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Pneumocystis
cariniiKatrina KittlesonSteda Lundak
Parasitology 2007
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Introduction
Fungus or Protozoan??
Orphan organism, phylogenic position has notyet been established
Opportunistic Parasite
Severe pathology in immunodeficient hosts
Severely malnourished newborns
One of the initial signs of AIS emergence
!ives in interstitial tissue of lungs
"arely disseminates to spleen, lymph nodes, bonemarrow, eyes
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Fungus vs# Protozoan
Fungus
from nucleic acid andbiochemical analysis
r"$A homologous to
that found in fungistains with some fungalstains
Affinity for %rocott&smethenamine silverstain
Produces chitinhas ultrastructuralcharacteristics similarto some fungi
Protozoan
other structures similarto Toxoplasma andPlasmodium
is sensitive to a varietyof antiprotozoal agents#
It&s membraneproperties resemblethose of amebas
Shows surface
antigenic variationwhich occurs inprotozoa and has notbeen established infungi
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%eographic istribution
'orldwide
(ost children e)posed by the age
of *+ years-ommonly found in the lungs of
healthy individuals, but no disease
occurs
'idespread in mammals
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.osts
.umans
Pneumocystis jiroveci(i) alternate names
Pneumocystis carinii hominis
/lderly, malnourished children, primaryimmunodeficiency disorders, AIS
Patients receiving cytoto)ic or
immunosupressive drugs for
lymphoresticular cancers or transplants
Other mammals0 rabbits, dogs, goats, swine,
cats, chimpanzees, owl mon1eys, horses
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2ransmission
Aerosol droplets
irect contact
-ongenital infection.ousehold pets
Interspecies transmission?
"eactivation of latent infection whenimmunocompromised
Or, new infection?
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!ife -ycle
!ife cycle is not fully 1nown
Ase)ual and se)ual reproduction 3--4
Four general morphological forms in mammals
2rophozoite 3has amoeboid trophozoite form4Precysts
-ysts
Sporozoites 3intracystic bodies4
-yst 3diagnostic form4chitinous membrane and 5 intracystic bodies
Pore in cyst wall used for releasing sporozoites#
-an be spherical or collapsed#
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!ife -ycle
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-linical Presentation
-auses Pneumonitis, Pneumocystis
pneumonia 3P-P4
!ung epithelium becomes des6uamated
alveoli fill with foamy e)udate
containing parasites
Fever, non productive cough, breathing
difficulty on e)ertion, respiratory failure,cyanosis
eath by asphy)ia
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iagnosis
-linical symptoms
Sputum or bronchial lavage
Special staining with toluidine blue,methenamine silver
%ram+'eigert stain for cysts
/!ISA, immunofluorescence assay,$A amplification being developed
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iagnosis
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Pictures
2rophozoites in 7A!
material#
-ysts in 7A! material
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2reatments
2rimethoprim+sulfametho)azole32(P+S(84
Pentamidine isethionate inhalant
2reatments can be to)ic and patientmust be monitored closely
Prophylactic treatment if - count is
low 39:;;4.AA"2 regimen to boost immunesystem function, corticosteroids
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Pneumocystis cariniiInfection0
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(ore information="eferences
Parasitology te)tboo1
iscussion article
Familydoctor#org
Aafp#org
$ational !ibrary of (edicine http0==
www#nlm#nih#gov=
-enter for isease -ontrol and Preventionhttp0==www#cdc#gov
http://www.nlm.nih.gov/http://www.nlm.nih.gov/http://www.cdc.gov/http://www.cdc.gov/http://www.cdc.gov/http://www.nlm.nih.gov/http://www.nlm.nih.gov/http://www.nlm.nih.gov/