causing pneumonia in immunocompromised hosts. It is a severe infection with a high mortality rate in oncology/hematology patients and hematopoietic stem cell transplant recipients. The administration of corticosteroids is the main risk factor for acquiring this infection. Currently infections occur in patients who do not receive adequate prophylaxis. Molecular diagnostic techniques are recommended because of their high sensitivity, specificity, and speed. In the study period, the overall incidence of P. jirovecii in immunocompromised patients at our hospital was 4.8%, with an overall mortality rate of 20%. Factors of a poor prognosis are the presence of coinfections and the need for mechanical respiratory assistance. Early suspicion in high-risk patients is important to confirm the diagnosis through molecular studies and start adequate and early treatment (AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Reação em Cadeia da Polimerase/métodos , Infecções por Pneumocystis/diagnóstico , Infecções por Pneumocystis/epidemiologia , Hospedeiro Imunocomprometido , Técnicas de Diagnóstico Molecular/métodos , Pneumocystis carinii/isolamento & purificação , Hospitais Pediátricos/estatística & dados numéricos , Estudos Transversais , Estudos Retrospectivos
4.
Med Mycol ; 59(8): 802-812, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-33578417

RESUMO

BACKGROUND: The epidemiology of Pneumocystis jirovecii, known to colonize the respiratory tract and cause a life-threatening HIV-associated pneumonia (PCP), is poorly described in Africa. We conducted a systematic review to evaluate P. jirovecii prevalence in African HIV-positive adults with or without respiratory symptoms. METHODS: We searched Medline, Embase, Cochrane library, Africa-Wide, and Web of Science for studies employing PCR and/or microscopy for P. jirovecii detection in respiratory samples from HIV-positive adults in Africa between 1995 and 2020. Prevalence with respiratory symptoms was pooled using random-effect meta-analysis, and stratified by laboratory method, sample tested, study setting, CD4 count, and trimethoprim/sulfamethoxazole prophylaxis. Colonization prevalence in asymptomatic adults and in adults with non-PCP respiratory disease was described, and quantitative PCR (qPCR) thresholds to distinguish colonization from microscopy-confirmed PCP reviewed. RESULTS: Thirty-two studies were included, with 27 studies (87%) at high risk of selection bias. P. jirovecii was detected in 19% [95% confidence interval (CI): 12-27%] of 3583 symptomatic and in 9% [95% CI: 0-45%] of 140 asymptomatic adults. Among symptomatic adults, prevalence was 22% [95% CI: 12-35%] by PCR and 15% [95% CI: 9-23%] by microscopy. Seven percent of 435 symptomatic adults had PCR-detected Pneumocystis colonization without evidence of PCP [95% CI: 5-10%, four studies]. One study established a qPCR cutoff of 78 copies/5µl of DNA in 305 induced sputum samples to distinguish Pneumocystis colonization from microscopy-confirmed PCP. CONCLUSION: Despite widened access to HIV services, P. jirovecii remains common in Africa. Prevalence estimates and qPCR-based definitions of colonization are limited, and overall quality of studies is low.


Assuntos
Infecções por HIV/complicações , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/isolamento & purificação , Adulto , África/epidemiologia , Infecções Assintomáticas/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Infecções por Pneumocystis/diagnóstico , Pneumocystis carinii/classificação , Prevalência
5.
Mayo Clin Proc ; 96(2): 400-407, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33549258

RESUMO

OBJECTIVE: To assess host factors in pneumocystis jirovecii pneumonia (PCP)-related hospitalizations and compare outcomes between HIV and non-HIV patients. METHODS: Using the National Inpatient Sample database, we identified 3384 hospitalizations with PCP (International Classification of Diseases, Ninth Revision, Clinical Modification code: 136.3) as the primary discharge diagnosis from 2005 to 2014. We evaluated hospitalizations for the following host factors: HIV, malignancies, organ transplantation, rheumatologic diseases, and vasculitides. We compared the prevalence of individual host factors among PCP hospitalizations over time, and compared intervention rates and outcomes between HIV and non-HIV patients with PCP. RESULTS: Among all hospitalizations for PCP, malignancy was the most prevalent host factor (46.0%, n=1559), followed by HIV (17.8%, n=604); 60.7% (n=946) of malignancies were hematologic. The prevalence of HIV among hospitalizations for PCP decreased from 25.1% in 2005 to 9.2% in 2014 (P<.001), whereas the prevalence of non-HIV immunocompromising conditions increased. Compared with HIV patients, PCP patients without HIV had higher rates of bronchoscopy (52.3% vs 26.7%, P<.001) and endotracheal intubation (17.0% vs 7.9%, P<.001), prolonged hospitalizations (11.5 vs 8.7 days, P<.001), higher hospitalization costs (86.8 vs 48.2×103 USD, P<.001) and increased in-hospital mortality (16.0% vs 5.0%, P<.001). After adjusting for age, sex, and smoking status, there was no difference in mortality between non-HIV and HIV patients with PCP (adjusted odds ratio, 1.4; 95% CI, 0.9 to 2.3). CONCLUSION: The epidemiology of PCP has shifted with an increase in the prevalence of non-HIV patients who have higher intubation rates and prolonged hospitalizations compared with matched HIV patients.


Assuntos
Hospitalização/estatística & dados numéricos , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/microbiologia , Suscetibilidade a Doenças , Feminino , Soropositividade para HIV , Humanos , Hospedeiro Imunocomprometido , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infecções por Pneumocystis/epidemiologia , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia
6.
Arch Microbiol ; 202(7): 1647-1652, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32274557

RESUMO

Pneumocystis jirovecii is an opportunistic respiratory pathogen causing Pneumocystis pneumonia (PcP) in immunocompromised patients. The aim of this study was to investigate the genetic diversity of P. jirovecii isolates (n: 84) obtained from PcP patients using multilocus sequencing method based on mt26S, SOD, and CYB loci. Among the 84 clinical samples that were positive for P. jirovecii DNA, 31 (36.90%) of them were genotyped using at least one locus. Of the 31 clinical samples, 26 of them were successfully genotyped using all loci whereas three samples were genotyped using either mt26S/CYB loci or mt26S/SOD loci. Additionally, there were two more clinical samples that were genotyped using CYB or SOD locus. Using mt26S locus, genotypes 2, 3, 7, and 8 were detected. Frequencies of genotype 7 and 8 were higher and both of them were found in 11 (n: 29; 37.93%) clinical samples. Using SOD locus, SOD 1, 2, and 4 genotypes were detected. SOD 1 was the predominant genotype (20/28; 71.42%). During the analyses of CYB locus, CYB 1, 2, 5, 6, and 7 as well as a new CYB genotype were detected. CYB 1 (16/29; 55.17%) and 2 (10/29; 34.48%) were the predominant genotypes. Overall, according to the multilocus sequencing results E, F, M, N, P, and V multilocus genotypes were detected among the PcP patients. In addition, SOD 1 was the predominant genotype and CYB had a more polymorphic locus.


Assuntos
Epidemiologia Molecular , Infecções por Pneumocystis/microbiologia , Pneumocystis carinii/genética , DNA Fúngico/genética , Variação Genética , Genótipo , Humanos , Tipagem de Sequências Multilocus , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/isolamento & purificação , Turquia/epidemiologia
7.
BMC Nephrol ; 20(1): 479, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881863

RESUMO

BACKGROUND: Urinary tract infections (UTI) are the most common of infections after renal transplantation. The consequences of UTIs in this population are serious, with increased morbidity and hospitalisation rates as well as acute allograft dysfunction. UTIs may impair overall graft and patient survival. We aimed to identify the prevalence and risk factors for post-transplant UTIs and assess UTIs' effect on renal function during a UTI episode and if they result in declining allograft function at 2 years post-transplant. Additionally, the causative organism, the class of antibacterial drug employed for each UTI episode and utilisation rates of trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were also quantified. METHODS: This was a retrospective study of 72 renal transplant patients over a 5-year period who were managed at the Royal Brisbane and Women's Hospital. Patient charts, pathology records and dispensing histories were reviewed as part of this study and all UTIs from 2 years post transplantation were captured. RESULTS: Of these patients, 20 (27.8%) had at least one UTI. Older age (p = 0.015), female gender (p < 0.001), hyperglycaemia (p = 0.037) and acute rejection episodes (p = 0.046) were risk factors for developing a UTI on unadjusted analysis. Female gender (OR 4.93) and age (OR 1.03) were statistically significant risk factors for a UTI on adjusted analysis. On average, there was a 14.4% (SEM 5.20) increase in serum creatinine during a UTI episode, which was statistically significant (p = 0.027), and a 9.1% (SEM 6.23) reduction in serum creatinine after the UTI episode trending toward statistical significance. (p = 0.076). Common organisms (Escherichia coli and Klebsiella pneumoniae) accounted for 82% of UTI episodes with 70% of UTI cases requiring only a single course of antibiotic treatment. Furthermore, the antibiotic class used was either a penicillin (49%) or cephalosporin (36%) in the majority of UTIs. The use of TMP/SMX prophylaxis for Pneumocystis carinii pneumonia prophylaxis did not influence the rate of UTI, with > 90% of the cohort using this treatment. CONCLUSIONS: There was no significant change in serum creatinine and estimated glomerular filtrate rate from baseline to 2 years post-transplant between those with and without a UTI.


Assuntos
Hospitais de Ensino/tendências , Transplante de Rim/efeitos adversos , Transplantados , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Adulto , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Feminino , Humanos , Transplante de Rim/tendências , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Pneumocystis/diagnóstico , Infecções por Pneumocystis/epidemiologia , Queensland/epidemiologia , Estudos Retrospectivos
8.
Pediatr Infect Dis J ; 38(3): 241-247, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29794652

RESUMO

BACKGROUND: Although the epidemiology of immunocompromising condition in children has evolved over time, updated epidemiology of pediatric pneumocystis infection in the United States is not available. METHODS: We performed a retrospective analysis using the Kids' Inpatient Database, a nationally representative sample of US pediatric hospital discharges collected in 1997, 2000, 2003, 2006, 2009 and 2012. Pneumocystis cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification, code 136.3 among children 0-18 years of age. Demographic data of cases with and without mortality were compared. RESULTS: We identified 1902 [standard error (SE): 95] pneumocystis cases during the study period. The pneumocystis hospitalization rate decreased from 7.5 (SE: 0.91) to 2.7 (SE: 0.31) per a million US children from 1997 to 2012 (63.2% decrease). Cases with HIV infection decreased from 285 (SE: 56) cases in 1997 to 29 (SE: 7) cases in 2012, whereas hematologic malignancy and primary immunodeficiency became more prominent. Infants were the most commonly affected [510 cases (SE: 40)]. All-cause in-hospital mortality was 11.7% (SE: 1.3%) and was particularly high among cases with hematopoietic stem cell transplant [32.4%(SE: 7.1%); P < 0.001]. CONCLUSIONS: Pneumocystis infection in children showed a marked decrease from 1997 to 2012 in the United States, largely driven by the reduction in HIV-associated cases, and cases with non-HIV illnesses became more prominent. Hematopoietic stem cell transplant-associated cases had particularly high mortality. Clinicians should be aware of high-risk groups that may benefit from chemoprophylaxis, particularly in infancy.


Assuntos
Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Infecções por Pneumocystis/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Bases de Dados Factuais , Feminino , Infecções por HIV/epidemiologia , Neoplasias Hematológicas/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Mortalidade Hospitalar/tendências , Humanos , Lactente , Masculino , Infecções por Pneumocystis/mortalidade , Doenças da Imunodeficiência Primária/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
9.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(10): 621-626, dic. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-176926

RESUMO

INTRODUCTION: The incidence of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients after an episode of Pneumocystis jirovecii pneumonia (PJP) seems to be lower than with other opportunistic infections. We conducted an observational study in order to determine the incidence, clinical characteristics and outcome of patients diagnosed with PJP-related IRIS. METHODS: We conducted an observational study of HIV patients diagnosed with PJP-related IRIS from January 2000 to November 2015. We analyzed epidemiological and clinical characteristics as well as laboratory findings. We also carried out a systematic review of published cases. RESULTS: Six cases of IRIS out of 123 (4.9%) HIV-infected patients with PJP who started ART were diagnosed. All six cases were men with a median age of 34 (IQR: 8) years. The six patients developed paradoxical IRIS. Subjects younger than 40 years old (p = 0.084) and with an HIV-RNA viral load >100000 copies/ml (p = 0.081) at diagnosis showed a tendency to develop IRIS. Thirty-seven published cases of PJP-related IRIS were identified. Although 51% of cases involved respiratory failure, no deaths were reported. CONCLUSIONS: PJP-related IRIS is rare condition compared to other opportunistic infections. It can lead to a severe respiratory failure in a significant proportion of cases, although no deaths have been reported


INTRODUCCIÓN: La incidencia del síndrome inflamatorio de reconstitución inmune (SIRI) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) después de un episodio de neumonía por Pneumocystis jirovecii (PJP) parece ser menor que con otras infecciones oportunistas. Hemos realizado un estudio observacional con el objetivo de conocer la incidencia, las características clínicas y la evolución de los pacientes diagnosticados de SIRI asociado con la PJP. MÉTODOS: Se ha realizado un estudio observacional de pacientes con VIH diagnosticados de SIRI asociado a PJP desde enero del 2000 hasta noviembre de 2015. Fueron analizadas características epidemiológicas y clínicas, así como hallazgos de laboratorio. Asimismo, se ha llevado a cabo una revisión sistemática de los casos publicados previamente. RESULTADOS: Se identificaron 6 casos de SIRI en 123 pacientes con VIH (4,9%) con PJP que comenzaron TAR. Los 6 casos eran varones con una edad media de 34 (IQR :8) años. En los 6 casos se trató de una SIRI paradójico. Los sujetos menores de 40 años (p = 0,084) y con VIH-ARN al diagnóstico mayor de 100.000 copias/ml (p = 0,081) mostraron una tendencia a desarrollar SIRI. Se identificaron 37 casos publicados de SIRI relacionado con PJP en la literatura. Aunque el 51% de los casos presentaron insuficiencia respiratoria, no se reportaron muertes. CONCLUSIONES: El SIRI asociado con PJP es una entidad infrecuente comparada con el relacionado con otras infecciones oportunistas. Puede provocar insuficiencia respiratoria grave en un porcentaje importante de casos, si bien no se han reportado muertes


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Pneumocystis carinii/imunologia , Infecções por Pneumocystis/epidemiologia , Síndrome Inflamatória da Reconstituição Imune/epidemiologia , Síndrome Inflamatória da Reconstituição Imune/imunologia , Incidência , Espanha/epidemiologia , Estudo Observacional , Estudos Retrospectivos
10.
J Vet Diagn Invest ; 30(6): 862-867, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30204066

RESUMO

We used a real-time PCR (rtPCR) targeting a 150-bp amplicon of the mitochondrial small subunit of ribosomal RNA (mtSSU rRNA) to screen for Pneumocystis DNA in lungs of wild squirrels ( Callosciurus finlaysonii, n = 85) and river rats ( Myocastor coypus, n = 43) in Italy. The rtPCR revealed Pneumocystis DNA in 20 of 85 (24%) squirrels and in 35 of 43 (81%) river rats, and was more sensitive than a nested PCR that targets a portion of the mtSSU rRNA and the mitochondrial large subunit of rRNA (mtLSU rRNA). Phylogenetic analysis based on mtSSU rRNA and mtLSU rRNA sequences showed distinct Pneumocystis sequence types in these rodents. The rtPCR assay should be reliable for screening large populations for this potential pathogen, thereby allowing cost-effective monitoring of the disease in wild animals.


Assuntos
Espécies Introduzidas , Infecções por Pneumocystis/veterinária , Pneumocystis/isolamento & purificação , Doenças dos Roedores/epidemiologia , Roedores , Animais , DNA Fúngico/análise , Itália/epidemiologia , Pulmão/microbiologia , Filogenia , Infecções por Pneumocystis/epidemiologia , Infecções por Pneumocystis/microbiologia , Prevalência , RNA Ribossômico/análise , Reação em Cadeia da Polimerase em Tempo Real , Doenças dos Roedores/microbiologia , Sciuridae , Análise de Sequência de RNA/veterinária
11.
Ann Hematol ; 97(12): 2501-2508, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30121845

RESUMO

Multidrug-resistant organisms (MDRO) have been developing as an emerging problem in allogeneic hematopoietic cell transplantation (HCT). Since no data are available on the course of MDRO colonization after HCT, we investigated in this retrospective, single-center study, persistence and clearance of MDRO after HCT. From June 2010 to December 2015, 121 consecutive HCT patients were included. Patients received a MDRO screening before conditioning as well as surveillance cultures after HCT. In MDRO-colonized patients, surveillance specimens were taken until MDRO were no longer detectable. Thirty-three patients (27%) were found to be colonized by at least one MDRO at any time point until day 100 post HCT. Day 100 (2-year) non-relapse mortality (NRM) and overall survival (OS) of MDRO-colonized (MDRO+) versus non-colonized (MDRO-) patients were essentially the same. NRM is 15% (21%) versus 15% (24%). Two-year OS is 60 versus 55% for MDRO+ versus MDRO- patients. Out of the 33 MDRO+ patients, 21 cleared the MDRO. Median time to non-detectability of MDRO was 6 months. In 12 patients, the MDRO persisted. There was a significant (p < 0.0001) survival difference between patients who cleared the MDRO versus those with MDRO persistence (2-year OS 80 vs 40%). Except for the length of antibiotic therapy as a potential risk factor for MDRO persistence after HCT, no other conventional factors could be identified. (a) colonization by MDRO per se had no negative impact on the outcome, (b) MDRO can be cleared by the majority of patients after allogeneic HCT, and (c) to increase the probability to clear MDRO, the use of antibiotics in MDRO+ patients should be reviewed critically.


Assuntos
Farmacorresistência Bacteriana Múltipla , Farmacorresistência Fúngica Múltipla , Transplante de Células-Tronco Hematopoéticas , Staphylococcus aureus Resistente à Meticilina , Infecções por Pneumocystis , Pneumocystis carinii , Infecções Estafilocócicas , Adulto , Idoso , Aloenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pneumocystis/tratamento farmacológico , Infecções por Pneumocystis/epidemiologia , Infecções por Pneumocystis/etiologia , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia
12.
Clin Microbiol Rev ; 31(3)2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29899010

RESUMO

Pneumocystis, a unique atypical fungus with an elusive lifestyle, has had an important medical history. It came to prominence as an opportunistic pathogen that not only can cause life-threatening pneumonia in patients with HIV infection and other immunodeficiencies but also can colonize the lungs of healthy individuals from a very early age. The genus Pneumocystis includes a group of closely related but heterogeneous organisms that have a worldwide distribution, have been detected in multiple mammalian species, are highly host species specific, inhabit the lungs almost exclusively, and have never convincingly been cultured in vitro, making Pneumocystis a fascinating but difficult-to-study organism. Improved molecular biologic methodologies have opened a new window into the biology and epidemiology of Pneumocystis. Advances include an improved taxonomic classification, identification of an extremely reduced genome and concomitant inability to metabolize and grow independent of the host lungs, insights into its transmission mode, recognition of its widespread colonization in both immunocompetent and immunodeficient hosts, and utilization of strain variation to study drug resistance, epidemiology, and outbreaks of infection among transplant patients. This review summarizes these advances and also identifies some major questions and challenges that need to be addressed to better understand Pneumocystis biology and its relevance to clinical care.


Assuntos
Infecções por Pneumocystis/epidemiologia , Infecções por Pneumocystis/microbiologia , Pneumocystis/fisiologia , Classificação , Surtos de Doenças , Farmacorresistência Fúngica , Especificidade de Hospedeiro , Pneumocystis/classificação
13.
J Hosp Infect ; 99(3): 332-345, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28943270

RESUMO

BACKGROUND: Twenty-five patients, of whom 22 were renal transplant recipients, developed Pneumocystis jirovecii infections at the nephrology department of Reims University Hospital (France) from September 2008 to October 2009, whereas only four sporadic cases had been diagnosed in this department over the 14 previous years. AIM: This outbreak was investigated by analysing patient encounters and P. jirovecii types. METHODS: A transmission map was drawn up. P. jirovecii typing at DHPS, ITS and mtLSU rRNA sequences was performed in the patients of the cluster (18 patients with Pneumocystis pneumonia (PCP) and seven colonized patients), 10 unlinked control patients (six PCP patients and four colonized patients), as well as 23 other patients diagnosed with P. jirovecii (nine PCP patients and 14 colonized patients) in the same department over a three-year post-epidemic period. FINDINGS: Eleven encounters between patients harbouring the same types were observed. Three PCP patients and one colonized patient were considered as possible index cases. The most frequent types in the cluster group and the control group were identical. However, their frequency was significantly higher in the first than in the second group (P < 0.01). Identical types were also identified in the post-epidemic group, suggesting a second outbreak due to the same strain, contemporary to a disruption in prevention measures. CONCLUSIONS: These results provide additional data on the role of both PCP and colonized patients as infectious sources. Longitudinal screening of P. jirovecii types in infected patients, including colonized patients, is required in the investigation of the fungus's circulation within hospitals.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Genótipo , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/classificação , Pneumocystis carinii/isolamento & purificação , Idoso , Análise por Conglomerados , Infecção Hospitalar/transmissão , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Transmissão de Doença Infecciosa , Feminino , França/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Epidemiologia Molecular , Filogenia , Infecções por Pneumocystis/transmissão , Pneumocystis carinii/genética , Análise de Sequência de DNA , Adulto Jovem
14.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da condutas da emergência do InCor: cardiopneumologia / IInCor Emergency Conduct Manual: Cardiopneumology. São Paulo, Manole, 2ª revisada e atualizada; 2017. p.830-837.
Monografia em Português | LILACS | ID: biblio-848520
15.
J Infect ; 73(1): 1-7, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27189843

RESUMO

OBJECTIVES: This study examined the prevalence of Pneumocystis jirovecii in the sputum of adults with cystic fibrosis during clinical stability and acute pulmonary exacerbation. METHODS: This was a prospective, longitudinal observational study of patients attending the Manchester Adult Cystic Fibrosis Centre. Sputum samples were analysed for P. jirovecii DNA using PCR at enrolment and up to 5 follow-up visits. Patients were classified as stable or exacerbating using a modified Fuch's pulmonary exacerbation score. RESULTS: 226 samples were tested from 111 patients. P. jirovecii was more likely to be detected in samples at acute pulmonary exacerbation (7/76 (9.2%)) compared with stable visits (3/150 (2%)), p = 0.03. P. jirovecii was detected less frequently if patients had received co-trimoxazole within 3 months of sample collection (0% versus 29.7%, p = 0.03). CONCLUSIONS: Prevalence of P. jirovecii in stable patients is low, but P. jirovecii is detected in approximately 1 in 10 patients experiencing an acute pulmonary exacerbation.


Assuntos
Fibrose Cística/complicações , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/isolamento & purificação , Escarro/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , DNA Fúngico/análise , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Estudos Prospectivos , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-26491278

RESUMO

BACKGROUND: The detection of Pneumocystis jirovecii DNA in respiratory specimen from individuals who do not have signs or symptoms of pneumonia has been defined as colonization. The role of P. jirovecii colonization in the development or progression of various lung diseases has been reported, but little information about P. jirovecii colonization in patients is available in the People's Republic of China. OBJECTIVE: To determine the prevalence of P. jirovecii colonization in patients with various pulmonary diseases, including the acute and stable stage of COPD, interstitial lung diseases, cystic fibrosis, and chronic bronchiectasis. MATERIALS AND METHODS: A loop-mediated isothermal amplification (LAMP) and a conventional polymerase chain reaction (PCR) method for detecting P. jirovecii were developed. Ninety-eight HIV-negative patients who were followed-up and who had undergone bronchoscopy for diagnosis of various underlying respiratory diseases were included in the study. Sputa of these patients were analyzed with LAMP amplification of P. jirovecii gene. In addition, conventional PCR, Giemsa and Gomori's methenamine silver nitrate staining assays were applied to all specimens. RESULTS: The sensitivity and specificity test showed that there was no cross-reaction with other fungi or bacteria in detecting the specific gene of P. jirovecii by LAMP, and the minimum detection limits by LAMP was 50 copies/mL. P. jirovecii DNA was detected in 62 of 98 (63.3%) sputa specimens by LAMP assay and 22.45% (22/98) by conventional PCR. However, no P. jirovecii cysts were found by Giemsa and Gomori's methenamine silver nitrate in all of gene-positive specimens. CONCLUSION: The results of our study showed that prevalence of P. jirovecii colonization is particularly high in patients with chronic pulmonary diseases in the People's Republic of China, and the LAMP method is better for evaluation of the colonization of P. jirovecii in sputum specimen than conventional PCR.


Assuntos
Líquido da Lavagem Broncoalveolar/microbiologia , Pneumopatias/classificação , Pneumopatias/complicações , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/genética , Escarro/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Broncoscopia , China/epidemiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Adulto Jovem
18.
Vet Pathol ; 52(6): 1210-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26169386

RESUMO

Norway (Rattus norvegicus) and black rats (Rattus rattus) are common peridomestic species, yet little is known about wild rat ecology, including their natural diseases. We describe gross and histological lesions in the respiratory tract of a sample of 711 wild urban rats. A subset was examined for 19 distinct categories of histological lesions in the respiratory tract. Testing for known respiratory pathogens included serology and polymerase chain reaction (PCR) of lung samples. Grossly evident lesions were rare (8/711; 1%). Upper respiratory tract inflammation was present in 93 of 107 (87%) rats and included rhinitis, submucosal and periglandular lymphoplasmacytic tracheitis, and/or tracheal intraluminal necrotic debris and was significantly associated (P < .05) with the presence of cilia-associated respiratory bacillus (CARB), Mycoplasma pulmonis, and increased body mass (odds ratio [OR] = 1.09; 95% confidence interval [CI] = 1.05-1.14 per 10 g). Within the lungs, peribronchiolar and/or perivascular lymphoplasmacytic cuffs were present in 152 of 199 rats (76%) and were also significantly associated (P ≤ .02) with CARB, M. pulmonis, and increased body mass (OR = 1.20; 95% CI = 1.14-1.27 per 10 g). Rats were frequently coinfected with M. pulmonis and CARB, and lesions associated with these pathogens were histologically indistinguishable. Pneumocystis sp was detected in 48 of 102 (47%) rats using PCR but was not significantly associated with lesions. This description of pathology in the respiratory system of wild rats demonstrates that respiratory disease is common. Although the impact of these lesions on individual and population health remains to be investigated, respiratory disease may be an important contributor to wild rat morbidity and mortality.


Assuntos
Pneumopatias/veterinária , Infecções por Mycoplasma/veterinária , Mycoplasma pulmonis/isolamento & purificação , Infecções por Pneumocystis/veterinária , Pneumocystis/isolamento & purificação , Doenças dos Roedores/epidemiologia , Animais , Feminino , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias/epidemiologia , Pneumopatias/microbiologia , Pneumopatias/patologia , Masculino , Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/microbiologia , Infecções por Mycoplasma/patologia , Mycoplasma pulmonis/genética , Mycoplasma pulmonis/imunologia , Noruega/epidemiologia , Pneumocystis/genética , Pneumocystis/imunologia , Infecções por Pneumocystis/epidemiologia , Infecções por Pneumocystis/microbiologia , Infecções por Pneumocystis/patologia , Ratos , Doenças dos Roedores/microbiologia , Doenças dos Roedores/patologia
19.
Mycopathologia ; 179(1-2): 141-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25266324

RESUMO

The present study was undertaken to detect Pneumocystis jirovecii infection among HIV-positive patients presenting with symptoms of lower respiratory tract infection and analyze the associated dihydropteroate synthase (DHPS) and dihydrofolate reductase (DHFR) mutations. P. jirovecii infection was detected in 12.6% cases. We did not find DHPS gene mutations at the commonest positions of codon 55 and 57; however, mutation at codon 171 was detected in two cases. No mutations in DHFR gene were detected. The results indicate low prevalence of DHPS and DHFR mutations in Indian P. jirovecii isolates, suggesting that the selective pressure of sulfa drugs on the local strains has probably not reached the levels found in developed nations.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Di-Hidropteroato Sintase/genética , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/genética , Tetra-Hidrofolato Desidrogenase/genética , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Antirretrovirais/uso terapêutico , Sequência de Bases , Contagem de Linfócito CD4 , DNA Fúngico/genética , Farmacorresistência Fúngica/genética , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/genética , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Infecções por Pneumocystis/complicações , Pneumocystis carinii/enzimologia , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Análise de Sequência de DNA , Adulto Jovem
20.
Semin Immunopathol ; 37(2): 153-62, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25420451

RESUMO

Pneumocystis jirovecii is a common opportunistic infection in the HIV-positive population and is re-emerging as a growing clinical concern in the HIV-negative immunosuppressed population. Newer targeted immunosuppressive therapies and the discovery of rare genetic mutations have furthered our understanding of the immunity required to clear Pneumocystis infection. The immune system can also mount a pathologic response against Pneumocystis following removal of immunosuppression and result in severe damage to the host lung. The current review will examine the most recent epidemiologic studies about the incidence of Pneumocystis in the HIV-positive and HIV-negative populations in the developing and developed world and will detail methods of diagnosis for Pneumocystis pneumonia. Finally, this review aims to summarize the known mediators of immunity to Pneumocystis and detail the pathologic immune response leading to Pneumocystis-related immune reconstitution inflammatory syndrome.


Assuntos
Interações Hospedeiro-Patógeno/imunologia , Infecções por Pneumocystis/etiologia , Pneumocystis/imunologia , Infecções Oportunistas Relacionadas com a AIDS , Animais , Humanos , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Síndrome Inflamatória da Reconstituição Imune/etiologia , Imunidade , Hospedeiro Imunocomprometido , Infecções por Pneumocystis/diagnóstico , Infecções por Pneumocystis/epidemiologia , Infecções por Pneumocystis/terapia
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