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Serum Antibody Levels to the Pneumocystis jirovecii Major Surface Glycoprotein in the Diagnosis of P. jirovecii Pneumonia in HIV+ Patients  [PDF]
Kpandja Djawe,Laurence Huang,Kieran R. Daly,Linda Levin,Judy Koch,Alexandra Schwartzman,Serena Fong,Brenna Roth,Anuradha Subramanian,Katherine Grieco,Leah Jarlsberg,Peter D. Walzer
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014259
Abstract: Pneumocystis jirovecii remains an important cause of fatal pneumonia (Pneumocystis pneumonia or PcP) in HIV+ patients and other immunocompromised hosts. Despite many previous attempts, a clinically useful serologic test for P. jirovecii infection has never been developed.
Serologic Responses to Recombinant Pneumocystis jirovecii Major Surface Glycoprotein among Ugandan Patients with Respiratory Symptoms  [PDF]
Robert J. Blount, Leah G. Jarlsberg, Kieran R. Daly, William Worodria, J. Lucian Davis, Adithya Cattamanchi, Kpandja Djawe, Alfred Andama, Judith Koch, Peter D. Walzer, Laurence Huang, International HIV-Associated Opportunistic Pneumonias (IHOP) Study
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0051545
Abstract: Background Little is known about the serologic responses to Pneumocystis jirovecii major surface glycoprotein (Msg) antigen in African cohorts, or the IgM responses to Msg in HIV-positive and HIV-negative persons with respiratory symptoms. Methods We conducted a prospective study of 550 patients, both HIV-positive (n = 467) and HIV-negative (n = 83), hospitalized with cough ≥2 weeks in Kampala, Uganda, to evaluate the association between HIV status, CD4 cell count, and other clinical predictors and antibody responses to P. jirovecii. We utilized ELISA to measure the IgM and IgG serologic responses to three overlapping recombinant fragments that span the P. jirovecii major surface glycoprotein: MsgA (amino terminus), MsgB (middle portion) and MsgC1 (carboxyl terminus), and to three variations of MsgC1 (MsgC3, MsgC8 and MsgC9). Results HIV-positive patients demonstrated significantly lower IgM antibody responses to MsgC1, MsgC3, MsgC8 and MsgC9 compared to HIV-negative patients. We found the same pattern of low IgM antibody responses to MsgC1, MsgC3, MsgC8 and MsgC9 among HIV-positive patients with a CD4 cell count <200 cells/μl compared to those with a CD4 cell count ≥200 cells/μl. HIV-positive patients on PCP prophylaxis had significantly lower IgM responses to MsgC3 and MsgC9, and lower IgG responses to MsgA, MsgC1, MsgC3, and MsgC8. In contrast, cigarette smoking was associated with increased IgM antibody responses to MsgC1 and MsgC3 but was not associated with IgG responses. We evaluated IgM and IgG as predictors of mortality. Lower IgM responses to MsgC3 and MsgC8 were both associated with increased in-hospital mortality. Conclusions HIV infection and degree of immunosuppression are associated with reduced IgM responses to Msg. In addition, low IgM responses to MsgC3 and MsgC8 are associated with increased mortality.
Neumonía por Pneumocystis jirovecii
Zunen Hernández Puentes,Yaimara; Pi?era,Bárbara Mercedes Paula; Salinas Olivares,Mercedes; Vila González,William; Casa de Valle Castro,Midalys;
Revista Cubana de Medicina Militar , 2010,
Abstract: objective: to present the atypical case of a hiv-negative patient, deceased from pneumocystis jirovecii more frequent in persons infected with the aids virus and in those underwent transplantation. description: a patient with a history of alcoholism, asthma, respiratory symptoms and fever, hiv-negative, with a torpid course deceased at 11 days after admission. lung: peripheral emphysema, scattered zones of a fleshy red appearance mixed with not much aired zones and impasted. intervention: a clinical necropsy was carried out where the direct cause of death was from pneumocystis jirovecii, diagnosed using hematoxylin-esosin stain proving the presence of a characteristic foamy edema. in the silver methenamine stain it was possible to corroborate the presence of the microorganism. conclusions: in this case the leading cause of death was pneumocystis jirovecii pneumonia, an opportunistic pathogen frequently reported a cause of death in hiv-aids patients and also in those immunocompromised due to other causes, e.g. those with transplantation.
Pneumocystis jirovecii infection of the external auditory canal
CM Samuel, S Maistry, E Meyer, A Whitelaw
Southern African Journal of HIV Medicine , 2010,
Abstract: Pneumocystis jirovecii is well known to cause interstitial plasma cell pneumonia in immunocompromised patients. It has been implicated as a rare cause of infections in other anatomical sites.1 We report a rare case of P. jirovecii infection of the external auditory canal. This was the first manifestation of a previously unknown HIV infection.
Pneumocystis Jirovecii Pneumonia- Imaging findings in 19 patients
Mahmoud Goudarzi
Iranian Journal of Radiology , 2009,
Abstract: Pneumocystis jirovecii pneumonia (PJP),formely called pneumocystis carinii pneumonia, is a serious disease in immunocompromised patients, particularly those with AIDS. However, many patients with this disease are unaware of their HIV serostatus, requiring early and prompt diagnosis of the disease. Early chest radiographic findings of PJP may be subtle or equivocal. On the other hand, advances in the treatment and prevention of the disease is associated with an increased rate of atypical manifestations, so it is important for radiologists to be familiar with the spectrum of imaging findings of the entity. The first report on imaging findings of PJP in a group of Iranian patients is presented.
Neumonía por Pneumocystis jirovecii Pneumocystic jirovecii pneumonia  [cached]
Yaimara Zunen Hernández Puentes,Bárbara Mercedes Paula Pi?era,Mercedes Salinas Olivares,William Vila González
Revista Cubana de Medicina Militar , 2010,
Abstract: OBJETIVO: presentar un caso atípico de una paciente VIH negativo, fallecida por Pneumocystis jirovecii, más frecuente en personas infectadas por el virus del SIDA y postrasplantados. DESCRIPCIóN: se presenta una paciente con antecedentes de alcoholismo, asma, con síntomas respiratorios y fiebre, VIH negativo, con evolución tórpida que fallece a los 11 días del ingreso. Pulmones: enfisema periférico, zonas dispersas de aspecto rojo carnoso entre mezclado con zonas poco aireadas, empastadas. INTERVENCIóN: se realizó autopsia clínica encontrándose como causa directa de la muerte, neumonía por Pneumocystis jirovecii, diagnosticado con coloración de hematoxilina y eosina donde se observó presencia del edema espumoso característico. Se corroboró con coloración de plata metenamina donde se pudo observar el microorganismo. CONCLUSIONES: el caso presentó como causa directa de la muerte una neumonía por Pneumocystis jirovecii, patógeno oportunista reportado con frecuencia como causa de muerte en pacientes infectados por el VIH-SIDA y en inmunocomprometidos por otras causas, como los trasplantados. OBJECTIVE: to present the atypical case of a HIV-negative patient, deceased from Pneumocystis jirovecii more frequent in persons infected with the AIDS virus and in those underwent transplantation. DESCRIPTION: a patient with a history of alcoholism, asthma, respiratory symptoms and fever, HIV-negative, with a torpid course deceased at 11 days after admission. Lung: peripheral emphysema, scattered zones of a fleshy red appearance mixed with not much aired zones and impasted. INTERVENTION: a clinical necropsy was carried out where the direct cause of death was from Pneumocystis jirovecii, diagnosed using hematoxylin-esosin stain proving the presence of a characteristic foamy edema. In the silver methenamine stain it was possible to corroborate the presence of the microorganism. CONCLUSIONS: in this case the leading cause of death was Pneumocystis jirovecii pneumonia, an opportunistic pathogen frequently reported a cause of death in HIV-AIDS patients and also in those immunocompromised due to other causes, e.g. those with transplantation.
Ventila??o mecanica n?o-invasiva em paciente com provável pneumonia por pneumocystis jirovecii: relato de caso
Carneiro, élida Mara;Maneira, Renata Zago;Rocha, Eduardo;
Revista Brasileira de Terapia Intensiva , 2008, DOI: 10.1590/S0103-507X2008000200016
Abstract: background and objectives: pneumocystis jirovecii pneumonia has been one of the most common diseases and life-threatening infectious complications in acquired immunodeficiency syndrome patients. the objective of the case report was to present a patient with probable diagnosis of pneumocystis jirovecii pneumonia who received noninvasive positive pressure ventilation. case report: a female patient, 25 years old, with probable diagnosis of pneumocystis jirovecii pneumonia received noninvasive positive pressure ventilation. conclusions: all respiratory parameters progressively improved in the first five days. results suggest the efficacy of this support to improve oxygenation, to revert hypoxemia and to prevent orotracheal intubation.
Serum markers in interstitial pneumonia with and without Pneumocystis jirovecii colonization: a prospective study
Yasuo Shimizu, Noriaki Sunaga, Kunio Dobashi, Makoto Fueki, Naoto Fueki, Sohei Makino, Masatomo Mori
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-47
Abstract: This study investigated the prevalence of P. jirovecii colonization in IP patients and assessed pulmonary injury due to P. jirovecii colonization by measurement of serum markers (KL-6, SP-A, SP-D, and (1→3) β-D-glucan (β-D-glucan)) and the peripheral lymphocyte counts, prospectively. A total of 75 patients with idiopathic pulmonary fibrosis (n = 29), collagen vascular-related interstitial pneumonia (n = 19), chronic bronchitis or pneumonia (n = 20), and Pneumocystis pneumonia (n = 7) were enrolled in this prospective study. P. jirovecii DNA was detected in sputum samples, while serum markers and the lymphocyte count were measured in the peripheral blood.IP patients (idiopathic pulmonary fibrosis and collagen vascular-related IP) who received oral corticosteroids had a high prevalence of P. jirovecii colonization (23.3%). In IP patients, oral corticosteroid therapy was a significant risk factor for P. jirovecii colonization (P < 0.05). Serum markers did not show differences between IP patients with and without P. jirovecii colonization. The β-D-glucan level and lymphocyte count differed between patients with Pneumocystis pneumonia or P. jirovecii colonization.Serum levels of KL-6, SP-A, SP-D, and β-D-glucan were not useful for detecting P. jirovecii colonization in IP patients. However, the serum β-D-glucan level and lymphocyte count were useful for distinguishing P. jirovecii colonization from pneumocystis pneumonia in IP patients.Pneumocystis jirovecii (P. jirovecii) is a fungus, and a high prevalence of P. jirovecii colonization has been reported among non-human immunodeficiency virus (HIV)-infected immunocompetent patients with primary respiratory disease [1-3]. Interstitial pneumonia (IP) is also associated with a high colonization rate of P. jirovecii [4]. The mortality rate of patients with acute exacerbation of IP is 78% after hospital admission [5]. After acute exacerbation of IP occurs in IP patient with P. jirovecii colonization, it is difficult to disting
Newly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia
Ju-Yeon Cho, Dong-Min Kim, Yong Kwon, Sung Yoon, Seung Lee
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-171
Abstract: We encountered two cases of spontaneous pneumomediastinum with subcutaneous emphysema in HIV-infected patients being treated for Pneumocystis jirovecii pneumonia with trimethoprim/sulfamethoxazole.Clinicians should be aware that cystic lesions and bronchiectasis can develop in spite of trimethoprim/sulfamethoxazole treatment for P. jirovecii pneumonia. The newly formed bronchiectasis and cyst formation that were noted in follow up high resolution computed tomography (HRCT) but were not visible on HRCT at admission could be risk factors for the development of pneumothorax or pneumomediastinum with subcutaneous emphysema in HIV-patients.Pneumocystis jirovecii, formerly named Pneumocystis carinii, is one of the most common opportunistic infections in human immunodeficiency virus (HIV)-infected patients [1,2]. Spontaneous pneumothorax has been recognized as a frequent complication in patients with P. jirovecii pneumonia (PCP) since it was first described in 1984 [3], and pneumomediastinum is an uncommon complication associated with pneumothorax in the aforementioned population. We report two cases of spontaneous pneumomediastinum with subcutaneous emphysema in HIV-infected patients being treated for P. jirovecii pneumonia with trimethoprim/sulfamethoxazole.A 33-year-old man presented with fever, dyspnea, and odynophagia. Five months prior to admission, the patient had been treated for dental caries at a local hospital, and at that time examination revealed seropositivity for human immunodeficiency virus. On admission, temperature was 39.0'C, pulse 92 beats per minute, respiratory rate 20 breaths per minute and blood pressure 130/80 mmHg. Physical examination revealed oral thrush, consistent with findings of extensive esophageal candidiasis in endoscopic gastroduodenscopy performed five days before admission. Laboratory data on admission revealed a WBC count of 1,760/uL, Hb 10.9 g/dL, and platelet count of 297,000/uL. Arterial blood gas analysis while breathing room air
Pneumocystis jirovecii: cien a?os de historia
Calderón Sandubete,Enrique; de Armas Rodríguez,Yaxsier; Capó de Paz,Virginia;
Revista Cubana de Medicina Tropical , 2011,
Abstract: introduction: pneumocystis jirovecii is one of the most important opportunistic pathogens affecting aids individuals and immunodepressive patients. in spite of the fact that it was observed one hundred years ago for the first time, many fundamental aspects of its biology and the morbidity it causes are still unknown. objective: this paper was aimed at presenting updating on the main aspects of the history, the epidemiology and the biology of p. jirovecii and the disease it causes. conclusions: a number of review articles have been published since the discovery, all of which provide details and novel elements of the microorganism. however, few original papers dealing with this problem have been found in the spanish literature.
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