Colonization of Pneumocystis jirovecii in Chronic Obstructive Pulmonary Disease (COPD) patients and the rate of Pneumocystis pneumonia in Iranian non-HIV(+) immunocompromised patients
-
Maryam-Fatemeh Sheikholeslami
,
Javid Sadraei
,
Parissa Farnia
,
Mehdi Forozandeh
,
Hamid Emadi Kochak
,
Payam Tabarsi
,
Seyed Alireza Nadji
,
Majid Pirestani
,
Mohammad-Reza Masjedi
,
AliAkbar Velayati
Abstract
Background and Objectives: With increasing rate of immunodeficiency diseases in the world, opportunistic micro-organism such as Pneumocystis jirovecii (P. jirovecii) become more important. Little information is available on prevalence of this life- threatening microorganism in Iran. This study was designed to determine the colonization and the rate of active disease caused by P. jirovecii in two groups of Iranian immunosuppressed patients.
Materials and Methods: Two hundred and fifty five pulmonary samples were collected from two groups of immunosuppress- ed patients to detect a 260bp fragment of mt LSU rRNA gene of P. jirovecii by nested PCR. The first group was COPD patients consumed oral, inhaled or injectable corticosteroid and the second group was patients with malignancies under chemotherapy. Both groups were referred to National Research Institute of Tuberculosis and Lung Disease and Imam Khomeini hospital because of pulmonary symptoms. All patients introduced to this project were confirmed HIV sera-negative by ELISA and western blot test.
Results: The mean age of COPD patients was 66.5 ± 11 (41-88) years and all of them were men. The mean age of patients with malignancy (PMs) was 43 ± 11 (23-65) years and 51.6% were men. The P. jirovecii was colonized in 7 of 89 COPD patients (7.9%) and its DNA was isolated from 11 of 153 PMs (7.2%). The microorganism could cause active disease in 7 of 67 (10.5%) PMs who suffered from pneumonia.
Conclusion: The study showed that P. jirovecii was one of colonizing agents in the COPD patients, but it could cause active disease in PMs. Generally, the microorganism can exist in the lung of non-HIV+ immunosuppressed patients. Therefore, it should be considered as a potential infective agent in non-HIV+ immunocompromised patients.
Morris A, Lundgren JD, Masur H, Walzer PD, Hanson DL, Frederick T, et al. Current epidemiology of Pneumocystis pneumonia. Emerg Infect Dis 2004; 10:1713-1720.
Gajdusek DC. Pneumocystis carinii; etiologic agent of interstitial plasma cell pneumonia of premature and young infants. Pediatrics 1957; 19(4 Part 1): 543-565.
Burke BA, Good RA. Pneumocystis carinii infection.Medicine (Baltimore). 1973; 52: 23-51.
Hill R. Rowlands DR, Rifkind D. Infectious pulmonary disease in patients receiving immunosuppressive therapy for organ transplantation. N Engl J Med 1964;271: 1021-1027.
Nevez G, Jounieaux V, Linas MD, Guyot K, Leophonte P, Massip P, et al. High frequency of Pneumocystis carinii sp.f. hominis colonization in HIV-negative patients. J Eukaryot Microbiol. 1997; 44: 36S.
Nevez G, Raccurt C, Jounieaux V, Dei-Cas E, Mazars E. Pneumocystosis versus pulmonary Pneumocystis carinii colonization in HIV-negative and HIV-positive patients. AIDS 1999; 13: 535-536.
Sing A, Roggenkamp A, Autenrieth IB, Heesemann J. Pneumocystis carinii carriage in immunocompetent patients with primary pulmonary disorders as detected by single or nested PCR. J Clin Microbiol 1999; 37:3409-3410.
Hauser PM, Blanc DS, Bille J, Nahimana A, Francioli P.Carriage of Pneumocystis carinii by immunosuppressed patients and molecular typing of the organisms. AIDS 2000; 14: 461-463.
Nevez G, Nevez G, Totet A, Raccurt C. Typing of Pneumocystis carinii f.sp. hominis in patients with or without pneumocystosis. J Eukaryot Microbiol 2001; Suppl: 124S-125S.
Vargas SL, Hughes WT, Santolaya ME, Ulloa AV, Ponce CA, Cabrera CE, et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis 2001; 32: 855-861.
Morris A, Kingsley LA, Groner G, Lebedeva IP, Beard CB, Norris KA. Prevalence and clinical predictors of Pneumocystis colonization among HIV-infected men. AIDS 2004; 18: 793-798.
Wakefield AE,Lindley AR, Ambrose HE, Denis CM, Miller RF. Limited asymptomatic carriage of Pneumocystis jirovecii in human immunodeficiency virus-infected patients. J Infect Dis 2003; 187: 901-908.
Mori S, Sugimoto M. Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis. Rheumatology (Oxford). 2012 Dec; 51: 2120-2130.
Masur H. Clinical studies of Pneumocystis carinii and relationships to AIDS. J Protozool 1989; 36: 70-74.
Peters BS, Beck EJ, Coleman DG, Wadsworth MJ, McGuinness O, Harris JR, Pinching AJ. Changing disease patterns in patients with AIDS in a referral centre in the United Kingdom: the changing face of AIDS. BMJ 1991; 302(6770): 203-207.
Azoulay E, Parrot A, Flahault A, Cesari D, Lecomte I, Roux P, et al. AIDS-related Pneumocystis carinii pneumonia in the era of adjunctive steroids: implication of BAL neutrophilia. Am J Respir Crit Care Med 1999; 160: 493-499.
Markell E.K.;Voge, John Dt. Medical Parasitology.1992 (7th ed. Philadelphia, WB Saunders).
Kaplan JE, Hanson D, Dworkin MS, Frederick T, Bertolli J, Lindegren ML, et al. Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis 2000; 30 Suppl 1: S5-14.
Fisk DT, Meshnick S, Kazanjian PH. Pneumocystis carinii pneumonia in patients in the developing world who have acquired immunodeficiency syndrome. Clin Infect Dis 2003; 36: 70-78.
Wakefield AE. DNA sequences identical to Pneumocystis carinii f. sp. carinii and Pneumocystis carinii f. sp. hominis in samples of air spora. J Clin Microbiol 1996;34: 1754-1759.
Totet A, Latouche S, Lacube P, Pautard JC, Jounieaux V, Raccurt C, et al. Pneumocystis jirovecii dihydropteroate synthase genotypes in immunocompetent infants and immunosuppressed adults, Amiens, France. Emerg Infect Dis 2004; 10: 667-673.
Montes-Cano MA, de la Horra C, Martin-Juan J, Varela JM, Torronteras R, Respaldiza N, et al. Pneumocystis jiroveci genotypes in the Spanish population. Clin Infect Dis 2004; 39: 123-128.
Nüesch R, Bellini C, Zimmerli W. Pneumocystis carinii pneumonia in human immunodeficiency virus (HIV)- positive and HIV-negative immunocompromised patients. Clin Infect Dis 1999; 29: 1519-1523.
Ledergerber B, Egger M, Erard V, Weber R, Hirschel B, Furrer H, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA 1999; 282: 2220-2226.
Morris A, Beard CB, Huang L. Update on the epidemiology and transmission of Pneumocystis carinii.Microbes Infect 2002; 4: 95-103.
Pifer LL, Hughes WT, Stagno S, Woods D. Pneumocystis carinii infection: evidence for high prevalence in normal and immunosuppressed children. Pediatrics 1978; 61:35-41.
Calderón EJ, Regordan C, Medrano FJ, Ollero M, Varela JM. Pneumocystis carinii infection in patients with chronic bronchial disease. Lancet 1996;347(9006):977.
Calderón E, de la Horra C, Medrano FJ, López-Suárez A, Montes-Cano MA, Respaldiza N et al. Pneumocystis jiroveci isolates with dihydropteroate synthase mutations in patients with chronic bronchitis. Eur J Clin Microbiol Infect Dis 2004; 23: 545-549.
Probst M, Ries H, Schmidt-Wieland T, Serr A. Detection of Pneumocystis carinii DNA in patients with chronic lung diseases. Eur J Clin Microbiol Infect Dis 2000; 19:644-645.
Morris A, Wei K, Afshar K, Huang L. Epidemiology and clinical significance of pneumocystis colonization. J Infect Dis 2008; 197: 10-17.
Calderón EJ, Rivero L, Respaldiza N, Morilla R, Montes- Cano MA, Friaza V, et al. Systemic inflammation in patients with chronic obstructive pulmonary disease who are colonized with Pneumocystis jiroveci. Clin Infect Dis 2007; 45: e17-19.
Neiman PE, Thomas ED, Reeves WC, Ray CG, Sale G, Lerner KG, et al. Opportunistic infection and interstitial pneumonia following marrow transplantation for aplastic anemia and hematologic malignancy. Transplant Proc 1976; 8: 663-667.
Fossieck BE Jr, Spagnolo SV. Pneumocystis carinii pneumonitis in patients with lung cancer. Chest 1980;78: 721-722.
| Files | ||
| Issue | Vol 5 No 4 (2013) | |
| Section | Articles | |
| Keywords | ||
| COPD Colonization Non-HIV immunocompromised patients P. jirovecii | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
