Pneumocystis Cariinii 29 2 2013

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

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Pneumocystis Cariinii 29 2 2013