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Histologic section from open lung biopsy of lingula from patient with lymphoproliferative disease. Several typical pneumocysts are clustered within an alveolar lumen. (Methenamine silver stain original magnification x 1000).
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Pulmonary infection due to Pneumocystis carinii is now recognized as the leading cause of death from infection in patients with a hematologic malignancy who are in remission. Effective treatment requires suspicion of the infection in susceptible patients and rapid identification of the organism. In most patients, open lung biopsy performed through...
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Context 1
... diameter, and are round, oval, or, most characteristically, cup or crescent-shaped. The walls of the alveoli are usually thickened by hyper- trophic alveolar lining cells, interstitial edema, and a variable mononuclear cellular infiltrate often containing plasma cells. Special stains are essential to see the organism and establish the diagnosis (Fig. ...
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A pneumocistose é uma infecção oportunística freqüente em imunodeprimidos, principalmente naqueles com a síndrome da imunodeficiência adquirida (AIDS). Relata-se o caso de um paciente com quadro insidioso de febre, tosse e emagrecimento. Na radiografia de tórax observou-se imagem tumoral em seio costofrênico direito. Iniciou-se uso de prova terapêu...
Background:
Pneumocystis pneumonia (PCP) is one of the most devastating fungal diseases in patients with impaired immunity. Effective antiviral therapies have reduced the burden of PCP among AIDS patients, but an increase in the prevalence of this disease among persons receiving immunosuppressive therapies has been reported.
Methods:
We retrospe...
Pneumonia due to Pneumocystis jiroveci frequently occurs in patients with haematologic ma- lignancies. It may have typical as well as atypical presentation and carries high mortality in this group of patients. Hence, a high degree of suspicion is mandatory to arrive at a correct diagno- sis, institute appropriate treatment and prevent mortality. We...
Chest radiographic abnormalities in patients with AIDS usually are associated with opportunistic infection or neoplasm. One hundred five patients with AIDS and clinical evidence of pneumonitis had chest radiographs and underwent bronchoscopy with bronchoalveolar lavage, transbronchial biopsy, or open-lung biopsy. Chest radiographs were abnormal in...
Pneumocystis jiroveci (previously carinii) is a parasite, which can cause pneumonia and lung damage in immune compromised patients. Mortality rates may be high if there is no quick intervention. In this case report the pathogenesis and the clinical picture of the Pneumocystis jiroveci Pneumonia will be discussed. The rational of prophylaxis will al...
Citations
... 11,12 The Open-lung biopsy is the most invasive procedure with the highest sensitivity and specificity for diagnostic confirmation. 13 Treatment should be initiated in front of clinical suspicion of PCP in patients with known risk factors. 10 It depends on the clinical severity. ...
Pneumocystis jirovecii pneumonia, typically an opportunistic infection, is commonly associated with risk factors such as low CD4+ lymphocyte count, underlying malignancies, organ transplantation, or immunosuppressive medications. However, occurrences in healthy individuals without known risk factors are exceptionally rare and sparsely documented. In our retrospective analysis of a 42-year-old male without past medical history at Abderrahmane Mami Hospital, Tunisia, Pneumocystis jirovecii pneumonia was diagnosed. The patient presented with fever, productive cough, hemoptysis, and a decline in general health. Clinical examination revealed fever and hypoxemia, and imaging studies demonstrated bilateral necrotic alveolar opacities. Despite empirical antibiotics, nonresponse necessitated bronchoscopy, confirming Pneumocystis jirovecii. Treatment with oral Sulfamethoxazole-Trimethoprim yielded excellent outcomes. This case highlights the potential occurrence of Pneumocystis jirovecii pneumonia in immunocompetent individuals, underscoring the importance of direct microbiological methods in assessing suggestive clinical and radiological features.
... Moreover, in infants below 2 years of age, molecular assays performed on nasopharyngeal aspirate show positive results in only one third of cases [30]. BAL and open lung biopsy are most representative samples since they provide sensitivity of up to 90% or almost 100%, respectively [31,32]. However, these two sampling methods are highly invasive and thus, rarely performed in pediatric patients suspected for PcP. ...
Pneumocystis jirovecii can cause fatal Pneumocystis pneumonia (PcP). Many children have been exposed to the fungus and are colonized in early age, while some individuals at high risk for fungal infections may develop PcP, a disease that is difficult to diagnose. Insufficient laboratory availability, lack of knowledge, and local epidemiology gaps make the problem more serious. Traditionally, the diagnosis is based on microscopic visualization of Pneumocystis in respiratory specimens. The molecular diagnosis is important but not widely used. The aim of this study was to collect initial indicative data from Serbia, Greece, and Romania concerning pediatric patients with suspected PcP in order to: find the key underlying diseases, determine current clinical and laboratory practices, and try to propose an integrative future molecular perspective based on regional collaboration. Data were collected by the search of literature and the use of an online questionnaire, filled by relevant scientists specialized in the field. All three countries presented similar clinical practices in terms of PcP prophylaxis and clinical suspicion. In Serbia and Greece the hematology/oncology diseases are the main risks, while in Romania HIV infection is an additional risk. Molecular diagnosis is available only in Greece. PcP seems to be under-diagnosed and regional collaboration in the field of laboratory diagnosis with an emphasis on molecular approaches may help to cover the gaps and improve the practices.
... The diagnostic yield of BAL is >90%, and this may be increased if multiple lobes are sampled [10]. Open-lung biopsy is the most invasive procedure; however, shows very high sensitivity and specificity because it provides the greatest amount of tissue for the diagnosis [11]. ...
We herein report the case of a 37-year-old immunocompetent man who died from Pneumocystis jirovecii pneumonia (PCP). He was initially treated for an acute exacerbation of interstitial pneumonia; however, the elevation of the patient’s serum (1-3) β -D glucan (BG) level suggested the possibility of PCP and sulfamethoxazole trimethoprim was added. A postmortem pathological examination and retrospective Grocott's methenamine silver (GMS) staining of the bronchoalveolar lavage fluid (BALF), which was obtained on the day of admission, revealed PCP. The present case suggests that it is essential to perform a BG assay and GMS staining of BALF specimens when patients show diffuse ground-glass opacity on chest computed tomography, regardless of their immune status.
Der Autor, der sich mit der „Klinik der malignen Lymphome“zu befassen hat, begegnet speziellen Schwierigkeiten, die mit der Semantik der einzelnen Spielarten und Formen von Lymphomen zusammenhängen und den jeweiligen Stand unserer Kenntnisse widerspiegeln. In der älteren Literatur z.B. wird ausschließlich die alte deutsche Klassifizierung der Non-Hodgkin-Lymphome benutzt; später, ab 1956 folgt die Rappaportsche Einteilung mit einer differenten Nomenklatur, die bis heute vor allem das angelsächsische Schrifttum bestimmt. In den letzten Jahren wurden neuere Klassifikationen eingeführt, die auf einer verfeinerten Diagnostik der Zellen des lymphatischen Systems und deren malignen Abkömmlingen beruhen; sie sind mit den Namen Dorfman (1974); Bennett
et al. (1974); Lukes u. Collins (1974); Lennert
et al. (1975) sowie Mathé
et al. (1976) verbunden. Die sog. Kieler Klassifikation, die von Lennert
et al. (1975) konzipiert wurde, hat Stein im Kapitel „Systematik der Non-Hodgkin-Lymphome“ ausführlich dargestellt.
Fungal infections, other than those caused by Candida species, rarely are considered in the differential diagnosis for an acutely ill newborn infant, because disorders of bacterial and viral etiology are vastly more common. Nevertheless, fungal infections do occur in neonates, especially in premature infants and those of very low birth weight (less than 1500g), and can cause serious and frequently fatal disease. The number of cases of invasive infection attributed to fungi among all patients in the United States quadrupled between 1990 and 2000. With advances in neonatal care, the epidemiology of fungal infections in the neonatal intensive care unit (NICU) has changed dramatically, with an estimated 10-fold increase in the past decade. As with any other infectious disease, the risk of fungal infection depends on the host and risk of exposure. The neonate has some risk of exposure to either Malassezia furfur or Pneumocystis jiroveci (previously Pneumocystis carinii , newly classified as a fungus on the basis of DNA sequence analysis), has a limited risk of exposure to Aspergillus species, and has an extremely low risk of exposure to other fungi—especially in the NICU setting. Therefore, it is not surprising that the most common fungal infection in neonates is candidiasis, followed by infections with P. jiroveci and M. furfur , whereas case reports or small series constitute the literature on aspergillosis and other fungal infections.
Thirty-eight children were evaluated for interstitial pneumonia by open lung biopsy. In most instances the patients were immunosuppressed as a result of cancer chemotherapy and irradiation. Pneumocystis carinii infection was the most common cause of pneumonitis (60.4%), especially in children with leukemia (78.3%). The clinical triad of hypoxemia, tachypnea, and a diffuse interstitial infiltrate on chest x-ray, is an indication for early open lung biopsy. Survival was 91.7% in cases of acute pneumocystis pneumonia, a significant improvement over previous reports. These observations strongly support the concept of early open lung biopsy in the management of diffuse interstitial pneumonitis in patients who are immunosuppressed.
PNEUMOCYSTIS CARINII pneumonitis occurs almost exclusively in the debilitated or immunosuppressed individual? Mortality without therapy in this disease exceeds 50%. Treatment with pentamidine isethionate has improved the survival rate to 60 to 95%. However, pentamidine is toxic; adverse reactions occur in approximately 50% of recipients. Trimethoprim-sul famethoxazole is apparently effective and less toxic/ In this report we summarize our experience with TMP-SMZ treatment of five children with P. carinii pneumonitis, CASE REPORTS The age, sex, underlying disease, and diagnostic procedures for five patients with P. carinii infection are listed in Table I. Symptoms in four children were present for four to 21 days before starting treatment. One patient (No. 2) had easy fatiguabilitY, dyspnea, and mild cough for nine weeks; his respiratory symptoms had progressed during the last week. Such an insidious course has been recognized in P. carinii infections/All children had tachypnea, cough, and fever; three were cyanotic. At the time of diagnosis blood Pao2 was over 50 mm Hg in the three survivors and under 50 mm Hg in the two children who died subsequently. Total and differential white blood counts were not helpful in diagnosis but reflected either the underlying disease (Patient 1) or the effects of chemotherapy (Patients 2 to 5). All patients had extensive, bilateral interstitial infiltrates as demonstrated by chest radiographs?. 3 The first patient also developed a spontaneous pneumothorax. Aerobic and anaerobic bacteria, mycobacteria, fungi, and viruses were sought in all cases in smears and cultures of lung biopsy specimens; none was isolated. All lung biopsy
