Abstract
Pneumocystis is the classic opportunistic pathogen in that it does not produce any recognizable disease in an immunologically intact host, yet infection of the at-risk immunocompromised host results in a pneumonitis that is universally fatal if untreated. The organism was first identified in the early 1900s but was not appreciated to be a significant human pathogen until after World War II when outbreaks of Pneumocystis pneumonia (PCP) occurred in orphanages in Europe. These young infants who developed what was termed “interstitial plasma cell pneumonitis” were suspected to be immunosuppressed secondary to severe malnutrition. Two subsequent events firmly established Pneumocystis as a major opportunistic pathogen: the development of successful cancer chemotherapy in the late 1950s and 1960s and the start of the AIDS epidemic in the early 1980s. In fact, it was the recognition of a cluster of this “rare” pneumonia, PCP, in apparently healthy young gay men over a short period of time that led to the recognition that a new syndrome (AIDS) and infection (HIV) had emerged.
Presently, the population of patients at risk to develop PCP is growing steadily as we develop new modalities of therapy and potent immunosuppressive drugs to treat malignancies, organ failure, autoimmune, and inflammatory diseases. For example, in solid organ transplant recipients, as survival improves so does the recognition that these patients are at risk of developing PCP if not on specific prophylaxis. Most recently, the addition of antitumor necrosis factor (TNF) therapy to the management of patients with Crohn’s disease, rheumatoid arthritis, and other inflammatory conditions has resulted in the occurrence of PCP in populations that previously had not been considered to be at risk for the development of PCP. The importance of PCP as an opportunistic pneumonia is likely to increase as the use of immunosuppressive biologic response modifiers increases.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Masur H, Michelis MA, Greene JB. et al. An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. N Engl J Med. 1981;305:1431–8.
Gottlieb MS, Schroff R, Schanker HM. et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med. 1981;305:1425–31.
Gigliotti F. Host species-specific antigenic variation of a mannosylated surface glycoprotein of Pneumocystis carini. J Infect Dis. 1992;165:329–36.
Gigliotti F, Haidaris PJ, Haidaris CG, Wright TW, Van der Meid KR. Further evidence of host species-specific variation in antigens of Pneumocystis carinii using the polymerase chain reaction. J Infect Dis. 1993;168:191–4.
Wakefield AE. Genetic heterogeneity in Pneumocystis carinii: an introduction. FEMS Immunol Med Microbiol. 1998;22:5–13.
Gigliotti F, Harmsen AG, Haidaris CG, Haidaris PJ. Pneumocystis carinii is not universally transmissible between mammalian species. Infect Immun. 1993;61:2886–90.
Stringer JR, Cushion MT, Wakefield AE. New nomenclature for the genus Pneumocystis. J Eukaryot Microbiol. 2001;48(Suppl):184S–9.
Gigliotti F. Pneumocystis carinii: has the name really been changed? Clin Infect Dis. 2005;41:1752–5.
Vargas SL, Hughes WT, Santolaya ME, et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis. 2001;32:855–61.
Gigliotti F, Harmsen AG, Wright TW. Characterization of transmission of Pneumocystis carinii f. sp. muris through immunocompetent BALB/c mice. Infect Immun. 2003;71:3852–6.
Wright TW, Gigliotti F, Finkelstein JW, McBride JT, An CL, Harmsen AG. Immune-mediated inflammation directly impairs pulmonary function, contributing to the pathogenesis of Pneumocystis carinii pneumonia. J Clin Invest. 1999;104:1307–17.
Cheng VC, Yuen KY, Chan WM, Wong SS, Ma ES, Chan RM. Immunorestitution disease involving the innate and adaptive response. Clin Infect Dis. 2000;30:882–92.
Ng VL, Yajko DM, Hadley WK. Extrapulmonary pneumocystosis. Clin Microbiol Rev. 1997;10:401–18.
Butt AA, Michaels S, Kissinger P. The association of serum lactate dehydrogenase level with selected opportunistic infections and HIV progression. Int J Infect Dis. 2002;6:178–81.
Briel M, Bucher HC, Boscacci R, Furrer H. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV-infection. Cochrane Database Syst Rev. 2006;3:CD006150.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed 26 Dec 2014.
Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf. Accessed 26 Dec 2014.
Suggested Reading
Gigliotti F, Wright TW. Immunopathogenesis of Pneumocystis carinii pneumonia. Exp Rev Molec Med 2005;7:1–16. www.expertreviews.org.
Steele C, Shellito JE, Kolls JK. Immunity against the opportunistic fungal pathogen Pneumocystis. Med Mycol 2005;43:1–19.
Thomas CF, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004;350:2487–98.
Walzer PD, Cushion MT. Pneumocystis pneumonia. 3rd Ed. New York: Marcel Dekker, 2005.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Gigliotti, F., Wright, T. (2015). Pneumocystosis. In: Hospenthal, D., Rinaldi, M. (eds) Diagnosis and Treatment of Fungal Infections. Infectious Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-13090-3_14
Download citation
DOI: https://doi.org/10.1007/978-3-319-13090-3_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-13089-7
Online ISBN: 978-3-319-13090-3
eBook Packages: MedicineMedicine (R0)