Pneumocystis carinii

Late century - protozoa

RECENTLY BEEN PLACED IN A GROUP OF FUNGI ENTITLED THE ARCHIA SCOMYCETES

INTRODUCTION
Pneumocystis jiroveci (previously known as Pneumocystis carinii) is an unusual opportunistic organism, which causes a severe and often fatal pneumonia in immunocompromised individuals. Pneumocystis organisms were first reported and named Pneumocystis carinii in the beginning of last century. Finally in 2002, by the recognition of its genetic and functional distinctness, human pneumocystis organism was renamed Pneumocystis jiroveci, in honour of Otto Jirovec, who is credited for describing

 P.carinni is widespread in nature and occurs in many mammals Other mammals:

RESERVOIR

Pneumocystis jirovecii

Humans YOU

 The cystic form (sporangium) is The trophic form (yeast, thick-walled oval, approximately formerly trophozoite) 5 to 8 in diameter is small (2 to 5m), thin-walled, Contain up to eight daughter pleomorphic and often has forms (spores or endospores, an eccentric nucleus. The formerly known as intracystic trophic forms are often seen in bodies or sporozoites), which clusters. will become trophic forms after excystation.

TROPHOZOITE in BAL Material

CYSTS In BAL Material

Fig1.Alveolar cast of P.carinii(Geimsa stain) Fig 2 : Alveolar Cast of P.carinii (Papanicolaou stain)

D: Indirect immunofluorescence using monoclonal antibodies against Fig 4 : Cysts of P.carinii in Pneumocystis jirovecii. alveolar cast stained with 3F6 E: Direct immunofluorescence antibody antibody stain using monoclonal antibodies that D: Indirect immunofluorescence using monoclonal antibodies target Pneumocystis jirovecii. against Pneumocystis jirovecii.
Fig 3 : Cysts of P.carinii with capsular dots (Grocott Methenamine Silver Nitrate)
E: Direct immunofluorescence antibody stain using monoclonal antibodies that target D: Indirect immunofluorescence using Pneumocystis jirovecii.
monoclonal antibodies against Pneumocystis jirovecii. E: Direct immunofluorescence antibody stain using monoclonal antibodies that target Pneumocystis jirovecii.

Transmission
ACQUIRED - Respiratory droplet - Environment CONGENITAL TRANSMISSION - Direct transmission

 No detailed knowledge of the lifecycle and the mode of replication has not been definitely established

These fungi are found in the lungs of mammals where they reside without causing overt infection until the host's immune system The initial trophozoite is haploid and divides by binary fission or endogeny. becomes debilitated Two trophozoites may conjugate

giving rise to a diploid cell

Then divides for the haploid trophozoites or begin a meiotic process of division with two meiotic cycles where three stages takes place, forming a large spherical cell with eight nuclei(eight daughter trophozoites@ intracystic bodies) Cyst collapses releasing trophozoites Initiation of another cycle of multiplication .

CLINICAL FEATURES
The disease produced by it is called P.carinii pneumonia(PCP) which is also called as interstitial plasma cell pneumonia with massive lobar involvement Symptoms : fever, cough, shortness of breath Extrapulmonary pneumocystosis is a rare event. In disseminated cases, liver, heart,kidney,spleen,bone marrow pancreas, stomach,thyroid and adrenal gland may also be affected. The presence of cotton wool spots in the fundus of the eye (bukti paling kukuh pendiagnosan)

Laboratory NON SPECIFIC& SPECIFIC findings

1. ESR - Raised level (inflammation) 2. CRP C-Reactive Protein (bind to phosphocholine expressed on the surface of dead or dying cells) - Raised 3. ANEMIA,LEUKOPENIA, THROMBOCYTOPENIA occurs 4. X-RAY - Diffuse mottling of lung field

5. PULMONARY FUNCTION TEST - Reduction in vital capacity of total lung capacity 6. Gallium lung scanning 7. Histopathology examination of lung biopsy - Alveoli filled with granular, foamy honeycomb like acellular material, infiltrate with mononuclear cells

 SPECIFIC
DEMONSTRATION OF CYSTS In sputum, trancheobronchial lavage or tracheobronchial lavage or open lung biopsy. Cysts can be stained with Geimsa or Methanamine-Silver Techniqueor Gromorimethenamine Silver ((stained black) IMMUNOFLUORESENCE TEST DETECTION OF ANTIGEN OR ANTIBODIES - Monoclonal antibodies for direct detection of organisms in clinical specimens not available and appear to be very specific and sensitive CULTURE - Limited success.

Treatments
Trimethoprim-sulfamethoxazole (TMPSMZ) Pentamidine isethionate inhalant Treatments can be toxic and patient must be monitored closely Prophylactic treatment if CD4 count is low HAART(Highly Active Anti-Retroviral Therapy) regimen to boost immune system function, corticosteroids