Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia
In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a wellk-nown opportunistic infection and its management has been established. However, PCP is an emerging threat to immunocompromised patients without HIV infection, such as those receiving novel immun...
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| Format: | Article |
| Language: | English |
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The Korean Academy of Tuberculosis and Respiratory Diseases
2020-04-01
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| Series: | Tuberculosis and Respiratory Diseases |
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| Online Access: | https://e-trd.org/search.php?where=aview&id=10.4046/trd.2020.0015&code=0003TRD&vmode=FULL |
| _version_ | 1818537956050206720 |
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| author | Sadatomo Tasaka, M.D. |
| author_facet | Sadatomo Tasaka, M.D. |
| author_sort | Sadatomo Tasaka, M.D. |
| collection | DOAJ |
| description | In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a wellk-nown opportunistic infection and its management has been established. However, PCP is an emerging threat to immunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeutics for malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite different between patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult to diagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomography findings are different between PCP patients with HIV infection and those without. These differences in clinical and radiological features are due to severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of polymerase chain reaction and serum β-D-glucan assay for rapid and non-invasive diagnosis of PCP has been revealed. Although corticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, the optimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization is prevalent and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread of Pneumocystis by airborne transmission. These findings suggest the need for chemoprophylaxis in immunocompromised patients as well as infection control measures, although the indications remain controversial. Because a variety of novel immunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis and treatment of PCP are needed. |
| first_indexed | 2024-12-11T18:57:23Z |
| format | Article |
| id | doaj.art-fbe9a54419b8446dba8a5454af19472b |
| institution | Directory Open Access Journal |
| issn | 1738-3536 2005-6184 |
| language | English |
| last_indexed | 2024-12-11T18:57:23Z |
| publishDate | 2020-04-01 |
| publisher | The Korean Academy of Tuberculosis and Respiratory Diseases |
| record_format | Article |
| series | Tuberculosis and Respiratory Diseases |
| spelling | doaj.art-fbe9a54419b8446dba8a5454af19472b2022-12-22T00:54:07ZengThe Korean Academy of Tuberculosis and Respiratory DiseasesTuberculosis and Respiratory Diseases1738-35362005-61842020-04-01832132140Recent Advances in the Diagnosis and Management of Pneumocystis PneumoniaSadatomo Tasaka, M.D.0https://orcid.org/0000-0003-4861-4143Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a wellk-nown opportunistic infection and its management has been established. However, PCP is an emerging threat to immunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeutics for malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite different between patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult to diagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomography findings are different between PCP patients with HIV infection and those without. These differences in clinical and radiological features are due to severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of polymerase chain reaction and serum β-D-glucan assay for rapid and non-invasive diagnosis of PCP has been revealed. Although corticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, the optimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization is prevalent and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread of Pneumocystis by airborne transmission. These findings suggest the need for chemoprophylaxis in immunocompromised patients as well as infection control measures, although the indications remain controversial. Because a variety of novel immunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis and treatment of PCP are needed.https://e-trd.org/search.php?where=aview&id=10.4046/trd.2020.0015&code=0003TRD&vmode=FULLpneumocystis jirovecii pneumoniaimmunocompromised hostloop-mediated isothermal amplificationinfection controlchemoprophylaxis |
| spellingShingle | Sadatomo Tasaka, M.D. Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia Tuberculosis and Respiratory Diseases pneumocystis jirovecii pneumonia immunocompromised host loop-mediated isothermal amplification infection control chemoprophylaxis |
| title | Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia |
| title_full | Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia |
| title_fullStr | Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia |
| title_full_unstemmed | Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia |
| title_short | Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia |
| title_sort | recent advances in the diagnosis and management of pneumocystis pneumonia |
| topic | pneumocystis jirovecii pneumonia immunocompromised host loop-mediated isothermal amplification infection control chemoprophylaxis |
| url | https://e-trd.org/search.php?where=aview&id=10.4046/trd.2020.0015&code=0003TRD&vmode=FULL |
| work_keys_str_mv | AT sadatomotasakamd recentadvancesinthediagnosisandmanagementofpneumocystispneumonia |