DOCSLIB.ORG

Pulmonary Infections in HIV-Infected Patients: an Update in the 21St Century

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pulmonary Infections in HIV-Infected Patients: an Update in the 21St Century Eur Respir J 2012; 39: 730–745 DOI: 10.1183/09031936.00200210 CopyrightßERS 2012 REVIEW Pulmonary infections in HIV-infected patients: an update in the 21st century N. Benito*, A. Moreno#, J.M. Miro# and A. Torres",+ ABSTRACT: From the first descriptions of HIV/AIDS, the lung has been the site most frequently AFFILIATIONS affected by the disease. Most patients develop a pulmonary complication during the history of HIV *Infectious Diseases Unit, Internal Medicine Service, Hospital de la infection, mainly of infectious aetiology. Santa Creu i Sant Pau, Universitat Important changes in the epidemiology of HIV-related pulmonary infections have occurred. Autonoma de Barcelona, Overall, prescription of Pneumocystis jirovecii prophylaxis and the introduction of highly active #Infectious Diseases Service, " antiretroviral therapy (HAART) are the main causes. Pneumology Service, Hospital Clı´nic-IDIBAPS, Universitat de Currently, the most frequent diagnosis in developed countries is bacterial pneumonia, Barcelona, and especially pneumococcal pneumonia, the second most frequent cause is Pneumocystis +CIBERES, Barcelona, Spain. pneumonia and the third is tuberculosis. However, in Africa, tuberculosis could be the most common pulmonary complication of HIV. CORRESPONDENCE N. Benito Pulmonary infections remain one of the most important causes of morbidity and mortality in these Infectious Diseases Unit, Internal patients, and the first cause of hospital admission in the HAART era. Achieving an aetiological Medicine Service diagnosis of pulmonary infection in these patients is important due to its prognostic consequences. Hospital de la Santa Creu i Sant Pau Sant Antoni Maria Claret 167 KEYWORDS: AIDS, bacterial pneumonia, HIV, Pneumocystis pneumonia, pulmonary infections, Barcelona 08025 tuberculosis Spain E-mail: [email protected] he first published reports of AIDS because they have a delayed HIV diagnosis (i.e. an Received: appeared in 1981, when five homosexual advanced stage of disease at diagnosis) or they are Dec 28 2010 Accepted after revision: males in Los Angeles (CA, USA) were not in active care despite the availability of T Aug 15 2011 diagnosed with Pneumocystis carinii (currently HAART [5, 6]. First published online: Pneumocystis jiroveci) pneumonia [1]. Since then, Sept 01 2011 HIV infection has become a pandemic and remains From the first descriptions of HIV/AIDS, the one of the most important global health problems respiratory tract has been the site most frequently of the 21st century [2]. The number of people living affected by the disease. According to results of with HIV is increasing worldwide because of autopsy findings, the lung was affected with an ongoing accumulation of new infections (even at incidence ranging from 100% in the early period of a reduced rate) with longer survival times. There the epidemic to 70% in the HAART era [7–11]. Up to were 33.3 million people worldwide living with 70% of HIV patients have a pulmonary com- HIV at the end of 2009 compared with 26.2 million plication during the evolution of the disease, mainly in 1999; a 27% increase [2]. of infectious aetiology [11]. Lower respiratory tract infections are 25-fold more common in patients with Combination therapy with multiple agents against HIV than in the general community, occurring in up HIV, known as HAART (highly active antiretro- to 90 cases per 1,000 person-yrs [12]. Currently, viral therapy), became widely used between 1996 pulmonary infections, not only AIDS-related oppor- and 1997 in developed countries. As a result, the tunistic infections, remain a leading cause of incidence of opportunistic infections has decreased morbidity and mortality and one of the most and the life expectancy of HIV-infected persons frequent causes of hospital admission in HIV has increased [3, 4]. However, this has not occurred infected people worldwide [13]. An incidence of uniformly worldwide because antiretroviral ther- 20–25 episodes per 100 hospital admissions per apy (ART) is not yet available to millions of HIV- year has been observed [14, 15]. These numbers give infected people, mainly in resource-limited countries. an idea of the magnitude of the problem of pul- European Respiratory Journal Moreover, a significant percentage of patients in monary infections in HIV patients. Moreover, it has Print ISSN 0903-1936 developed countries are not receiving HAART been suggested that Pneumocystis pneumonia (PCP), Online ISSN 1399-3003 730 VOLUME 39 NUMBER 3 EUROPEAN RESPIRATORY JOURNAL N. BENITO ET AL. REVIEW: PULMONARY INFECTIONS IN HIV-INFECTED PATIENTS tuberculosis (TB) and bacterial pneumonia are associated with a TABLE 1 Aetiology of pulmonary infections in HIV-infected significantly worse subsequent HIV disease course, even a patients permanent decline in pulmonary function [16–19], although not all studies agree with these findings [20]. Aetiology# Cumulate incidence EPIDEMIOLOGY OF PULMONARY INFECTIONS IN HIV- Infectious aetiology 97% of pulmonary infiltrates INFECTED PATIENTS with diagnosis Few studies have systematically described the full spectrum of " Bacterial pneumonia 60% of pulmonary infiltrates HIV-associated pulmonary infections [14, 21–23]. Most investi- of infectious aetiology gators have focused on pneumonias of specific aetiologies. Streptococcus pneumoniae 70% of bacterial pneumonia Therefore, there is no consensus on any diagnostic algorithm of Haemophilus influenzae 10% of bacterial pneumonia pulmonary infections in HIV patients. The diagnostic decision Staphylococcus aureus 9% of bacterial pneumonia should be different depending on the epidemiological features in Legionella pneumophila 6% of bacterial pneumonia a specific geographical area [24]. Thus, the incidence of TB in HIV Gram-negative bacillus 5% of bacterial pneumonia patients varies considerably in different geographical areas, PCP 20% of pulmonary infiltrates depending on the prevalence of disease in the general population. of infectious aetiology In Africa, TB could be the most common pulmonary complication Mycobacteriosis 18% of pulmonary infiltrates of HIV, followed by community-acquired pneumonia [23, 24]. of infectious aetiology However, PCP is uncommon in Africa, although the incidence Mycobacterium tuberculosis 80% of mycobacteriosis seems to be increasing [24–26]. It remains speculative whether Mycobacterium kansasii, MAC, 20% of mycobacteriosis this trend denotes a true increase in the prevalence of PCP or Mycobacterium fortuitum whether the early reports underestimated the actual prevalence and Mycobacterium xenopi [25]. In Western Europe in the 1990s, PCP was the commonest Virus 5% of pulmonary infiltrates AIDS-defining illness, whereas pulmonary TB was more com- of infectious aetiology moninEasternEurope.WithinWesternEurope,TBremains Cytomegalovirus more common in the south than in the north [27]. Endemic fungi Influenza virus are common in HIV patients who live in endemic areas, but are Parainfluenza virus exceptional in patients that have never resided in or travelled to Respiratory syncytial virus endemic regions [28]. Fungus 2% of pulmonary infiltrates The epidemiology of pulmonary infections in HIV has notably of infectious aetiology changed in the last decades. There are several explanations for Cryptococcus these changes. The general prescription of PCP primary Aspergillus fumigatus prophylaxis since 1989 is one of the main causes, and the use of Endemic fungal infections HAART since 1996 is other underlying explanation. After PCP Parasite 0.5% of pulmonary infiltrates prophylaxis, the incidence of Pneumocystis infection greatly of infectious aetiology decreased in the USA and Europe. Additionally, some studies Toxoplasma gondii have suggested that prophylaxis with trimethoprim-sulfa- Strongyloides stercoralis methoxazole (TMP-SMX) could have decreased the incidence of Multiple organisms 7% of pulmonary infiltrates bacterial infections in HIV patients with ,200 CD4 lymphocytes of infectious aetiology per mm3; however, not all studies agree with this statement [29, Other+ 3% of pulmonary infiltrates 30]. Following the introduction of HAART, the relative incidence of infectious aetiology of aetiologies of HIV-associated pulmonary infections has Noninfectious aetiology 3% of pulmonary infiltrates changed, with bacterial pneumonia replacing PCP as the most with diagnosis frequently encountered cause of these infections [30, 31]. Pulmonary oedema Nevertheless, the influence of HAART on the incidence and Lung cancer prognosis of pulmonary diseases, mainly on non-opportunistic Other infections and malignancies, is still not well known. PCP: Pneumocystis pneumonia; MAC: Mycobacterium avium complex. #:incidence The risk of developing each infection is strongly influenced by the " of different aetiologies can vary in different geographical areas; :percentageof degree of inmunosuppression, the patient’s demographic char- each microorganism causing bacterial pneumonia is estimated among cases of acteristics, the place of current or previous residence, and bacterial pneumonia with identification of aetiology; +: bronchiectasis and whether they are using prophylaxis against common HIV- pulmonary abscess. Data are based on results from [10, 11, 24]. associated infections [28]. Genetic factors are probably important but have been less precisely defined. PULMONARY INFECTIONS IN PATIENTS WITH HIV and viruses contribute substantially to the burden of pulmonary INFECTION disease in patients infected with HIV worldwide. Bacterial pneumonia is currently the most frequent
Load more

Recommended publications
  • Rapid and Precise Diagnosis of Pneumonia Coinfected By
    Rapid and precise diagnosis of pneumonia coinfected by Pneumocystis jirovecii and Aspergillus fumigatus assisted by next-generation sequencing in a patient with systemic lupus erythematosus: a case report Yili Chen Sun Yat-Sen University Lu Ai Sun Yat-Sen University Yingqun Zhou First Peoples Hospital of Nanning Yating Zhao Sun Yat-Sen University Jianyu Huang Sun Yat-Sen University Wen Tang Sun Yat-Sen University Yujian Liang ( [email protected] ) Sun Yat-Sen University Case report Keywords: Pneumocystis jirovecii, Aspergillus fumigatus, Next generation sequencing, Case report Posted Date: March 19th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-154016/v2 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/12 Abstract Background: Pneumocystis jirovecii and Aspergillus fumigatus, are opportunistic pathogenic fungus that has a major impact on mortality in patients with systemic lupus erythematosus. With the potential to invade multiple organs, early and accurate diagnosis is essential to the survival of SLE patients, establishing an early diagnosis of the infection, especially coinfection by Pneumocystis jirovecii and Aspergillus fumigatus, still remains a great challenge. Case presentation: In this case, we reported that the application of next -generation sequencing in diagnosing Pneumocystis jirovecii and Aspergillus fumigatus coinfection in a Chinese girl with systemic lupus erythematosus (SLE). Voriconazole was used to treat pulmonary aspergillosis, besides sulfamethoxazole and trimethoprim (SMZ-TMP), and caspofungin acetate to treat Pneumocystis jirovecii infection for 6 days. On Day 10 of admission, her chest radiograph displayed obvious absorption of bilateral lung inammation though the circumstance of repeated fever had not improved.
    [Show full text]
  • ESTI 2011 Education in Chest Radiology June 23-25, 2011 Heidelberg, Germany
    Innovation and ESTI 2011 Education in Chest Radiology June 23-25, 2011 Heidelberg, Germany Joint Meeting of ESTI and The Fleischner Society Abstract Book www.ESTI2011.org EUROPEAN SOCIETY OF THORACIC IMAGING THE FLEISCHNER SOCIETY ESTI 2011 · June 23-25, 2011 Heidelberg, Germany Oral Presentations of patients with suspected pulmonary lesions on chest x-ray radiography (CXR). Materials and methods: Two-hundred-and-eighty-seven patients (173 male, 114 Functional imaging and therapy guidance in oncology female; age, 70.82±11.2 years) with suspected pulmonary lesions after the initial analysis of CXR underwent DT. Two independent readers prospectively analyzed CXR and DT Thursday, June 23 images and expressed a confidence score for each lesion (1 or 2: definitely or probably 14:15 – 15:45 extra-pulmonary or pseudolesion; 3: doubtful lesion nature; 4 or 5: probably or definitely Kopfklinik, Main Lecture Hall pulmonary). Patients did not undergo chest CT when DT did not confirm any pulmonary lesion (scores 1-2), or underwent chest CT when DT identified a definite non-calcific O1 pulmonary lesion (scores 4-5) or was not conclusive (score 3). In patients who did not undergo chest CT the DT findings was confirmed by 6-12 months imaging follow-up. CT-guided marking of pulmonary malignant lesions with microcoil wires The time of hospitalization, and the mean image interpretation time for DT and CT were Noeldge G.1, Radeleff B.1, Stampfl U.1, Kauczor H.-U.1 measured. 1University Hospital Heidelberg, Diagnostic and Interventional Radiology, Results: DT identified a total number of 182 thoracic lesions, 127 pulmonary and 55 Heidelberg, Germany extra-pulmonary, in 159 patients while in the re maining 99 patients DT did not confirm any lesion.
    [Show full text]
  • Outcome and Prognostic Factors of Pneumocystis Jirovecii Pneumonia
    Gaborit et al. Ann. Intensive Care (2019) 9:131 https://doi.org/10.1186/s13613-019-0604-x RESEARCH Open Access Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study Benjamin Jean Gaborit1,6* , Benoit Tessoulin2, Rose‑Anne Lavergne3, Florent Morio3, Christine Sagan4, Emmanuel Canet5, Raphael Lecomte1, Paul Leturnier1, Colin Deschanvres1, Lydie Khatchatourian1, Nathalie Asseray1, Charlotte Garret5, Michael Vourch5, Delphine Marest5, François Raf1, David Boutoille1,6 and Jean Reignier5 Abstract Background: Pneumocystis jirovecii pneumonia (PJP) remains a severe disease associated with high rates of invasive mechanical ventilation (MV) and mortality. The objectives of this study were to assess early risk factors for severe PJP and 90‑day mortality, including the broncho‑alveolar lavage fuid cytology profles at diagnosis. Methods: We prospectively enrolled all patients meeting pre‑defned diagnostic criteria for PJP admitted at Nantes university hospital, France, from January 2012 to January 2017. Diagnostic criteria for PJP were typical clinical features with microbiological confrmation of P. jirovecii cysts by direct examination or a positive specifc quantitative real‑time polymerase chain reaction (PCR) assay. Severe PJP was defned as hypoxemic acute respiratory failure requiring high‑ fow nasal oxygen with at least 50% FiO2, non‑invasive ventilation, or MV. Results: Of 2446 respiratory samples investigated during the study period, 514 from 430 patients were positive for P. jirovecii. Of these 430 patients, 107 met criteria for PJP and were included in the study, 53 (49.5%) patients had severe PJP, including 30 who required MV. All patients were immunocompromised with haematological malignancy ranking frst (n 37, 35%), followed by solid organ transplantation (n 27, 25%), HIV‑infection (n 21, 20%), systemic diseases (n 13,= 12%), solid tumors (n 12, 11%) and primary immunodefciency= (n 6, 8%).
    [Show full text]
  • Pneumocystis Pneumonia: Immunity, Vaccines, and Treatments
    pathogens Review Pneumocystis Pneumonia: Immunity, Vaccines, and Treatments Aaron D. Gingerich 1,2, Karen A. Norris 1,2 and Jarrod J. Mousa 1,2,* 1 Center for Vaccines and Immunology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; [email protected] (A.D.G.); [email protected] (K.A.N.) 2 Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA * Correspondence: [email protected] Abstract: For individuals who are immunocompromised, the opportunistic fungal pathogen Pneumocystis jirovecii is capable of causing life-threatening pneumonia as the causative agent of Pneumocystis pneumonia (PCP). PCP remains an acquired immunodeficiency disease (AIDS)-defining illness in the era of antiretroviral therapy. In addition, a rise in non-human immunodeficiency virus (HIV)-associated PCP has been observed due to increased usage of immunosuppressive and im- munomodulating therapies. With the persistence of HIV-related PCP cases and associated morbidity and mortality, as well as difficult to diagnose non-HIV-related PCP cases, an improvement over current treatment and prevention standards is warranted. Current therapeutic strategies have pri- marily focused on the administration of trimethoprim-sulfamethoxazole, which is effective at disease prevention. However, current treatments are inadequate for treatment of PCP and prevention of PCP-related death, as evidenced by consistently high mortality rates for those hospitalized with PCP. There are no vaccines in clinical trials for the prevention of PCP, and significant obstacles exist that have slowed development, including host range specificity, and the inability to culture Pneumocystis spp. in vitro. In this review, we overview the immune response to Pneumocystis spp., and discuss current progress on novel vaccines and therapies currently in the preclinical and clinical pipeline.
    [Show full text]
  • COVID-19 Pneumonia: the Great Radiological Mimicker
    Duzgun et al. Insights Imaging (2020) 11:118 https://doi.org/10.1186/s13244-020-00933-z Insights into Imaging EDUCATIONAL REVIEW Open Access COVID-19 pneumonia: the great radiological mimicker Selin Ardali Duzgun* , Gamze Durhan, Figen Basaran Demirkazik, Meltem Gulsun Akpinar and Orhan Macit Ariyurek Abstract Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since December 2019. Although the reference diagnostic test is a real-time reverse transcription-polymerase chain reaction (RT-PCR), chest-computed tomography (CT) has been frequently used in diagnosis because of the low sensitivity rates of RT-PCR. CT fndings of COVID-19 are well described in the literature and include predominantly peripheral, bilateral ground-glass opacities (GGOs), combination of GGOs with consolida- tions, and/or septal thickening creating a “crazy-paving” pattern. Longitudinal changes of typical CT fndings and less reported fndings (air bronchograms, CT halo sign, and reverse halo sign) may mimic a wide range of lung patholo- gies radiologically. Moreover, accompanying and underlying lung abnormalities may interfere with the CT fndings of COVID-19 pneumonia. The diseases that COVID-19 pneumonia may mimic can be broadly classifed as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). We summarize the imaging fndings of COVID-19 and the aforementioned lung pathologies that COVID-19 pneumonia may mimic. We also discuss the features that may aid in the diferential diagnosis, as the disease continues to spread and will be one of our main diferential diagnoses some time more.
    [Show full text]
  • The Diagnostic Challenge of Pneumocystis Pneumonia and COVID-19 Co-Infection in HIV Alistair G.B
    Official Case Reports Journal of the Asian Pacific Society of Respirology Respirology Case Reports The diagnostic challenge of pneumocystis pneumonia and COVID-19 co-infection in HIV Alistair G.B. Broadhurst1 , Usha Lalla2, Jantjie J. Taljaard3, Elizabeth H. Louw2, Coenraad F.N. Koegelenberg2 & Brian W. Allwood2 1Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. 2Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. 3Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. Keywords Abstract COVID-19, HIV, pneumocystis pneumonia, SARS- CoV-2. Coronavirus disease 2019 (COVID-19) and pneumocystis pneumonia (PCP) share many overlapping features and may be clinically indistin- Correspondence guishable on initial presentation in people living with HIV. We present Alistair G.B. Broadhurst, Division of General Medicine, the case of co-infection with COVID-19 and PCP in a patient with pro- DepartmentofMedicine,FacultyofMedicineand gressive respiratory failure admitted to our intensive care unit where the Health Sciences, Stellenbosch University and Tygerberg dominant disease was uncertain. This case highlights the difficulty in dif- Hospital, Francie van Zijl Drive, 7505 Cape Town, South Africa. E-mail: [email protected] ferentiating between the two diseases, especially in a high HIV preva- lence setting where PCP is frequently diagnosed using case definitions Received: 29 September 2020; Accepted: 3 February and clinical experience due to limited access to bronchoscopy, appropri- 2021; Associate Editor: Charles Feldman.
    [Show full text]
  • GAFFI Fact Sheet Pneumocystis Pneumonia
    OLD VERSION GLOBAL ACTION FUNDGAL FOR INFECTIONS FUN GAFFI Fact Sheet Pneumocystis pneumonia GLOBAL ACTION FUNDGAL FOR INFECTIONS Pneumocystis pneumonia (PCP) is a life-threatening illness of largely FUN immunosuppressed patients such as those with HIV/AIDS. However, when diagnosed rapidly and treated, survival rates are high. The etiologic agent of PCP is DARKER AREAS AND SMALLER VERSION TEXT FIT WITHIN CIRCLE (ALSO TO BE USED AS MAIN Pneumocystis jirovecii, a human only fungus that has co-evolved with humans. Other LOGO IN THE FUTURE) mammals have their own Pneumocystis species. Person to person transmission occurs early in life as demonstrated by antibody formation in infancy and early childhood. Some individuals likely clear the fungus completely, while others become carriers of variable intensity. About 20% of adults are colonized but higher colonization rates occur in children and immunosuppressed adults; ethnicity and genetic associations with colonization are poorly understood. Co-occurrence of other respiratory infections may provide the means of transmission in most instances. Patients with Pneumocystis pneumonia (PCP) are highly infectious. Prophylaxis with oral cotrimoxazole is highly effective in preventing infection. Pneumocystis pneumonia The occurrence of fatal Pneumocystis pneumonia in homosexual men in the U.S. provided one of earliest signals of the impending AIDS epidemic in the 1980s. Profound immunosuppression, especially T cell depletion and dysfunction, is the primary risk group for PCP. Early in the AIDS epidemic, PCP was the AIDS-defining diagnosis in ~60% of individuals. This frequency has fallen in the western world, but infection is poorly documented in most low-income countries because of the lack of diagnostic capability.
    [Show full text]
  • Induced Eosinophilic Pneumonitis in an Ascaris
    Downloaded from jcp.bmj.com on 1 March 2007 Ascaris-induced eosinophilic pneumonitis in an HIV-infected patient Susanna Kar Pui Lau, Patrick C Y Woo, Samson S Y Wong, Edmond S K Ma and Kwok-yung Yuen J. Clin. Pathol. 2007;60;202-203 doi:10.1136/jcp.2006.037267 Updated information and services can be found at: http://jcp.bmj.com/cgi/content/full/60/2/202 These include: References This article cites 7 articles, 1 of which can be accessed free at: http://jcp.bmj.com/cgi/content/full/60/2/202#BIBL Rapid responses You can respond to this article at: http://jcp.bmj.com/cgi/eletter-submit/60/2/202 Email alerting Receive free email alerts when new articles cite this article - sign up in the box at the service top right corner of the article Notes To order reprints of this article go to: http://www.bmjjournals.com/cgi/reprintform To subscribe to Journal of Clinical Pathology go to: http://www.bmjjournals.com/subscriptions/ Downloaded from jcp.bmj.com on 1 March 2007 202 CASE REPORT Ascaris-induced eosinophilic pneumonitis in an HIV-infected patient Susanna Kar Pui Lau, Patrick C Y Woo, Samson S Y Wong, Edmond S K Ma, Kwok-yung Yuen ................................................................................................................................... J Clin Pathol 2007;60:202–203. doi: 10.1136/jcp.2006.037267 Over the next 2 days he developed repeated episodes of AcaseofAscaris-induced eosinophilic pneumonitis in an HIV- bronchospasm and desaturation requiring biphasic intermittent infected patient is described. Owing to his HIV status and the positive airway pressure.
    [Show full text]
  • A Case of Dermatomyositis Causing Cryptogenic Organizing Pneumonia
    Open Access Case Report DOI: 10.7759/cureus.6296 A Case of Dermatomyositis Causing Cryptogenic Organizing Pneumonia Jeffrey A. Miskoff 1 , Rana Ali 2 , Moiuz Chaudhri 3 1. Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA 2. Medicine, Hackensack Meridian Health Jersey Shore University Medical Center, New Jersey , USA 3. Internal Medicine, Shore Pulmonary, New Jersey, USA Corresponding author: Jeffrey A. Miskoff, [email protected] Abstract Cryptogenic organizing pneumonia (COP), also known as idiopathic bronchiolitis obliterans organizing pneumonia (BOOP), is a rare inflammatory condition. It often presents as sequelae of existing chronic inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, and various connective tissue conditions. This case describes a 28-year-old African American female who presented with a complex clinical picture involving chronic inflammatory processes and the pulmonary system. The initial evaluation suggested pneumonia to be the underlying cause of respiratory symptoms; however, ultimately, a diagnosis of BOOP with dermatomyositis was made. Categories: Rheumatology, Pulmonology, Internal Medicine Keywords: chronic organizing pneumonia, bronchiolitis obliterans organizing pneumonia, interstitial lung diseases, chronic inflammatory conditions, dermatomyositis Introduction Cryptogenic organizing pneumonia (COP) is the idiopathic form of organizing pneumonia, previously known as bronchiolitis obliterans organizing pneumonia (BOOP). It is a form of diffuse interstitial
    [Show full text]
  • Pneumocystis Pneumonia — Los Angeles
    August 30, 1996 / Vol. 45 / No. 34 TM 729 Pneumocystis Pneumonia — Los Angeles 733 HIV Testing Among Women Aged 18–44 Years — United States, 1991 and 1993 737 Outbreaks of Salmonella Serotype Enteritidis Infection Associated with Consumption of Raw Shell Eggs — United States, 1994–1995 742 Notice to Readers As part of its commemoration of CDC’s 50th anniversary, MMWR is reprinting se- lected MMWR articles of historical interest to public health, accompanied by a current editorial note. On June 4, 1981, MMWR published a report about Pneumocystis carinii pneumo- nia in homosexual men in Los Angeles. This was the first published report of what, a year later, became known as acquired immunodeficiency syndrome (AIDS). This re- port and current editorial note appear below. Pneumocystis Pneumonia — Los Angeles PneumoniaIn the period — October Continued 1980–May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory- confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow. Patient 1: A previously healthy 33-year-old man developed P. c a r i n i i pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associ- ated with elevated liver enzymes, leukopenia, and CMV viruria. The serum complement-fixation CMV titer in October 1980 was 256; in May 1981 it was 32.* The patient’s condition deteriorated despite courses of treatment with trimethoprim- sulfamethoxazole (TMP/SMX), pentamidine, and acyclovir.
    [Show full text]
  • Recent Advances and Novel Approaches in Laboratory-Based Diagnostic Mycology
    Journal of Fungi Review Recent Advances and Novel Approaches in Laboratory-Based Diagnostic Mycology Lewis P. White * and Jessica S. Price Mycology Reference Laboratory, Public Health Wales, Microbiology Cardiff, Cardiff CF14 4XW, UK; [email protected] * Correspondence: [email protected]; Tel.: +44-(0)29-2074-6581 Abstract: What was once just culture and microscopy the field of diagnostic mycology has signifi- cantly advanced in recent years and continues to incorporate novel assays and strategies to meet the changes in clinical demand. The emergence of widespread resistance to antifungal therapy has led to the development of a range of molecular tests that target mutations associated with phenotypic resistance, to complement classical susceptibility testing and initial applications of next-generation sequencing are being described. Lateral flow assays provide rapid results, with simplicity allowing the test to be performed outside specialist centres, potentially as point-of-care tests. Mycology has responded positively to an ever-diversifying patient population by rapidly identifying risk and de- veloping diagnostic strategies to improve patient management. Nowadays, the diagnostic repertoire of the mycology laboratory employs classical, molecular and serological tests and should be keen to embrace diagnostic advancements that can improve diagnosis in this notoriously difficult field. Keywords: mycology; novel targets and applications; next-generation sequencing; advances in serology; advances in molecular diagnostics 1. Introduction Citation: White, L.P.; Price, J.S. The impact of fungal disease is greatly overlooked, but with an ever-increasing im- Recent Advances and Novel munosuppressed or immune-modulated (monoclonal antibody therapies) at-risk popu- Approaches in Laboratory-Based lation, coupled with inevitable exposure to fungi and the availability of more sensitive Diagnostic Mycology.
    [Show full text]
  • Jamaica UHSM ¤ 1,2* University Hospital Harish Gugnani , David W Denning of South Manchester NHS Foundation Trust ¤Professor of Microbiology & Epidemiology, St
    Burden of serious fungal infections in Jamaica UHSM ¤ 1,2* University Hospital Harish Gugnani , David W Denning of South Manchester NHS Foundation Trust ¤Professor of Microbiology & Epidemiology, St. James School of Medicine, Kralendjik, Bonaire (Dutch Caribbean). 1 LEADING WI The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K. INTERNATIONAL 2 FUNGAL The University Hospital of South Manchester, (*Corresponding Author) National Aspergillosis Centre (NAC) Manchester, U.K. EDUCATION Background and Rationale The incidence and prevalence of fungal infections in Jamaica is unknown. The first human case of Conidiobolus coronatus infection was discovered in Jamaica (Bras et al. 1965). Cases of histoplasmosis and eumycetoma are reported (Fincharn & DeCeulaer 1980, Nicholson et al., 2004; Fletcher et al, 2001). Tinea capitis is very frequent in children Chronic pulmonary (East-Innis et al., 2006), because of the population being aspergillosis with aspergilloma (in the left upper lobe) in a 53- predominantly of African ancestry. In a one year study of 665 HIV yr-old, HIV-negative Jamaican male, developing after one infected patients, 46% of whom had CD4 cell counts <200/uL, 23 had year of antitubercular treatment; his baseline IgG pneumocystis pneumonia and 3 had cryptococcal meningitis (Barrow titer was 741 mg/L (0-40). As a smoker, he also had moderate et al. 2010). We estimated the burden of fungal infections in Jamaica emphysema. from published literature and modelling. Table 1. Estimated burden of fungal disease in Jamaica Fungal None HIV Respiratory Cancer ICU Total Rate Methods condition /AIDS /Tx burden 100k We also extracted data from published papers on epidemiology and Oesophageal ? 2,100 - ? - 2,100 77 from the WHO STOP TB program and UNAIDS.
    [Show full text]