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{{Infobox_Disease |
  Name          = Pneumocystis jirovecii |
  Caption        = Pneumocystis jirovecii|
}}
{{About1|Pneumocystis jirovecii}}
{{DiseaseDisorder infobox |
  Name          = Pneumocystis jirovecii pneumonia |
  Image          = Pneumocystis.jpg |
  Caption        = '''''Pneumocystis jirovecii''''' cysts from bronchoalveolar lavage, stained with [[Toluidin blue O stain]] |
}}
{{Pneumocystis jirovecii pneumonia}}


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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


'''''Related Key Words and Synonyms:'''''
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Pneumocystis      jirovecii (previously classified as Pneumocystis carinii)      was previously classified as a protozoa.  Currently, it is considered a      fungus based on nucleic acid and biochemical analysis.
{{SK}} Pneumocystis carinii; pneumocystis; pneumocystis pneumonia; PCP; Pulmonary pneumocystosis


== Epidemiology and Demographics ==
==[[Pneumocystis jirovecii pneumonia overview|Overview]]==


Pneumocystis jirovecii pneumonia exists worldwide, in humans and animals. Serologic evidence indicates that most healthy children have been exposed by age 3 to 4.  Pneumocystis pneumonia (PCP) occurs in immunosuppressed individuals and in premature, malnourished infants.
==[[Pneumocystis jirovecii pneumonia historical perspective|Historical Perspective]]==


== Pathophysiology & Etiology==
==[[Pneumocystis jirovecii pneumonia classification|Classification]]==
[[Image:Pneumocystis LifeCycle.gif|left|thumb|300px|Life cycle of Pneumocystis spp.]]
Pneumocystis jirovecii (previously classified as Pneumocystis carinii) was previously classified as a protozoa.  Currently, it is considered a fungus based on nucleic acid and biochemical analysis.


This is a generalized life cycle proposed by John J. Ruffolo, Ph.D. (Cushion, MT, 1988) for the various species of Pneumocystis. These fungi are found in the lungs of mammals where they reside without causing overt infection until the host's immune system becomes debilitated. Then, an oftentimes lethal pneumonia can result. '''1''' Asexual phase: trophic forms replicate by mitosis '''2''' to '''3'''. Sexual phase: haploid trophic forms conjugate '''1''' and produce a zygote or sporocyte (early cyst) '''2'''. The zygote undergoes meiosis and subsequent mitosis to produce eight haploid nuclei (late phase cyst) '''3'''. Spores exhibit different shapes (such as, spherical and elongated forms). It is postulated that elongation of the spores precedes release from the spore case. It is believed that the release occurs through a rent in the cell wall. After release, the empty spore case usually collapses, but retains some residual cytoplasm '''4'''. A trophic stage, where the organisms probably multiply by binary fission is also recognized to exist. The organism causes disease in immunosuppressed individuals.
==[[Pneumocystis jirovecii pneumonia pathophysiology|Pathophysiology]]==
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=== History and Symptoms ===


The symptoms of Pneumocystis pneumonia (PCP) include [[dyspnea]], nonproductive [[cough]], and [[fever]]. Chest radiography demonstrates bilateral infiltrates.  Extrapulmonary lesions occur in a minority (<3%) of patients, involving most frequently the lymph nodes, spleen, liver, and bone marrow.  Typically, in untreated PCP increasing pulmonary involvement leads to death.
==[[Pneumocystis jirovecii pneumonia causes|Causes]]==


=== Laboratory Findings ===  
==[[Pneumocystis jirovecii pneumonia differential diagnosis|Differentiating Pneumocystis jirovecii pneumonia from other Diseases]]==


The specific diagnosis    is based on identification of P. jirovecii in bronchopulmonary secretions obtained    as induced sputum or bronchoalveolar lavage (BAL) material.  In situations where    these two techniques cannot be used, transbronchial biopsy or open lung biopsy may prove    necessary.  Microscopic identification of P. jiroveci trophozoites and cysts    is performed with stains that demonstrate either the nuclei of trophozoites and     intracystic stages (such as      Giemsa) or the cyst walls (such as the      silver stains).      In addition, immunofluorescence microscopy using monoclonal antibodies can identify the    organisms with higher sensitivity than conventional microscopy.
==[[Pneumocystis jirovecii pneumonia epidemiology and demographics|Epidemiology and Demographics]]==


====Microscopic====
==[[Pneumocystis jirovecii pneumonia risk factors|Risk Factors]]==


[[Image:Pneumocystis jirovecii.jpg|left|Pneumocystis jirovecii trophozoites]]
==[[Pneumocystis jirovecii pneumonia screening|Screening]]==


'''A:''' Pneumocystis jirovecii trophozoites in bronchoalveolar lavage (BAL) material.  Giemsa stain.  The trophozoites are small (size: 1 to 5 µm), and only their nuclei, stained purple, are visible (arrows).  AIDS patient seen in Atlanta, Georgia.
==[[Pneumocystis jirovecii pneumonia natural history|Natural History, Complications and Prognosis]]==
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[[Image:Pneumocystis jirovecii cysts.jpg|left|Pneumocystis jirovecii cysts]]


====Pneumocystis jirovecii cysts====
==Diagnosis==
[[Pneumocystis jirovecii pneumonia history and symptoms|History and Symptoms]] | [[Pneumocystis jirovecii pneumonia physical examination|Physical Examination]] | [[Pneumocystis jirovecii pneumonia laboratory tests|Laboratory Findings]] | [[Pneumocystis jirovecii pneumonia chest x ray|Chest X Ray]] | [[Pneumocystis jirovecii pneumonia CT|CT]] | [[Pneumocystis jirovecii pneumonia MRI|MRI]] | [[Pneumocystis jirovecii pneumonia other imaging findings|Other Imaging Findings]] | [[Pneumocystis jirovecii pneumonia other diagnostic studies|Other Diagnostic Studies]]


'''B:''' 3 cysts in bronchoalveolar material, Giemsa stain; the rounded cysts (size 4 to 7 µm) contain 6 to 8 intracystic bodies, whose nuclei are stained by Giemsa; the walls of the cysts are not stained; note the presence of several smaller, isolated trophozoites.
==Treatment==
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[[Pneumocystis jirovecii pneumonia medical therapy|Medical Therapy]] | [[Pneumocystis jirovecii pneumonia primary prevention|Primary Prevention]] | [[Pneumocystis jirovecii pneumonia secondary prevention|Secondary Prevention]] | [[Pneumocystis jirovecii pneumonia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pneumocystis jirovecii pneumonia future or investigational therapies|Future or Investigational Therapies]]
'''C:''' Cysts in lung tissue, silver stain; the walls of the cysts are stained black; the intracystic bodies are not visible with this stain; baby who died with pneumonia in California.


[[Image:Pneumocystis jirovecii cysts 2.jpg|left|Pneumocystis jirovecii cysts]]
==Case Studies==
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[[Pneumocystis jirovecii pneumonia case study one|Case #1]]
'''D:''' Pneumocystis jirovecii cysts in bronchoalveolar lavage material; silver stain; this greater magnification shows the irregular, saucer shape of the cysts.


[[Image:Pneumocystis jirovecii 2.jpg|left|Pneumocystis jirovecii]]
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'''E:''' Indirect immunofluorescence using monoclonal antibodies against Pneumocystis jirovecii.  Specimen from a patient with AIDS, seen in Georgia.
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====Molecular====
[[Image:Agarose gel.jpg|left|Agarose gel - PCR for Pneumocystis]]
Molecular methods for detection of P. jirovecii have shown very high sensitivity and specificity and constitute the gold standard for detection of this pathogen.
 
'''A:''' Agarose gel (2%) analysis of PCR-amplified products from DNA extracted from a bronchoalveolar lavage (BAL) diagnostic specimen of a patient with pulmonary symptoms.
 
*Lane S: Molecular base pair standard (100-bp ladder).  Black arrows show the size of standard bands.
*Lane 1: Single step PCR amplification with the pAZ102-E/pAZ102-H primer pair1 - diagnostic band size: 346 bp.
*Lane 2: Nested PCR amplification with the ITS nested PCR primers, 1724F/ITS2R (first round) and ITS1F/ITS2R1 (second round)2 - diagnostic band size: 550 bp.
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== Treatment ==
 
=== Pharmacotherapy ===
 
[[Trimethoprim-sulfamethoxazole]] is the drug of choice. Recommended alternatives include [[pentamidine]]; [[trimethoprim]] plus [[dapsone]]; [[atovaquone]]; and [[primaquine]] plus [[clindamycin]].
 
==References==
 
#http://www.dpd.cdc.gov/dpdx/HTML/Pneumocystis.htm
 
== Acknowledgements ==
 
The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.
 
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[[Category:DiseaseState]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Pulmonology]]


 
[[Category:Overview complete]]
 
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Latest revision as of 18:44, 18 September 2017

Pneumocystis jirovecii
Pneumocystis jirovecii
This page is about clinical aspects of the disease.  For microbiologic aspects of the causative organism(s), see Pneumocystis jirovecii.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Pneumocystis carinii; pneumocystis; pneumocystis pneumonia; PCP; Pulmonary pneumocystosis

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pneumocystis jirovecii pneumonia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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