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8/22/2019 Pneumocystis Cariinii 29 2 2013
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Pneumocystis cariniiDisease: Pneumocystosis
RECENTLY BEEN PLACED IN A GROUP
OF FUNGI ENTITLED THE
ARCHIA SCOMYCETES
Late century - protozoa
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Whats in a name?
Pneumocystis jiroveci (previously known asPneumocystis carinii) is an unusual opportunistic
organism, which causes a severe and often fatal
pneumonia in immunocompromised individuals.
Discovered in 1909 by Chagas (in guinea pigs) & in1910 by Carini (in rats).
In honor of Carini, named P carinii in 1912
Identified in humans (premature and malnourishedkids) in 1952 by Otto Jirovec
Species that affect humans renamed P jiroveci in
2001/2002
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RESERVOIR P.carinniis widespread in nature and
occurs in many mammals
Other mammals:
Pneumocystis jirovecii
Humans YOU
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CYSTS In BAL Material
The cystic form (sporangium) is
thick-walled oval, approximately5 to 8 in diameter
Contain up to eight daughter
forms (spores or endospores,
formerly known as intracystic
bodies or sporozoites), which
will become trophic
forms after excystation.
TROPHOZOITE in BAL
Material
The trophic form (yeast,
formerly trophozoite)
is small (2 to 5m), thin-walled,
pleomorphic and often has
an eccentric nucleus. The
trophic forms are often seen inclusters.
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A Giemsa stain for trophic forms (formerly called trophozoites) shows dot-
like nuclei and pale blue cytoplasm (right arrow). The spore cases (formerly
cysts) do not stain, but the intracystic bodies (formerly sporozoites) do (left
arrow). Two alveolar macrophages indicate the relative sizes of organismsand cells.
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Patient with Pneumocyst is j i rovec i pneumon ia. Photom icrograph of lungbiopsy specimen (Gomori methenamine silver, 600) shows multiple small blackorganisms (arrowheads ) typical o f P. jiro veci. (
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Gomori methenamine silver stain
This stain, often abbreviated as "GMS", is used to stain for fungi and for
Pneumocy st is j i roveci (car ini i ). The cell walls of these organisms are
stained, so the organisms are outlined by the brown to black stain. There
is a tendency for this stain to produce a lot of artefact from background
staining, so it is essential to be sure of the morphology of the organism
being sought.
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E: Direct immunofluorescence antibody stain using monoclonal
antibodies that target Pneumocystis jirovecii
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Transmission
ACQUIRED CONGENITAL
TRANSMISSION-Respiratory droplet
-Environment
-Direct transmission
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No detailed knowledge of
the lifecycle and the mode
of replication has not been
definitely established
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Life cycle
Mode of infection: inhalation of
mature cyst.Two forms: cyst and trophozoite
Trophozoites are amoeboid inshape with on nucleus . mature cyst
contain 8 trophozoites .
Mature cyst inhaled rupture
trophozoites multiply precyst
cyst .
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CLINICAL FEATURES The disease produced by it is called P.carinii
pneumonia(PCP) which is also called asinterstitial plasma cell pneumonia with
massive lobar involvement
Symptoms : fever, cough, shortness of
breath Extrapulmonary pneumocystosis is a rare
event. In disseminated cases, liver,
heart,kidney,spleen,bone marrow pancreas,
stomach,thyroid and adrenal gland may also
be affected.
The presence of cotton wool spots in the
fundus of the eye (bukti paling kukuh
pendiagnosan)
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Laboratory findings NON SPECIFIC& SPECIFIC
1. ESR
- Raised level (inflammation)
2. CRP C-Reactive Protein (bind to phosphocholine expressed
on the surface of dead or dying cells)
- Raised
3.ANEMIA,LEUKOPENIA, THROMBOCYTOPENIA occurs
4. X-RAY
- Diffuse mottling of lung field
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5. PULMONARY FUNCTION TEST
- Reduction in vital capacity of total lung capacity
6. Gallium lung scanning
7. Histopathology examination of lung biopsy
- Alveoli filled with granular, foamy honeycomb like
acellular material, infiltrate with mononuclear
cells
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SPECIFIC DEMONSTRATION OF CYSTS
In sputum, trancheobronchial lavage or tracheobronchial
lavage or open lung biopsy. Cysts can be stained with
Geimsa or Methanamine-Silver Techniqueor Gromori-
methenamine Silver ((stained black)
IMMUNOFLUORESENCE TEST
DETECTION OF ANTIGEN OR ANTIBODIES
- Monoclonal antibodies for direct detection of organisms in
clinical specimens not available and appear to be very
specific and sensitive
CULTURE
- Limited success.
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Treatments
Trimethoprim-sulfamethoxazole (TMP-SMZ)
Pentamidine isethionate inhalant
Treatments can be toxic and patient mustbe monitored closely
Prophylactic treatment if CD4 count is low
HAART(Highly Active Anti-RetroviralTherapy) regimen to boost immunesystem function, corticosteroids