New Development In Research In Pneumocystis Pneumonia And Analysis Of Five Clinical Cases

PNEUMOCYSTIS PNEUMONIA(PCP)is caused by the organism Pneumocystis jiroveci,formerly known as Pneumocystis carinii.It remains one of the leading causes of death in immunocompromised individuals,particulary those suffering from AIDS.Pneumocystis was recognized as a fungus,by gene analysis in late 1980s,which was thought to be a protoan before.It exists as cystS or trophozoiteS,which adheres to the typeâ… alveolus cells and leads to a series of inflammation.PCP,thought as "diagnosis" symptom in AIDS,has high incidence and mortality before the introduction of highly active antiretroviral therapy(HAART).However,patients of non-HIV immunocompromised,such as haematological malignancies,solid organs transplantation,connective tissue diseases,even in chronic Obstructive Lung Disease:Pneumocystis colonization was detected in 36.7%f patients with very severe COPD(Global Health Initiative on Obstructive Lung Disease[GOLD]Stageâ…£)Using nested polymerase chain reaction.Commonly clinical manifestations are nonproductive cough, dyspnea and fever,lack of specialties.The CD4 count dropping below 200 cells/uL is a predictor and a sign for PCP diagnosis.Chest radiographs most often demonstrate bilateral grass-ground or erstitial infiltrates,which progress to an alveolar pattern over time.Patients have impaired alveolar-oxygen gradients and often have elevated serum lactic dehydrogenase levels.Histopathotogically,PCP has characteristic intraalveolar acellular eosinophilic exudates that fill the alveoli along with large numbers of the organism.Gold criterion for diagnosis should be finding cysts or trophozoiteS by staining in sputum,BALF or biopsy.New teconology,immunofluorescent staining using monoclonal antibodies and PCR,has higher sensitivity and speciality. Traditional drugs including Trimethoprimsulfamethoxazole TMP-SMX), dapsone plus pyrimethamine,or aerosolized pentamidine,Atovaquone,has a high rate of side effects.Caspofungin,a new anti-fungi,roved effective in anti-Pneumocystis,rarelyhas hepatic orhematic toxicity. Adjunctive corticosteroids suggest a beneficial effect for patients with substantial hypoxemia.Appropriate non-invasive positive ventilation improves treatment course and decreases the rate of intubation. Prophylaxis should be initiated for anyone with a CD4 count less than 200 cells/mm3.TMP-SMX is the prophylactic drug of choice.