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Appendices

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Section 3. Summaries of Infectious Diseases

Pneumocystis jirovecii Infections

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS

Infants and children develop a characteristic syndrome of subacute diffuse pneumonitis with dyspnea, tachypnea, oxygen desaturation, nonproductive cough, and fever. However, the intensity of these signs and symptoms can vary, and in some immunocompromised children and adults, onset can be acute and fulminant. Chest radiographs often show bilateral diffuse interstitial or alveolar disease; rarely, lobar, miliary, and nodular lesions or even no lesions are seen. The mortality rate in immunocompromised patients ranges from 5% to 40% if treated and approaches 100% if untreated.


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ETIOLOGY

Nomenclature for Pneumocystis species is in evolution. Pneumocystis jirovecii has been proposed for human Pneumocystis, denoting the fact that Pneumocystis carinii only infects rats. At present, Pneumocystis carinii or P carinii f sp hominis continues to be used to refer to human Pneumocystis. Pneumocystis jirovecii is classified as a fungus on the basis of DNA sequence analysis. However, P jirovecii retains several morphologic and biologic similarities to protozoa, including susceptibility to a number of antiprotozoal agents but resistance to most antifungal agents. The 5- to 7-µm-diameter cysts contain up to 8 intracystic bodies.


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EPIDEMIOLOGY

Pneumocystis species is ubiquitous in mammals worldwide, particularly rodents, and has a tropism for growth on respiratory tract epithelia. Pneumocystis isolates recovered from mice, rats, and ferrets are diverse genetically from each other and from human Pneumocystis jirovecii; isolates from one animal species do not cross-infect other animal species. Asymptomatic human infection occurs early in life, with more than 85% of healthy children acquiring antibody by 20 months of age. In resource-limited countries and in times of famine, P jirovecii pneumonia (PCP) has occurred in epidemics, primarily affecting malnourished infants and children. Epidemics also have . . . [Go to Full Text]


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