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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, showing small nodular lesions surrounded by diffuse GGO
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f3-ccrpm-suppl.1-2015-019: High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO

Mentions: Granulomatous inflammation occurs in approximately 5% of patients (Fig. 3), usually early in the course of HIV infection while immunodeficiency is more limited, and can become evident at HRCT as a solitary nodule or mass mimicking lung carcinoma or as multiple nodules ranging from a few millimeters to more than 1 cm.78 However, small nodules and tree-in-bud opacities are uncommon in AIDS patients with PCP and usually indicate the presence of infectious bronchiolitis from other organisms.83 Patients recovering from PCP may have residual interstitial fibrosis.78,80,81 In addition, although rare, interstitial fibrosis can occur in AIDS patients with low-grade chronic PCP, a condition termed chronic PCP.86


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, showing small nodular lesions surrounded by diffuse GGO
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-ccrpm-suppl.1-2015-019: High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO
Mentions: Granulomatous inflammation occurs in approximately 5% of patients (Fig. 3), usually early in the course of HIV infection while immunodeficiency is more limited, and can become evident at HRCT as a solitary nodule or mass mimicking lung carcinoma or as multiple nodules ranging from a few millimeters to more than 1 cm.78 However, small nodules and tree-in-bud opacities are uncommon in AIDS patients with PCP and usually indicate the presence of infectious bronchiolitis from other organisms.83 Patients recovering from PCP may have residual interstitial fibrosis.78,80,81 In addition, although rare, interstitial fibrosis can occur in AIDS patients with low-grade chronic PCP, a condition termed chronic PCP.86

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