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- 주제어 : Pneumocystis jirovecii (검색결과 30 건)
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허희재,임경리,기창석,허경민,심향진,송동준,김예진,정두련,이남용 대한진단검사의학회 2019 Annals of Laboratory Medicine Vol.39 No.2
Background: Real-time PCR is more sensitive than microscopic examination for detecting Pneumocystis jirovecii. We compared the performance of two assays for detecting P. jirovecii DNA: the RealStar Pneumocystis jirovecii PCR Kit 1.0 CE (Altona Diagnostics, Hamburg, Germany) and the AmpliSens Pneumocystis jirovecii (carinii)-FRT PCR kit (InterLabService Ltd., Moscow, Russia). Methods: We used 159 samples from the lower respiratory tract (112 bronchoalveolar lavage [BAL] fluid, 37 sputum, and 10 endotracheal aspirate [ETA] samples) of non-HIV immunocompromised patients. Nested PCR and sequencing were used to resolve discordant results. The performance of the two assays was evaluated according to clinical categories (clinical Pneumocystis pneumonia [PCP], possible PCP, or unlikely PCP) based on clinical and radiological observations. Results: The positive and negative percent agreement values were 100% (95% confidence interval [CI], 85.4–100%) and 96.6% (95% CI, 90.9–98.9%), respectively, and kappa was 0.92 (95% CI, 0.84–0.99). P. jirovecii DNA load was significantly higher in the clinical PCP group than in the other groups (P<0.05). When stratified by sample type, the positive rate for BAL fluids from the clinical PCP group was 100% using either assay, whereas the positive rate for sputum/ETA samples was only 20%. Conclusions: The two assays showed similar diagnostic performance and detected low P. jirovecii burden in BAL fluids. Both assays may be useful as routine methods for detecting P. jirovecii DNA in a clinical laboratory setting, though their results should be interpreted considering sample type.
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이정현,이지영,신미란,안형기,김철환,김인선 대한병리학회 2011 Journal of Pathology and Translational Medicine Vol.45 No.1
Pneumocystis pneumonia (PCP) is caused by the yeast-like fungus Pneumocystis jirovecii, which is specific to humans. PCP could be a source of opportunistic infection in adults that are immunosuppressed and children with prematurity or malnutrition. The diagnosis should be confirmed by identification of the causative organism, by analysis of the sputum, a bronchoalveolar lavage or a tissue biopsy. In both histologic and cytologic specimens, the cysts are contained within frothy exudates, which form aggregated clumps. The cysts often collapse forming crescent-shaped bodies that resemble ping-pong balls. We recently diagnosed nine cases of PCP using an immunohistochemical stain for Pneumocystis. The patients consisted of five human immunodeficiency virus positive individuals, two renal transplant recipients, and two patients with a malignant disease. All nine patients were infected with P. jirovecii, which was positive for monoclonal antibody 3F6. In conclusion, the immunohistochemical stain used in this report is a new technique for the detection of P. jirovecii infection.
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안아리,장정현,성흥섭,김미나 대한진단검사의학회 2016 Laboratory Medicine Online Vol.6 No.4
Pneumocystis jirovecii pneumonia is a common opportunistic infection seen in patients with human immunodeficiency virus (HIV) infection. Dihydropteroate synthase (DHPS) is a target of sulfa drugs, and mutations in DHPS gene are associated with failure in treatment and prophylaxis of P. jirovecii infections in HIV-infected patients. Here, we report a case of a patient with P. jirovecii infection, harboring DHPS gene mutations, who had not been previously treated with trimethoprim/sulfamethoxazole (TMP/SMX). A 50-yr-old man was admitted to the hospital with symptoms such as fever, cough, sputum, and sore throat. Chest computed tomography scanning revealed diffuse ground glass opacity in both the lungs, and the patient was diagnosed as having HIV infection with a CD4+ T cell count of 22/μL. Immunohistochemical test results were positive for P. jirovecii. He was treated with TMP/SMX; however, his symptoms and laboratory findings did not improve. The treatment was changed to clindamycin and primaquine, and his symptoms improved after 3 days. Molecular testing of the sample for the detection of DHPS gene mutations and the typing of mitochondrial large subunit rRNA (mtlsurRNA) revealed DHPS gene mutations at codon 55 and 57, respectively, and the case had type 3 mtlsur- RNA. This case study illustrates that DHPS mutation test results can be positive even in patients without previous exposure to TMP/SMX. 폐포자충은 사람면역결핍바이러스 감염 환자에서 흔한 기회감염균이다. DHPS는 설파계열 약물의 표적이 되는 부위로 DHPS 유전자의 돌연변이는 치료와 예방 실패와 연관이 있다. 저자들은 설파계열 약물에 치료받은 경험이 없는 환자에서 DHPS 유전자 돌연변이가 있었던 폐포자충 감염 사례를 보고하고자 한다. 50세 남자가 발열, 기침, 가래, 인후통을 호소하여 내원하였다. 흉부 컴퓨터단층촬영술에서 양측 폐 전반에 걸쳐 간유리 음영이 보였고 환자는 사람면역결핍바이러스에 감염되어 있었으며 CD4+ T 세포 수는 22/L이었다. 면역조직화학염색에서 폐포자충이 양성이었다. 환자는 TMP/SMX로 치료받았으나 증상의 호전이 없어서 clindamycin과 primaquine으로 치료 약제를 바꾼 후에 증상이 호전되었다. 분자 진단에서 mtlsurRNA 유형3이었고 DHPS 유전자 돌연변이가 55번째와 57번째 코돈에서 모두 양성이었다. 이 사례에서는 DHPS 유전자 돌연변이가 약제 노출력이 없어도 발생할 수 있기 때문에 환자를 치료할 때 유의해야 함을 시사한다.
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부검에서 발견된 폐와 간의 육아종성 병변을 동반한 폐포자충 폐렴 1예
김문영,박선미,박소형,최민성,이숭덕 대한법의학회 2016 대한법의학회지 Vol.40 No.3
We report the case of a 42-year-old woman who died in hospital from severe respiratory failure, 10 days after the onset of symptoms. Autopsy and microscopic examination identified features of diffuse alveolar damage in both lungs including hyaline membranes and intra-alveolar exudate. Gomori's methenamine silver stain of pink frothy materials in these exudates revealed thin-walled and cup-shaped microorganisms and a diagnosis of Pneumocystis jirovecii pneumonia was made. There were small granulomas in the pulmonary interstitium and hepatic lobules representing an unusual inflammatory reaction against Pneumocystis jirovecii. Extrapulmonary involvement with pneumocystis infection is a rare event occurring in 1% to 2% of all pneumocystis cases. Screening and confirmatory tests for human immunodeficiency virus (HIV) detection were positive. There was no information available regarding the patient’s medical history or the possibility of HIV infection prior to the autopsy, because the patient was a foreign worker who arrived in Korea 2 months before her death. Medical examiners often perform autopsies with limited information regarding the deceased person, even when person is a Korean national. Therefore, an awareness of protection protocols during autopsy, as well as of the atypical patterns of critical diseases, is crucial.
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Kim, Kyung-Ran,Kim, Jong Min,Kang, Ji-Man,Kim, Yae-Jean The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.6
Purpose: Pneumocystis jirovecii pneumonia occurs in various immunocompromised patients. Despite the prophylaxis strategies in clinical practice, certain patients develop P. jirovecii pneumonia. This study was performed to investigate pediatric cases with P. jirovecii pneumonia in a single center. Methods: We identified pediatric patients younger than 19 years with microbiologically confirmed P. jirovecii pneumonia from January 2000 to February 2014. A retrospective chart review was performed. Results: Fifteen episodes of P. jirovecii pneumonia in 14 patients were identified with median age of 8.3 years (range, 0.4-18.6 years). Among these patients, 11 patients had hematology-oncology diseases, 2 had primary immunodeficiency disorders (one with severe combined immunodeficiency and the other with Wiskott Aldrich syndrome), 1 had systemic lupus erythematosus and 1 received kidney transplant. Four patients were transplant recipients; 1 allogeneic and 2 autologous hematopoietic cell transplant and 1 with kidney transplant. The median absolute lymphocyte count at the diagnosis of P. jirovecii pneumonia was $5,156cells/mm^3$ (range, $20-5,111cells/mm^3$). In 13 episodes (13 of 15, 86.7%), patients were not receiving prophylaxis at the onset of P. jirovecii pneumonia. For treatment, trimethoprim/sulfamethoxazole was given as a main therapeutic agent in all 15 episodes. Steroid was given in 9 episodes (60%). Median treatment duration was 15 days (range, 4-33 days). Overall mortality at 60 days was 35.7% (5 of 14). Conclusion: Majority of our patients developed P. jirovecii pneumonia while not on prophylaxis. Continuous efforts and more data are needed to identify high risk patients who may get benefit from P. jirovecii pneumonia prophylaxis.
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김경란,김종민,강지만,김예진 대한소아청소년과학회 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.9
Purpose Pneumocystis jirovecii pneumonia occurs in various immunocompromised patients. Despite the prophylaxis strategies in clinical practice, certain patients develop P. jirovecii pneumonia. This study was performed to investigate pediatric cases with P. jirovecii pneumonia in a single center. Methods We identified pediatric patients younger than 19 years with microbiologically confirmed P. jirovecii pneumonia from January 2000 to February 2014. A retrospective chart review was performed. Results Fifteen episodes of P. jirovecii pneumonia in 14 patients were identified with median age of 8.3 years (range, 0.4–18.6 years). Among these patients, 11 patients had hematology-oncology diseases, 2 had primary immunodeficiency disorders (one with severe combined immunodeficiency and the other with Wiskott Aldrich syndrome), 1 had systemic lupus erythematosus and 1 received kidney transplant. Four patients were transplant recipients; 1 allogeneic and 2 autologous hematopoietic cell transplant and 1 with kidney transplant. The median absolute lymphocyte count at the diagnosis of P. jirovecii pneumonia was 5,156 cells/mm3 (range, 20–5,111 cells/mm3). In 13 episodes (13 of 15, 86.7%), patients were not receiving prophylaxis at the onset of P. jirovecii pneumonia. For treatment, trimethoprim/sulfamethoxazole was given as a main therapeutic agent in all 15 episodes. Steroid was given in 9 episodes (60%). Median treatment duration was 15 days (range, 4–33 days). Overall mortality at 60 days was 35.7% (5 of 14). Conclusion Majority of our patients developed P. jirovecii pneumonia while not on prophylaxis. Continuous efforts and more data are needed to identify high risk patients who may get benefit from P. jirovecii pneumonia prophylaxis.
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김경란,김종민,강지만,김예진 대한소아청소년과학회 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.6
Purpose: Pneumocystis jirovecii pneumonia occurs in various immunocompromised patients. Despite the prophylaxis strategies in clinical practice, certain patients develop P. jirovecii pneumonia. This study was performed to investigate pediatric cases with P. jirovecii pneumonia in a single center. Methods: We identified pediatric patients younger than 19 years with microbiologically confirmed P. jirovecii pneumonia from January 2000 to February 2014. A retrospective chart review was performed. Results: Fifteen episodes of P. jirovecii pneumonia in 14 patients were identified with median age of 8.3 years (range, 0.4–18.6 years). Among these patients, 11 patients had hematology-oncology diseases, 2 had primary immunodeficiency disorders (one with severe combined immunodeficiency and the other with Wiskott Aldrich syndrome), 1 had systemic lupus erythematosus and 1 received kidney transplant. Four patients were transplant recipients; 1 allogeneic and 2 autologous hematopoietic cell transplant and 1 with kidney transplant. The median absolute lymphocyte count at the diagnosis of P. jirovecii pneumonia was 5,156 cells/mm3 (range, 20–5,111 cells/mm3). In 13 episodes (13 of 15, 86.7%), patients were not receiving prophylaxis at the onset of P. jirovecii pneumonia. For treatment, trimethoprim/sulfamethoxazole was given as a main therapeutic agent in all 15 episodes. Steroid was given in 9 episodes (60%). Median treatment duration was 15 days (range, 4–33 days). Overall mortality at 60 days was 35.7% (5 of 14). Conclusion: Majority of our patients developed P. jirovecii pneumonia while not on prophylaxis. Continuous efforts and more data are needed to identify high risk patients who may get benefit from P. jirovecii pneumonia prophylaxis.
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( Ji Youn Sung ),( Joungho Han ),( Young Lyun Oh ),( Gee Young Suh ),( Kyeong Man Jeon ),( Tae Eun Kim ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.5
Background: Pneumocystis jirovecii is a fungus that has become an important cause of opportunistic infections. We present a summary of the clinical status and findings from bronchoalveolar lavage (BAL) of patients with Pneumocystis jirovecii pneumonia (PJP). Methods: We selected 30 cases of PJP that were proven through a surgical specimen evaluation. BAL fluid cytology was reviewed, and agreement with the initial diagnosis was evaluated. Results: All 30 cases of PJP occurred in immunocompromised patients. Only 15 of the 30 cases were initially diagnosed as PJP. We found PJP in 13 of the 15 cases that were negative at the initial diagnosis. The most characteristic finding of PJP was frothy exudates, and BAL fluid tended to show rare neutrophils. Two of seven patients with PJP and diffuse alveolar damage (DAD) revealed no frothy exudates in BAL fluid. Conclusion: BAL fluid cytology was reconfirmed as a sensitive and rapid method to diagnose PJP. We must be aware of the possibility of PJP to maintain high diagnostic sensitivity. We cannot exclude PJP in cases of PJP with DAD, even if frothy exudates are not observed in the BAL fluid.
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이성학,신옥란,이은정,이교영 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.4
Pneumocystis jirovecii is an atypical fungus that causes severe pneumonia in immune compromised patients. While Pneumocystis jirovecii pneumonia (PCP) is more commonly diagnosed in individuals who have HIV infection, it can occur in individuals with other forms of immunosuppression. Fat embolism most commonly develops after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, closed-chest cardiac massage, and liposuction. Overlap in the clinical presentation of these diseases has not yet been reported. We report here on a case of PCP with fat embolism in 52-year-old female patient who had no obvious risk factors for HIV infection. Even if risk factors for HIV or other forms of immunosuppression are not present, PCP can also be seen in patients who present with fat embolism, and the clinical presentation of both conditions can overlap.
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Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia
( Sadatomo Tasaka ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.2
In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a wellknown opportunistic infection and its management has been established. However, PCP is an emerging threat to immunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeutics for malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite different between patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult to diagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomography findings are different between PCP patients with HIV infection and those without. These differences in clinical and radiological features are due to severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of polymerase chain reaction and serum β-D-glucan assay for rapid and non-invasive diagnosis of PCP has been revealed. Although corticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, the optimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization is prevalent and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread of Pneumocystis by airborne transmission. These findings suggest the need for chemoprophylaxis in immunocompromised patients as well as infection control measures, although the indications remain controversial. Because a variety of novel immunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis and treatment of PCP are needed.
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