High transient colonization by Pneumocystis jirovecii between mothers and newborn

Vera, Cristian; Aguilar, Yudy; Vélez, Lázaro A.; Rueda, Zulma Vanessa

doi:10.1007/s00431-017-3011-z

Cited by 21 publications

(18 citation statements)

References 35 publications

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“…We raise the hypothesis that the primary Pneumocystis infection may adversely affect the respiratory physiology and the response to infections or other respiratory insults of the developing infant lung. The predictable epidemiology with a high prevalence of Pneumocystis in 2-to 5-month-old infants, 11,12,14,16,21 plus the fact that the present results are consistent with those of prior studies in autopsied infants and in animal models documenting Pneumocystis-associated pathology, underlines the importance of testing this hypothesis. However, the inability to apply the Koch criteria for determining causality is challenging.…”

Section: Discussionsupporting

confidence: 90%

Progression of Type 2 Helper T Cell–Type Inflammation and Airway Remodeling in a Rodent Model of Naturally Acquired Subclinical Primary Pneumocystis Infection

Iturra

Rojas

Pérez

et al. 2018

The American Journal of Pathology

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Subclinical primary Pneumocystis infection is the most common pulmonary infection in early infancy, making it important to determine whether it damages the lung. Pneumocystis peaks at 2 to 5 months of age, when respiratory morbidity coincidently increases. We have documented that Pneumocystis increases mucus production in infant lungs, and animal models reveal lung lesions that warrant characterization. Herein, immunocompetent rats infected at birth with Pneumocystis by cohabitation, to resemble community-acquired infection, underwent lung assessments at 45, 60, and 75 days of age. Lungs fixed by vascular perfusion to prevent collapse during necropsy were used for morphometry evaluations of mucus production, airway epithelial thickening, perivascular and peribronchiolar inflammation, and structural airway remodeling. Changes in these histologic features indicate lung disease. Selected immune markers were assessed in parallel using fresh-frozen lung tissue from sibling rats of the same cages. Sequential activation of NF-κB and an increased Gata3/T-bet mRNA level ratio, consistent with a type 2 helper T-cell-type inflammatory response, and subacute fibrosis were recognized. Therefore, documenting subclinical Pneumocystis infection induces lung disease in the immunocompetent host. Taken together with the peak age of primary Pneumocystis infection, results warrant investigating the clinical impact of this often subclinical infection on the severity of respiratory diseases in early infancy. This model can also be used to assess the effects of airway insults, including coinfections by recognized respiratory pathogens.

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Section: Discussionsupporting

confidence: 90%

Progression of Type 2 Helper T Cell–Type Inflammation and Airway Remodeling in a Rodent Model of Naturally Acquired Subclinical Primary Pneumocystis Infection

Iturra

Rojas

Pérez

et al. 2018

The American Journal of Pathology

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show abstract

“…The prevalence of P. jirovecii colonization among healthy adults in most studies varies from 0 to 20% (16). Higher prevalences of 32 to 100% have been reported for immunocompetent infants based on microscopic or PCR studies of autopsy or nasopharyngeal samples (1,2,(448)(449)(450). Primary exposure to Pneumocystis likely occurs commonly at an early age, as evidenced by the increasing serum antibody titers against Pneumocystis found in the first few years of life (2,451,452).…”

Section: Transmissionmentioning

confidence: 99%

“…Primary exposure to Pneumocystis likely occurs commonly at an early age, as evidenced by the increasing serum antibody titers against Pneumocystis found in the first few years of life (2,451,452). Healthy pregnant women have been found to have a colonization prevalence of 16% during the third trimester, based on PCR studies of nasopharyngeal swabs (450,453). Health care workers (HCWs) in close contact with PCP patients with active PCP may have an increased risk of colonization (24%) compared to that for noncontact HCWs (11%) (454).…”

Section: Transmissionmentioning

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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“…In immune-defective hosts, the Pneumocystis jirovecii infection can progress and result in diffuse lung injury secondary to a dysfunctional immune response [1]. e route of Pneumocystis jirovecii transmission is unclear where both mothers [6,18] and healthy infants [7] have been postulated but not proven as reservoirs for transmission. To our knowledge, this is the first reported case of PCP in an infant due to acquired combined immunodeficiency resulting from maternal chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Acquired Immunodeficiency from Maternal Chemotherapy and Severe Primary Pneumocystis Infection in an Infant

Lim

Mattke

Clark

et al. 2020

Case Reports in Pediatrics

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Pneumocystis jirovecii is recognized as an opportunistic pathogen in immunosuppressed patients. We report a case of severe Pneumocystis pneumonia (PCP) in an infant with acquired combined immunodeficiency secondary to maternal chemotherapy exposure during the second and third trimesters of pregnancy. e infant required cardiorespiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. is case highlights the potential for severe acquired immunodeficiency in this patient cohort and further postnatal surveillance is highly recommended.

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High transient colonization by Pneumocystis jirovecii between mothers and newborn

Cited by 21 publications

References 35 publications

Progression of Type 2 Helper T Cell–Type Inflammation and Airway Remodeling in a Rodent Model of Naturally Acquired Subclinical Primary Pneumocystis Infection

Progression of Type 2 Helper T Cell–Type Inflammation and Airway Remodeling in a Rodent Model of Naturally Acquired Subclinical Primary Pneumocystis Infection

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

Acquired Immunodeficiency from Maternal Chemotherapy and Severe Primary Pneumocystis Infection in an Infant

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