Pneumocystis carinii (actually pneumocystis jiroveci) for most people is completely harmless, many people are its carriers without realizing it and never getting sick because of it. Unfortunately, in the case of impaired immunity, this pathogen is very dangerous - it causes pneumocystic pneumonia. It is good to know when to fear jiroveci infection and what its symptoms are. How is pneumocystosis treated?

Pneumocystis jiroveci(formerlypneumocystis carinii ) is a fungus pathogenic to humans that causes so-called opportunistic infections, i.e. infections caused by microorganisms living in our body characteristic of people with impaired immunity.

P. jiroveci for many years was considered a protozoan, only the application of genetic and molecular tests allowed it to join the Kingdom of Mushrooms. For this reason, the nomenclature of the pathogen has changed.

There are various forms in the development of P. jroveci in the human body: sporocysts, cysts and free trophic forms. The infection occurs through the air, therefore P. jiroveci primarily attacks the respiratory system and multiplies there as well.

When is Pneumocistis jiroveci dangerous?

Under normal conditions, many organs in the human body, e.g. the large intestine, the oral cavity or the respiratory tract, are colonized by microorganisms - bacteria or fungi, they are needed for various reasons, e.g. they produce vitamin K.

Our immune system keeps their development in check, preventing them from multiplying too intensively. Unfortunately, this balance can be disturbed by an impaired immune system, which causes the development of diseases caused by these microorganisms.

The states of a weakened immune response include not only the well-known AIDS and other infections (e.g. parasites or tuberculosis), but also long-term intensive steroid therapy, immunosuppressive treatment, cancer, especially hematological disease, and the state after organ transplantation.

Unfortunately, among the people at risk of P. jiroveci there are also children: premature babies, infants with congenital immunodeficiency and severe malnutrition.

It is believed that an infection with P. jiroveciis the most common opportunistic infection in AIDS patients, it is often the first manifestation of this disease, and pneumocystosis should always lead to looking for other ailments or causes of reduced immunity.

Pneumonia caused by P. jiroveci (pneumocystosis)

Pneumocystosis, a disease caused by P. jiroveci, most often manifests itself in the form of pneumonia, although it is not the only manifestation, it happens that this pathogen affects the lymph nodes, spleen, bone marrow, liver, intestines, eyes, or skin, these less common locations occur especially in advanced immunodeficiency.

Pneumonia in the course of this disease is interstitial, i.e. it takes place in the tissue on which the alveoli are stretched, entwined by a network of blood vessels, and not in the alveoli, typically for other pneumonia. These types of infections are characterized by the progressive destruction of the lung structure, leading to the loss of their effective work.

Pneumocystosis pneumonia (Pneumocystosis): symptoms

The disease can develop slowly, and the manifestations look innocent - the dominant ones are: shortness of breath, dry cough and fever, i.e. symptoms not typical of dangerous infections, in advanced cases, cyanosis, weight loss, and finally respiratory failure are added.

Pneumocystosis pneumonia (Pneumocystosis): research

The examination may reveal rapid breathing and heart rate, and sometimes auscultatory changes over the lung fields, and fungal lesions in the oral cavity, as pneumocystosis is often accompanied by other mycoses.

Often the radiological image of the lungs is correct, which makes the diagnosis even more difficult, sometimes in the X-ray we can see the image of the so-called milk glass, which indicates that the entire lungs are involved.

In the field of imaging tests, computed tomography is also used, in which the appearance of the lungs is similar to that in X-ray. The course of advanced pneumocystosis is severe, leading to respiratory failure and often death.

The infection requires hospital treatment and advanced diagnostics, the most reliable is the examination of bronchoalveolar lavage obtained during bronchoscopy, less often sputum, and ultimately lung biopsy material.

The material obtained in this way is subjected to genetic testing in order to detect the DNA of the fungus, unfortunately the waiting period for the test results is long, so the therapy should be started when this disease is suspected.

Pneumocystic pneumonia (Pneumocystosis): treatment

Treatment of pneumocystosis is not always effective, the mainstaythere are antibiotics and chemotherapeutic agents, there are also supportive treatments aimed at relieving the most troublesome symptoms, as well as respiratory failure therapy, including oxygen therapy and often respiratory support - e.g. intubation.

The prognosis for this infection is serious, mortality is up to 20% among those infected with HIV. The prognosis for cure is uncertain, as pneumocystosis is caused by a microorganism that commonly colonizes the human respiratory tract, and the main cause of the disease is immune deficiency. Therefore, as long as it exists, there is a risk of recurrent pneumocystosis.

After the end of treatment, prophylaxis is often necessary - drugs that inhibit the development of P. jiroveci until the immune system rebuilds, as well as regular checks at the infectious disease clinic for the purpose of ongoing assessment of possible infection.

Due to the high risk of developing the disease and the serious complications of pneumocystosis in people infected with HIV, the occurrence of symptoms of this disease, i.e. dyspnoea and cough, is an indication for urgent hospital diagnosis and immediate treatment.

SUMMARY

Pneumocystis jiroveci is a fungus that lives in the respiratory tract of many he althy people, we often acquire it from other people in early childhood, but when the immune system is functional, this infection does not cause symptoms. In immunosuppressed states, this pathogen is activated and penumocystosis develops.

It is a severe infection, often fatal, belongs to the group of diseases that define AIDS, i.e. diseases characteristic of this immunodeficiency, to which AIDS patients are particularly vulnerable.

It is estimated that in Poland it is one of the three most common diseases that define this immunodeficiency. Therefore, everyone with pneumocystosis should be tested for HIV.

Symptomatic jiroveci infection is an indication for hospitalization, especially if there is severe dyspnea, antibiotics are the treatment of choice, antifungal drugs are ineffective.

Fortunately, in recent years, the incidence of this disease has been gradually declining thanks to more and more effective antiretroviral drugs (against HIV).

  • Bacterial pneumonia
  • Viral Pneumonia
  • Pneumonia in children
  • Interstitial Pneumonia
  • SARS - atypical pneumonia

Category:

Infectious diseases