Refractory acute respiratory failure due to Pneumocystis jiroveci (PCP) and Cytomegalovirus (CMV) pneumonitis: A case report and review of literature

Shah, Kairav; Cherabuddi, Kartikeya; Beal, Stacy G.; Kalyatanda, Gautam

doi:10.1016/j.idcr.2017.08.011

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…(483)(484)(485), Candida spp. (486), Histoplasma capsulatum (487), Mycobacterium tuberculosis (488)(489)(490)(491), Legionella pneumophila (492)(493)(494)(495), Salmonella enterica serovar Enteritidis (496), cytomegalovirus (497)(498)(499)(500)(501)(502)(503)(504)(505)(506), influenza virus (507-509), herpesvirus 6 (510), Strongyloides stercoralis (511,512), Toxoplasma gondii (513), and Trichomonas vaginalis (514). The majority of these cases occurred in patients with severe immunodeficiency.…”

Section: Strain Variation Of P Jiroveciimentioning

confidence: 99%

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

2018

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, 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 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, making a fascinating but difficult-to-study organism. Improved molecular biologic methodologies have opened a new window into the biology and epidemiology of. 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 biology and its relevance to clinical care.

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Section: Strain Variation Of P Jiroveciimentioning

confidence: 99%

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

2018

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“…A Wright-Giemsa stained smear was the most common conventional diagnostic method in the past few decades and other methods such as methenamine silver and cresyl echt violet fluorescence staining and nucleic acid amplification testing may further increase the detection sensitivity. Despite high incidence of PCP in HIV-infected patients, the diagnosis of PCP remains challenging due to its non-specific signs and symptoms and inadequate performance of conventional diagnostic methods ( 18 ). CMV pneumonitis is uncommon, and its diagnosis is challenging as the clinical manifestations and radiological features of CMV pneumonia are also non-specific ( 7 , 10 , 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Despite high incidence of PCP in HIV-infected patients, the diagnosis of PCP remains challenging due to its non-specific signs and symptoms and inadequate performance of conventional diagnostic methods ( 18 ). CMV pneumonitis is uncommon, and its diagnosis is challenging as the clinical manifestations and radiological features of CMV pneumonia are also non-specific ( 7 , 10 , 18 , 19 ). The challenges of prompt appropriate diagnosis of PCP and CMV-mixed pulmonary infection are well-reflected in the present case report.…”

Section: Discussionmentioning

confidence: 99%

“…So, the cut-off reads of NGS to be used as a marker of invasive PCP and CMV disease is uncertain. A study suggested that specific reads of P. jirovecii ranking among the top 15 or its relative reads proportion in fungi higher than 85% might be satisfactory cut-off values for clinical diagnosis of PCP ( 18 ). In patients with PCP, the co-presence of CMV in BALF has traditionally been presumed to be non-invasive and there were no difference in outcome between anti-CMV-treated and CMV-untreated groups ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Next-Generation Sequencing in Diagnosis of Pneumonia Due to Pneumocystis jirovecii and Cytomegalovirus in a Patient With HIV Infection

et al. 2021

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Background: Pulmonary infections remain a significant cause of morbidity and mortality in immunocompromised patients. The pathogens spectrum of pulmonary infection that can affect patients with human immunodeficiency virus (HIV) is wide such as bacterial, fungal, viral, parasitic organisms, and so on. The risk of multi-pathogenic pneumonia is higher in HIV-infected patients. However, the fast and accurate diagnosis of multi-pathogenic pneumonia is challenging because of the limitations of current conventional tests.Case Presentation: Here, we report a case of pneumonia due to Pneumocystis jirovecii and cytomegalovirus (CMV) in a 22-year-old male with newly diagnosed HIV infection. Blood tests revealed a low CD4 count, a chest computed tomography (CT) scan showed extensive ground-glass opacities in the bilateral lung with multiple cavity lesions in the left upper lung. Microscopic examination of stained sputum and bronchoalveolar lavage fluid (BALF) smear specimens did not find any pathogens. There was also no evidence of pathogens known to cause pneumonia in bacteria and fungi culture tests and virus antibodies such as EBV, CMV, and COVID-19. The nucleic acid of CMV in blood was reported by quantitative PCR. Next-generation sequencing (NGS) analysis of BALF specimens identified a large number of P. jirovecii and CMV reads, and confirmed the diagnosis of pneumonia due to P. jirovecii and CMV. Following the patient's treatment with anti-PCP and anti-CMV, the patient was cured and discharged.Conclusions: This case highlights the combined application of NGS in the clinical diagnosis of multi-pathogenic pneumonia in an HIV-infected patient. NGS is proposed as an important adjunctive diagnostic approach for identifying pathogens of multi-pathogenic pneumonia in HIV-infected patients.

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“…CMV is a kind of prevalent human herpesvirus with nondominant clinical syndrome in immunocompetent people, more likely being concomitant with the occurrence of PJP. [10,11] In immunocompromised patients, either the reactivation of latent CMV acquired in early life or primary infection in previously uninfected individuals could result in CMV infection. [12] Patients experiencing CMV viremia are at an increased risk of subsequent development of invasive fungal disease like PJP because of the common shared clinical risk factors including immunosuppres-sion, corticosteroids, graft-versus-host disease and graft rejection.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jiroveci pneumonia with cytomegalovirus infection diagnosed by metagenomic next-generation sequencing in a patient with nephrotic syndrome

Yu¹,

Ding²,

Wang³

et al. 2021

Medicine

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Introduction:Opportunistic infection with multiple pathogens currently has become less uncommon since the application of immunosuppressant or corticosteroid in non- Human immunodeficiency virus patients. However, the clinical diagnosis of the co-infection remains difficult since the uncertainty and deficiency of the microbiologic testing methods.Patient concerns:A 66-year-old male patient was admitted to our hospital with chest stuffiness, shortness of breath and elevated body temperature.Diagnosis:He was diagnosed with the co-infection of Pneumocystis jiroveci and cytomegalovirus by metagenomic next-generation sequencing of bronchoalveolar lavage fluid after bronchoscopy.Interventions:The patient was empirically treated with broad-spectrum antibiotics, trimethoprim/ sulfamethoxazole and ganciclovir in the beginning of the admission.Outcomes:The condition of this patient was not improved even with the intervention at the early stage of the disease. His family requested discharge after 24 inpatient days.Lessons:This case highlights the application of metagenomic next-generation sequencing in the clinical diagnosis of pulmonary co-infection. Suitable prophylaxis, necessary clinical awareness and accurate diagnosis are indispensable for immunocompromised patients with pulmonary infection.

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Refractory acute respiratory failure due to Pneumocystis jiroveci (PCP) and Cytomegalovirus (CMV) pneumonitis: A case report and review of literature

Cited by 4 publications

References 16 publications

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

Case Report: Next-Generation Sequencing in Diagnosis of Pneumonia Due to Pneumocystis jirovecii and Cytomegalovirus in a Patient With HIV Infection

Pneumocystis jiroveci pneumonia with cytomegalovirus infection diagnosed by metagenomic next-generation sequencing in a patient with nephrotic syndrome

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