Sokulska Magdalena, Kicia Marta, Wesołowska Maria, Hendrich Andrzej B
Department of Biology and Medical Parasitology, Wrocław Medical University, ul. Mikulicza-Radeckiego 9, 50-367, Wrocław, Poland.
Parasitol Res. 2015 Oct;114(10):3577-85. doi: 10.1007/s00436-015-4678-6. Epub 2015 Aug 19.
Pneumocystis pneumonia is an opportunistic disease caused by invasion of unicellular fungus Pneumocystis jirovecii. Initially, it was responsible for majority of morbidity and mortality cases among HIV-infected patients, which later have been reduced due to the introduction of anti-retroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients. Pneumocystis pneumonia, however, is still a significant cause of mortality among HIV-negative patients being under immunosuppression caused by different factors, such as transplant recipients as well as oncologically treated ones. The issue of pneumocystosis among these people is particularly emphasized in the article, since rapid onset and fast progression of severe symptoms result in high mortality rate among these patients, who thereby represent the group of highest risk of developing Pneumocystis pneumonia. In contrast, fungal invasion in immunocompetent people usually leads to asymptomatic colonization, which frequent incidence among healthy infants has even suggested the possibility of its association with sudden unexpected infant death syndrome. In the face of emerging strains with different epidemiological profiles resulting from genetic diversity, including drug-resistant genotypes, the colonization phenomenon desires particular attention, discussed in this article. We also summarize specific and sensitive methods, required for detection of Pneumocystis invasion and for distinguish colonization from the disease.
肺孢子菌肺炎是由单细胞真菌耶氏肺孢子菌入侵引起的一种机会性疾病。最初,它是导致HIV感染患者发病和死亡的主要原因,后来由于抗逆转录病毒疗法的引入以及对这些患者进行抗肺孢子菌预防,其发病率和死亡率有所降低。然而,肺孢子菌肺炎在因不同因素(如移植受者以及接受肿瘤治疗的患者)而处于免疫抑制状态的HIV阴性患者中,仍然是一个重要的死亡原因。本文特别强调了这些人群中的肺孢子菌病问题,因为严重症状的快速发作和快速进展导致这些患者的死亡率很高,因此他们是发生肺孢子菌肺炎风险最高的群体。相比之下,免疫功能正常的人受到真菌入侵通常会导致无症状定植,健康婴儿中这种情况的频繁发生甚至提示了其与婴儿猝死综合征相关的可能性。面对由遗传多样性导致的具有不同流行病学特征的新菌株出现,包括耐药基因型,这种定植现象值得特别关注,本文对此进行了讨论。我们还总结了检测肺孢子菌入侵以及区分定植和疾病所需的特异性和灵敏性方法。