Pneumocystis jirovecii pneumonia (PJP) is an opportunistic pulmonary infection that commonly occurs in immunocompromised children. We report a case of infantile leukemia complicated by PJP and review the relevant literature. A summary and analysis of 10 infantile leukemia patients with PJP infection (9 cases reported in the literature and 1 case from our center) showed that PJP mostly occurred in the early stages of chemotherapy (80%, 8/10). The main clinical manifestations were dyspnea (100%, 10/10) and hypoxemia (50%, 5/10), while pulmonary imaging findings lacked specificity. In most cases (50%, 5/10), diagnosis was established by identifying pathogens in bronchoalveolar lavage fluid under microscopy. In our case, diagnosis was confirmed using targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid. Treatment with intravenous sulfamethoxazole complex was administered in 8 patients, all of whom eventually recovered. PJP may occur in the early stages of chemotherapy for infantile leukemia, thus early prevention is necessary. tNGS facilitates early diagnosis of PJP, and sulfamethoxazole complex remains an effective therapeutic option.
Humans ; Infant ; Bronchoalveolar Lavage Fluid/microbiology* ; Immunocompromised Host ; Leukemia/complications* ; Pneumocystis carinii/isolation & purification* ; Pneumonia, Pneumocystis/diagnosis* ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use*

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.
Acquired Immunodeficiency Syndrome ; complications ; Adult ; Amphotericin B ; therapeutic use ; Antifungal Agents ; therapeutic use ; Bronchoalveolar Lavage Fluid ; microbiology ; Coinfection ; diagnosis ; pathology ; Cryptococcosis ; complications ; diagnosis ; pathology ; Cryptococcus neoformans ; isolation & purification ; Humans ; Male ; Microscopy ; Pneumocystis carinii ; isolation & purification ; Pneumonia, Pneumocystis ; complications ; diagnosis ; pathology ; Treatment Outcome ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use

AIDS-Related Opportunistic Infections ; diagnosis ; microbiology ; Acquired Immunodeficiency Syndrome ; diagnosis ; microbiology ; Bronchoalveolar Lavage Fluid ; microbiology ; Female ; Humans ; Immunohistochemistry ; Male ; Methenamine ; Pneumocystis carinii ; isolation & purification ; Pneumonia, Pneumocystis ; diagnosis ; microbiology ; Polymerase Chain Reaction ; Silver Staining ; methods

Pneumocystis carinii is a pulmonary pathogen of immunocompromised humans or other mammals. Its infection results from activation of organisms involved in latent infection or from new infection through the air. Almost all children are known to be infected within 2 to 4 years of birth, though prenatal transplacental transmission has not yet been demonstrated. In this study we observed experimental P. carinii infection in neonatal rats, thus investigating the possibility of transplacental vertical transmission by Diff-Quik staining of the lung impression smears and in-situ hybridization for lung sections. The positive rate of P. carinii infection in immunosuppressed maternal rats was 100%, but that in normal maternal rats was 0%. Cystic forms of P. carinii were observed in three of six 1-week old neonatal rats born of heavily infected mothers, but none of them was positive by in-situ hybridization. Five weeks after birth, cystic forms were detected in four neonatal rats. In the lobes of the lungs, no predilection site of P. carinii was recognized. Counts of cystic forms on smears and the reactivity of in-situ hybridization in the lungs of neonatal rats were significantly lower than in maternal rats. The present findings suggest that P. carinii is rarely transmitted through the placenta and proliferates less successfully in the lungs of neonatal rats than in mothers.
Animal ; Animals, Newborn/microbiology* ; Disease Transmission, Vertical* ; Female ; Immunocompromised Host ; Lung/microbiology ; Male ; Opportunistic Infections/transmission* ; Opportunistic Infections/complications ; Pneumocystis carinii/isolation & purification ; Pneumonia, Pneumocystis carinii/transmission* ; Pneumonia, Pneumocystis carinii/complications ; Pregnancy ; Rats ; Rats, Wistar

Molecular karyotyping was applied to Pneumocystis carinii(Pc) from two strains of experimental rats, Sprague Dawley(SD) and Fisher(F), in Korea. Field inversion gel electrophoresis and contour clamped homogeneous electric field electrophoresis resolved 15 chromosomal bands from the Pc. The size of the bands was estimated 270kb to 684kb from SD rats, and 273kb to 713 kb from F rats. The bands of 283 kb from SD rats and of 273 kb from F rats stained more brightly suggesting duplicated bands. Total number of chromosomes was at least 16, and total genomic size was estimated 7 x 10(6) bp. All of the bands from F rats hybridized to the probe of repeated DNA sequences of Pc and the band of 448 kb size was proved to contain rDNA sequences, but Pc. chromosome bands from SD rats showed no reactions to the probes. The 2 different karyotypes of P. carinii from 2 strains of rats were maintained consistently for 2 years.
Electrophoresis- ; ; Korea- ; ; Nucleic-Acid-Hybridization ; Pneumocystis-carinii-isolation-and-purification ; Rats- ; *Karyotyping- ; ; *Pneumocystis-carinii-genetics ; *Rats,-Inbred-F344-microbiology ; *Rats,-Sprague-Dawley-microbiology