Pneumocystis carinii new clinical spectrum?

Article Abstract:

Pneumocystis carinii is the most common fatal opportunistic infection among patients with acquired immunodeficiency syndrome (AIDS), but the organism can seriously affect other types of patients as well. Almost without exception, P. carinii infections, which cause a form of pneumonia, develop in people whose immune systems are suppressed. The major predisposing conditions are AIDS or other immunodeficiency diseases, malnutrition, prematurity, and the use of corticosteroids or immunosuppressive drugs. In patients infected with human immunodeficiency virus (HIV), the number of circulating CD4 cells (a class of immune system cell) is associated with the risk of infection with P. carinii. In a study by Jacobs et al. in The New England Journal of Medicine, none of the five elderly patients who were infected with pneumocystis were admitted to the hospital with symptoms suggestive of the infection. The diagnosis was made 7 to 32 days later, and it is not clear how they were infected. At this point, it is also not clear whether this small group of cases represents an isolated occurrence or a change in the clinical features of pneumocystis infection. However, it can be concluded that P. carinii infection should be considered when diagnosing symptoms of pneumonia in the elderly. Elderly people and patients without predisposing factors who become infected with P. carinii should have a thorough immunological evaluation. More epidemiologic information about P. carinii needs to be gathered. Finally, infection control guidelines need to take into account the risk of direct exposure to patents with P. carinii. (Consumer Summary produced by Reliance Medical Information, Inc.)

AIDS patients, Hospitalization, editorial

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A cluster of Pneumocystis carinii pneumonia in adults without predisposing illness

Article Abstract:

Until the advent of the AIDS epidemic, Pneumocystis carinii pneumonia was fairly uncommon. Only 107 cases were reported between 1955 and 1964, during which time about 99 percent of patients with the disease had a preexisting condition such as lymphoma, leukemia, organ transplantation, or else they were being treated with corticosteroids or chemotherapy. The disease rarely attacks adults whose immune systems are healthy. P. carinii infections developed in five elderly patients without AIDS or any other predisposing illness during a three-month period. The cases are discussed in this article. These patients may have been infected with a potent form of P. carinii, but such a conclusion requires more extensive investigation. It is also possible that exposure to P. carinii in the community or hospital has risen in recent years. One report claims that the incidence of P. carinii pneumonia has increased among cancer patients. In the cases presented, the mechanism of transmission is unknown, especially since the five patients occupied different floors of the hospital. P. carinii can clearly infect patients without predisposing conditions, and the elderly may be especially susceptible to this organism. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies

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Neurocysticercosis in an orthodox Jewish community in New York City

Article Abstract:

Some patients with seizures and cystic brain lesions may be diagnosed neurocysticercosis, despite not eating pork or traveling to a country with a high incidence of tapeworm infections. Neurocysticercosis is an infection of the central nervous system by tapeworm larva characterized by the formation of larval cysts. Four individuals experienced recurrent seizures, and had brain lesions resembling larval cysts. All of the individuals were Orthodox Jews, and did not eat pork. Pigs are another host of tapeworm infections. Two patients had not traveled to an area with a high incidence of tapeworm infections, but one had eight years before developing symptoms. The other patient had been born in Morocco. The two patients who died were diagnosed during an autopsy, and the two that survived were diagnosed using a blood test. It is suspected that the patients contracted the infection from household employees who had immigrated from Latin American countries with a high incidence of tapeworm infections.

Diagnosis, Cysticercosis, Cestode diseases, Tapeworm diseases

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