Disseminated pneumocystis carinii infection in AIDS.

Abstract

Eight patients with AIDS and Pneumocystis carinii infection were studied. Protean manifestations were a feature not untypical of disseminated pneumocystosis. Aerosolised pentamidine as prophylaxis against P carinni pneumonia was ineffective at suppressing dissemination. The knowledge that extrapulmonary infection can occur has implications for the detection and treatment of, and prophylaxis against, P carinji infection. The survival of patients with disseminated pneumocystosis is particularly poor, and may be due to a lack of clinical awareness and consequent delay in diagnosis. A 26 year old homosexual man presented with severe abdominal pain. A chest x ray picture on admission showed bilateral pulmonary infiltrates suggestive of P carinii pneumonia. He had been found to be HIV antigen and antibody positive two years previously (November 1988). Mycobacterium malmoense had been isolated from sputum samples in June 1990 and at that time he had started quadruple anti-tuberculous treatment. He had developed an enlarged non-tender thyroid six weeks before admission and was found to be hypothyroid for which he was being treated with thyroxine. Auto-antibodies were not detected. He had received aerosolised pentamidine (300 mg fortnightly) as prophylaxis against P carinii pneumonia for six months. At laparotomy a perforation of the small bowel was found and repaired, but he died seven days later. CASE 32A 33 year old homosexual man presented with a history of weight loss, anorexia, dry cough, fever and night sweats. He had been found to be HIV-1 antibody positive three years previously and had developed P carinii pneumonia two years and again 10 months before admission. Since his first episode ofP carinii pneumonia he had been maintained on aerosolised pentamidine (300 mg fortnightly). He was feverish (39-4°C) and cachectic. His chest and abdomen were clinically normal, as were chest x ray picture and arterial blood gas analysis. Bronchoscopy

Neumocistosis extrapulmonar: comunicación de un caso

“…Todos ellos con inmunocompromiso grave 1,13 . La mayoría de los casos descritos son durante la década de los 90s, en los cuales no era claro si los pacientes VIH en etapa SIDA eran más susceptibles a una diseminación extrapulmonar que otros pacientes con riesgo de neumonía por P. jiroveci 13,14 . Sin embargo, tres factores podrían tener importancia, el primero es que los pacientes con infección por VIH logran sobrevivir más tiempo y pueden llegar a etapas de mayor inmunocompromiso.…”

“…Se ha descrito compromiso de pabellón auricular, coroides, retina, tiroides, paratiroides, hígado, bazo, páncreas, riñón, uréteres, glándulas adrenales, corazón, tráquea, ganglios linfáticos, pleura, líquido ascítico, orina, médula ósea, músculos, hipófisis, meninges, corteza cerebral, tracto gastrointestinal, incluyendo un caso de perforación de intestino delgado 17 . El sitio más frecuente de compromiso extrapulmonar corresponde a los ganglios linfáticos [6][7][8][9][10][11][12][13][14][15][16] . La vía de diseminación puede ser hematógena, linfática, y también por contigüidad como en casos descritos de neumonía por P. jiroveci con derrame pleural concomitante [6][7][8][9][10][11][12][13][14][15][16] .…”

“…El sitio más frecuente de compromiso extrapulmonar corresponde a los ganglios linfáticos [6][7][8][9][10][11][12][13][14][15][16] . La vía de diseminación puede ser hematógena, linfática, y también por contigüidad como en casos descritos de neumonía por P. jiroveci con derrame pleural concomitante [6][7][8][9][10][11][12][13][14][15][16] . El diagnóstico de neumocistosis extrapulmonar no es difícil una vez que es considerado como diagnóstico diferencial, sin embargo, rara vez es sospechado por su baja frecuencia, presentación clínica no específica que puede ser atribuido a una amplia variedad de otras infecciones o enfermedades oportunistas que ocurren en pacientes con VIH e inmunocompromiso grave 6,20,21 .…”

“…Una vez sospechada la diseminación extrapulmonar y ante la ausencia de un método de cultivo in vitro para P. jiroveci, es necesario demostrar sus quistes o trofozoitos en el o los tejidos afectados o en líquidos estériles 6,22 . Cabe mencionar que en muchos de los casos publicados se realizó el diagnóstico en forma incidental o post mortem, de los cuales varios pacientes presentaban otras infecciones o enfermedades en forma concomitante (CMV, Cryptococcus neoformans, Mycobacterium avium complex, Mycobacterium tuberculosis, candidiasis, sarcoma de Kaposi y hepatitis B) 1,6,14,20 . Por lo tanto, es difícil estimar la real implicancia de la infección extrapulmonar por P. jiroveci en relación a letalidad o pronóstico.…”

Small-Intestine Pneumocystis jiroveci Pseudotumor as an Acquired Immunodeficiency Syndrome–Presenting Illness: Report of a Case and Review of the Literature

“…4 Some studies have suggested that the disseminated form of Pneumocystis infection is associated with CMV coinfection. 8 Our patient had no known history of P jiroveci pneumonia and had not used aerosolized pentamidine. The relationship between extrapulmonary pneumocystosis and aerosolized pentamidine is somewhat complex.…”