Pulmonary co‐infections by <i>Pneumocystis jirovecii</i> and <i>Aspergillus fumigatus</i> in non‐<scp>HIV</scp> patients: A report of two cases and literature review

Markantonatou, Anthi-Marina; Ioakimidou, Aliki; Arvaniti, Kostoula; Manou, Eleni; Papadopoulos, Vassilios; Kiriklidou, Parthena; Samaras, Konstantinos; Kioumi, Anna; Vyzantiadis, Timoleon‐Achilleas

doi:10.1111/myc.12642

Cited by 21 publications

(13 citation statements)

References 38 publications

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“…(4) PJP is an opportunistic infection. A part of PJP cases are associated with other fungi such as aspergillosis, which is considered a risk factor increasing the mortality of PJP (Markantonatou et al, 2017). Additionally, the level of BDG can also rise with some fungi such as aspergillosis and candida.…”

Section: Discussionmentioning

confidence: 99%

High initial (1, 3) Beta-d-Glucan concentration may be a predictor of satisfactory response of c aspofungin combined with TMP/SMZ for HIV-negative patients with moderate to severe Pneumocystis jirovecii pneumonia

Fan

Liu

Chen

et al. 2019

International Journal of Infectious Diseases

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The aim of this study was to investigate the efficacy of combination therapy of caspofungin and TMP/SMZ (trimethoprim/sulfamethoxazole) in moderate to severe pneumocystis jirovecii pneumonia (PJP) in patients without human immunodeficiency virus infection (HIV) and the relationship between therapeutic effect and plasma (1, 3) Beta-D-Glucan (BDG) levels. Methods: We retrospectively reviewed HIV-negative patients with PJP diagnosed in our department, who were treated with combination therapy of caspofungin and TMP/SMZ or monotherapy of TMP/SMZ during a six and a half year period. Results: A total of 126 moderate to severe PJP patients were enrolled in the study. In the multivariate analysis, low lymphocyte counts, high serum lactate dehydrogenase levels at the diagnosis of PJP and progression to shock were significant risk factors for death. In all patients, there was no significant difference in risk of death at 3 months. In the group of BDG ! 800 pg/m, patients receiving combination therapy was associated with a significantly decreased risk of death at 3 months, whereas in the group of BDG<800 pg/ml, there were no statistically significant difference in survival rate between the two treatment regimens. Conclusion: High initial plasma (1, 3) Beta-D-Glucan concentration may be a predictor of satisfactory caspofungin response to HIV-negative patients with PJP. Based on our findings, we suggest the choice of combination therapy with caspofungin and TMP/SMZ as the initial treatment when BDG ! 800 pg/ml in moderate to severe HIV-negative patients with PJP.

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Section: Discussionmentioning

confidence: 99%

High initial (1, 3) Beta-d-Glucan concentration may be a predictor of satisfactory response of c aspofungin combined with TMP/SMZ for HIV-negative patients with moderate to severe Pneumocystis jirovecii pneumonia

Fan

Liu

Chen

et al. 2019

International Journal of Infectious Diseases

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“…In addition to coinfection with multiple strains of P. jirovecii, there are considerable case reports of pulmonary coinfection of P. jirovecii with one or more other pathogens, including Aspergillus spp. (479)(480)(481)(482), Cryptococcus spp. (483)(484)(485), Candida spp.…”

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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“…Despite increasing reports of P. jirovecii colonization, there are only a few studies of coinfection with other respiratory pathogens in patients with P. jirovecii colonization [40][41][42]. Our study found that the majority of individuals with P. jirovecii colonization had concurrent infections with other fungal or bacterial pathogens (Table 4).…”

Section: Discussionmentioning

confidence: 47%

Pneumocystis jirovecii Colonization and Its Association with Pulmonary Diseases Based on a Multicenter Study by an Improved Loop-Mediated Isothermal Amplification Assay

Xue¹,

Fan

et al. 2019

Preprint

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Background Pneumocystis jirovecii is an opportunistic pathogen fungus and the role of its colonization in respiratory diseases has become a popular focus in recent years. The aim of present study is to develop an improved loop-mediated isothermal amplification (LAMP) assay for detection of Pneumocystis jirovecii (P. jirovecii) DNA and use it to examine the prevalence and association of P. jirovecii colonization among non-HIV patients with various pulmonary diseases. Methods We modified the previously reported LAMP assay for P. jirovecii by adding real-time detection. This method was used to detect P. jirovecii colonization in respiratory samples collected from 403 non-HIV patients with various respiratory diseases enrolled from 5 hospitals in China. We determined the prevalence of P. jirovecii colonization in 7 types of pulmonary diseases and assessed the association of P. jirovecii colonization with clinical characteristics of these diseases. Results The new LAMP assay showed no cross-reactivity with other common respiratory microbes and was 1,000 times more sensitive than that of conventional PCR. Using the new LAMP assay, we detected P. jirovecii colonization in 281 (69.7%) of the 403 patients enrolled. P. jirovecii colonization was more common in interstitial lung diseases than in chronic obstructive pulmonary disease (COPD) (84.6% vs 64.5%, P < 0.05). Patients with acute exacerbation of COPD had a higher prevalence of P. jirovecii colonization compared to patients with stabilized COPD (67.4% vs 43.3%, P < 0.05). P. jirovecii colonization was associated with decreased pulmonary function, increased levels of 1,3-β-D-glucan and C-reactive protein, and decreased levels of CD4+ T-cell counts (P < 0.05 for each). Approximately 70% of P. jirovecii colonized patients had confections with other fungi or bacteria. Conclusions We developed an improved LAMP assay for detecting P. jirovecii. Our multi-center study of 403 patients supports that P. jirovecii colonization is a risk factor for the development of pulmonary diseases and highlights the need to further study the pathogenesis and transmission of P. jirovecii colonization in pulmonary diseases. Keywords: P. jirovecii; colonization; respiratory diseases; loop-mediated isothermal amplification.

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Pulmonary co‐infections by Pneumocystis jirovecii and Aspergillus fumigatus in non‐HIV patients: A report of two cases and literature review

Cited by 21 publications

References 38 publications

High initial (1, 3) Beta-d-Glucan concentration may be a predictor of satisfactory response of c aspofungin combined with TMP/SMZ for HIV-negative patients with moderate to severe Pneumocystis jirovecii pneumonia

High initial (1, 3) Beta-d-Glucan concentration may be a predictor of satisfactory response of c aspofungin combined with TMP/SMZ for HIV-negative patients with moderate to severe Pneumocystis jirovecii pneumonia

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

Pneumocystis jirovecii Colonization and Its Association with Pulmonary Diseases Based on a Multicenter Study by an Improved Loop-Mediated Isothermal Amplification Assay

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