Pneumocystis

Pneumocystis (carinii) jiroveci

History of Change in Nomenclature

- first reported by Chagas- 1909 - Trypanosoma cruzi -later name as Pneumocystis carinii -From the time of its discovery, until late in the 1980s,Pneumocystis was widely thought to be a protozoan

Protozoans???
1) strong similarities in microbe morphology and host pathology 2) absence of some phenotypic features typical of fungi 3) presence of morphologic features typical of protozoa 4) ineffectiveness of antifungal drugs 5) effectiveness of drugs generally used to treat protozoan infections

 1988- DNA analysis demonstrated that Pneumocystis is a fungus - lacks ergosterol - difficult to grow in culture additional DNA data showed that Pneumocystis organisms in different mammals are quite different 1999-first valid new binomial appeared organism that causes human PCP is now named Pneumocystis jiroveci - Otto Jirovec

 Geographic Distribution - Worldwide Reservoir: - Human tissue - MOT: airborne routes Unique Risk factors - debilitated/ immunocompromised host - HIV/AIDS, cancer treatments, or organ transplants - Malnourished babies and children - HIV-exposed but uninfected children - People who are receiving immunosuppressive therapies, such as organ transplant patients - People with connective tissue diseases or chronic lung diseases

Human Infection
Pneumocystis pneumonia (PCP) Pneumocystis carinii pneumonia (PCP) Opportunistic infection impaired immune systems Lung tissue and from aspirates from the lungs and related structure At first Resembles Mycoplasma infection Yeast multiplies in the alveolar spaces Macrophages ingest Pneumocystis Fibrosis of alveoli

 Signs and symptoms - fever, dry cough, shortness of breath, and fatigue - HIV-infected patients -presents sub-acutely - low-grade fever. - HIV-uninfected patients - develop more quickly and patients typically experience a high fever.

 Specimen sources - Bronchial brushings - bronchopulmonary secretion - sputum -bronchoalveolar lavage -transbronchial biopsy or open lung biopsy

Laboratory diagnosis
Immunology -immunofluorescence method - monoclonal Ab

 Microscopic identification - Tissue-impression smears Stains: - GMS/ toluidine blue- cyst - Giemsa or Wright-Giemsa stain- trophozoite

Microscopic Morphology
Unicellular Cyst thick-walled, rounded 5-8 m in size Contain up to 8 oval sporozoite

Precysts - spherical, 4-7 m - do not contain intracystic bodies

 Trophozoites -amoeboid/pleomorphic - 1-5um - single visible nucleus - covered with tiny projections - lungs and many other extrapulmonary specimens

Molecular Diagnosis
-very high sensitivity and specificity - gold standard

Treatment
trimethoprim sulfamethoxazole pentamidine; trimethoprim plus dapsone; atovaquone; and primaquine plus clindamycin.