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Pneumocystis Pneumonia in Human Immunodeficiency Virus-infected Adults and Adolescents: Current Concepts and Future Directions.

Tasaka S - Clin Med Insights Circ Respir Pulm Med (2015)

Bottom Line: High-resolution computed tomography, which typically shows diffuse ground-glass opacities, is informative for the evaluation of immunocompromised patients with suspected PCP and normal chest radiography.Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for the treatment of mild to severe PCP, although it is often complicated with various side effects.Since TMP-SMX is widely used for the prophylaxis, the putative drug resistance is an emerging concern.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

ABSTRACT
Pneumocystis jirovecii pneumonia (PCP) is one of the most common opportunistic infections in human immunodeficiency virus-infected adults. Colonization of Pneumocystis is highly prevalent among the general population and could be associated with the transmission and development of PCP in immunocompromised individuals. Although the microscopic demonstration of the organisms in respiratory specimens is still the golden standard of its diagnosis, polymerase chain reaction has been shown to have a high sensitivity, detecting Pneumocystis DNA in induced sputum or oropharyngeal wash. Serum β-D-glucan is useful as an adjunctive tool for the diagnosis of PCP. High-resolution computed tomography, which typically shows diffuse ground-glass opacities, is informative for the evaluation of immunocompromised patients with suspected PCP and normal chest radiography. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for the treatment of mild to severe PCP, although it is often complicated with various side effects. Since TMP-SMX is widely used for the prophylaxis, the putative drug resistance is an emerging concern.

No MeSH data available.


Related in: MedlinePlus

High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia in a 45-year-old male patient with AIDS, showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.
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f1-ccrpm-suppl.1-2015-019: High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia in a 45-year-old male patient with AIDS, showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.

Mentions: High-resolution computed tomography (HRCT) typically shows diffuse GGO with patchy distribution, reflecting accumulation of intra-alveolar fibrin, debris, and organisms (Fig. 1).79,80 Although the presence of GGO is nonspecific for PCP, their absence strongly argues against the diagnosis of PCP in HIV-infected patients, and no further diagnostic testing for PCP is generally warranted in these cases.81 In some patients with PCP, GGO is distributed in subpleural lung parenchyma, whereas peripheral sparing of GGO occurs in others.82,83 A study involving 32 patients with AIDS-related PCP showed a central distribution of GGO with relative peripheral sparing in 41% of patients, a mosaic pattern in 29%, and a diffuse distribution in 24%.83 A predilection for the upper lobes has also been described.78,82 With more advanced disease, septal lines with or without intralobular lines superimposed on GGO (crazy paving)83 and consolidation may develop.78,82


Pneumocystis Pneumonia in Human Immunodeficiency Virus-infected Adults and Adolescents: Current Concepts and Future Directions.

Tasaka S - Clin Med Insights Circ Respir Pulm Med (2015)

High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia in a 45-year-old male patient with AIDS, showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4536784&req=5

f1-ccrpm-suppl.1-2015-019: High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia in a 45-year-old male patient with AIDS, showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.
Mentions: High-resolution computed tomography (HRCT) typically shows diffuse GGO with patchy distribution, reflecting accumulation of intra-alveolar fibrin, debris, and organisms (Fig. 1).79,80 Although the presence of GGO is nonspecific for PCP, their absence strongly argues against the diagnosis of PCP in HIV-infected patients, and no further diagnostic testing for PCP is generally warranted in these cases.81 In some patients with PCP, GGO is distributed in subpleural lung parenchyma, whereas peripheral sparing of GGO occurs in others.82,83 A study involving 32 patients with AIDS-related PCP showed a central distribution of GGO with relative peripheral sparing in 41% of patients, a mosaic pattern in 29%, and a diffuse distribution in 24%.83 A predilection for the upper lobes has also been described.78,82 With more advanced disease, septal lines with or without intralobular lines superimposed on GGO (crazy paving)83 and consolidation may develop.78,82

Bottom Line: High-resolution computed tomography, which typically shows diffuse ground-glass opacities, is informative for the evaluation of immunocompromised patients with suspected PCP and normal chest radiography.Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for the treatment of mild to severe PCP, although it is often complicated with various side effects.Since TMP-SMX is widely used for the prophylaxis, the putative drug resistance is an emerging concern.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

ABSTRACT
Pneumocystis jirovecii pneumonia (PCP) is one of the most common opportunistic infections in human immunodeficiency virus-infected adults. Colonization of Pneumocystis is highly prevalent among the general population and could be associated with the transmission and development of PCP in immunocompromised individuals. Although the microscopic demonstration of the organisms in respiratory specimens is still the golden standard of its diagnosis, polymerase chain reaction has been shown to have a high sensitivity, detecting Pneumocystis DNA in induced sputum or oropharyngeal wash. Serum β-D-glucan is useful as an adjunctive tool for the diagnosis of PCP. High-resolution computed tomography, which typically shows diffuse ground-glass opacities, is informative for the evaluation of immunocompromised patients with suspected PCP and normal chest radiography. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for the treatment of mild to severe PCP, although it is often complicated with various side effects. Since TMP-SMX is widely used for the prophylaxis, the putative drug resistance is an emerging concern.

No MeSH data available.


Related in: MedlinePlus