Recent Advances in the Diagnosis of &lt;I&gt;Pneumocystis&lt;/I&gt; Pneumonia

Song, Yinggai; Ren, Yi; Wang, Xiaowen; Li, Ruoyu

doi:10.3314/mmj.16-00019

Cited by 31 publications

(18 citation statements)

References 46 publications

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“…Second, the diagnosis of PCP was mainly based on elevated levels of β-D-glucan and the detection of P. jirovecii by PCR. Although β-D-glucan is a useful serological marker for PCP diagnosis (Li et al 2015;Song et al 2016), colonization by P. jirovecii, as detected by a PCR method, has also been reported (Alanio and Bretagne 2017). Mori et al (2009) reported that 10.9% of asymptomatic carriers of P. jirovecii could be identified by PCR using the sputum or BALF of patients with RA, all of whom had received MTX.…”

Section: Discussionmentioning

confidence: 99%

Serum Soluble Interleukin-2 Receptor Is a Biomarker for <i>Pneumocystis jirovecii</i> Pneumonia among Patients with Rheumatoid Arthritis under Methotrexate Therapy

Sakamoto

Hara

Ishimoto

et al. 2019

Tohoku J. Exp. Med.

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Section: Discussionmentioning

confidence: 99%

Serum Soluble Interleukin-2 Receptor Is a Biomarker for <i>Pneumocystis jirovecii</i> Pneumonia among Patients with Rheumatoid Arthritis under Methotrexate Therapy

Sakamoto

Hara

Ishimoto

et al. 2019

Tohoku J. Exp. Med.

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“…je osjetljivost veća od 85 % i specifičnost veća od 90 % 3 . Za razlikovanje kolonizacije od infekcije od koristi je PCR u realnom vremenu, iako ciljani geni i referentne vrijednosti još uvijek nisu u potpunosti utvrđeni 8 . Inducirani iskašljaj je najprikladniji uzorak za analizu, s obzirom na to da se dobiva najmanje invazivnim putem, a osjetljivost mu se kreće između 50 -90 %.…”

Section: Prikaz Slučajaunclassified

“…Također, prisutnost ground glass areala na HRCT-u nije specifična za PJP, međutim, njihova odsutnost snažno sugerira da nije riječ o PJP-u 5 . Osim opisanih, kao pomoćna metoda u detektiranju PJP-a može poslužiti i određivanje beta-D-glukana u serumu, s obzirom na to da je to sastojak gljivične stijenke 8 . Budući da je bolest brzo dijagnosticirana zahvaljujući molekularnoj dijagnostici (PCR) te je i odgovarajuće liječenje na vrijeme započeto, pacijentica je ozdravila od PJP-a.…”

Section: Prikaz Slučajaunclassified

Pneumocystis jirovecii pneumonija u imunokompromitiranog pacijenta neinficiranog virusom humane imunodeficijencije

Pospiš

Pavić

2019

Med. Flum. (Online)

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Sažetak. Cilj:Analizirati dijagnostičke postupke kod sumnje na pneumoniju u imunokompromitiranih pacijenata s naglaskom na molekularnu dijagnostiku koja omogućuje brzo identificiranje uzročnika i sukladno tome primjenu učinkovite kauzalne terapije. Prikaz slučaja: Pacijentica stara 64 godine primljena je u Kliniku za infektivne bolesti zbog febriliteta do 39 °C u trajanju od devet dana te blagog kašlja. Laboratorijski parametri ukazivali su na akutnu infekciju. Radiogram pluća pokazao je patološki intersticijski crtež bilateralno. Dosada je pacijenticu kontrolirao hematolog, s obzirom na to da je podvrgnuta alogenoj transplantaciji hematopoetskih matičnih stanica zbog akutne mijeloične leukemije. Postavila se sumnja na pneumoniju. Promptno su ordinirane hemokulture i urinokultura te je uzorak sputuma poslan na analizu. Budući da su kulture bile sterilne, a sputum bakteriološki i mikološki negativan, pacijentica je bila upućena na bronhoskopiju s bronhoalveolarnom lavažom (BAL). Mikrobiološka i citološka analiza ispirka nije bila specifična za postavljanje etiološke dijagnoze, stoga je uzorak obrađen testovima lančane reakcije polimerazom (engl. polymerase chain reaction; PCR) na prisutnost najčešćih respiratornih patogena, kao i na Mycobacterium tuberculosis i Pneumocystis jirovecii. U međuvremenu je učinjena kompjutorizirana tomografija visoke rezolucije (engl. high resolution computerized tomography, HRCT) toraksa koja je potvrdila obrazac atipične pneumonije obostrano. Po dobivanju pozitivnog nalaza PCR-a na Pneumocystis jirovecii iz bronhoalveolarnog lavata pacijentica se liječila trimetoprim-sulfometoksazolom i prednisonom te je otpuštena dobrog općeg stanja. Zaključak: Budući da je bolest brzo dijagnosticirana te je i odgovarajuće liječenje na vrijeme započeto, pacijentica je ozdravila od Pneumocystis jirovecii pneumonije (PJP), koja ima prosječnu smrtnost od 30 -50 %.Abstract: Aim: The aim of this paper is to analyse the procedure of diagnosing pneumonias in immunocompromised patients and to point out the importance of molecular diagnostic tests that enable the identification of pathogens causing the disease and administering adequate causal therapy accordingly. Case report: We report a case of a 64-years-old female patient presented with temperature up to 39 °C and mild cough for nine days. Patient was hospitalized in a clinic for infectious diseases. So far, the patient was controlled by hematologists due to allogenic transplantation of hematopoietic stem cells preformed because of acute myelogenous leukemia. In further diagnostic, laboratory parameters indicated acute infection and the radiogram of the lung showed pathological interstitial drawing bilaterally. Pneumonia was suspected as a most likely cause. Promptly ordered hemocultures and urinecultures were sterile, and the sputum was bacteriological and mycological negative, the patient was referred to bronchoalveolar lavage bronchoscopy. The microbiological and cytological analysis of the lavage was not specific to the etiologic

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“…Until recently, the definitive diagnosis of PCP required the microcscopic examination of bronchial lavage or induced sputum specimens for the direct visualization of Pneumocystis organisms . The need for both bronchoscopy and an experienced microscopist precluded its use in many low‐resource settings, hence the historically low‐rate of reported PCP in low‐income settings .…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Pneumonia in the developing world: Characteristic features and approach to management

Aston

2017

Respirology

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Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in adults worldwide, but its epidemiology varies markedly by region. Whilst in high-income countries, the predominant burden of CAP is in the elderly and those with chronic cardiovascular and pulmonary co-morbidity, CAP patients in low-income settings are often of working age and, in sub-Saharan Africa, frequently HIV-positive. Although region-specific aetiological data are limited, they are sufficient to highlight major trends: in high-burden settings, tuberculosis (TB) is a common cause of acute CAP; Gram-negative pathogens such as Klebsiella pneumoniae are regionally important; and HIV-associated opportunistic infections are common but difficult to diagnose. These differences in epidemiology and aetiological profile suggest that modified approaches to diagnosis, severity assessment and empirical antimicrobial therapy of CAP are necessary, but tailored individualized management approaches are constrained by limitations in the availability of radiological and laboratory diagnostic services, as well as medical expertise. The widespread introduction of the Xpert MTB/RIF platform represents a major advance for TB diagnosis, but innovations in rapid diagnostics for other opportunistic pathogens are urgently needed. Severity assessment tools (e.g. CURB65) that are used to guide early management decisions in CAP have not been widely validated in low-income settings and locally adapted tools are required. The optimal approach to initial antimicrobial therapy choices such as the need to provide early empirical cover for atypical bacteria and TB remain poorly defined. Improvements in supportive care such as correcting hypoxaemia and intravenous fluid management represent opportunities for substantial reductions in mortality.

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Recent Advances in the Diagnosis of <I>Pneumocystis</I> Pneumonia

Cited by 31 publications

References 46 publications

Serum Soluble Interleukin-2 Receptor Is a Biomarker for <i>Pneumocystis jirovecii</i> Pneumonia among Patients with Rheumatoid Arthritis under Methotrexate Therapy

Serum Soluble Interleukin-2 Receptor Is a Biomarker for <i>Pneumocystis jirovecii</i> Pneumonia among Patients with Rheumatoid Arthritis under Methotrexate Therapy

Pneumocystis jirovecii pneumonija u imunokompromitiranog pacijenta neinficiranog virusom humane imunodeficijencije

Pneumonia in the developing world: Characteristic features and approach to management

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