<Emphasis Type="Italic">Pneumocystis jiroveci</Emphasis> Pneumonia in Adult Patients with AIDS

Pneumocystis jiroveci (P. carinii) is an opportunistic pathogen that has gained particular prominence since the onset of the AIDS epidemic. Among several important advances in diagnosis and management, appropriately targeting chemoprophylaxis to HIV-infected patients at high clinical risk for P. jiroveci pneumonia and the introduction of effective combination anti-retroviral therapy (including highly active antiretroviral therapy [HAART]) have contributed to the reduced incidence of P. jiroveci pneumonia. Despite the success of these clinical interventions, P. jiroveci pneumonia remains the most common opportunistic pneumonia and the most common life-threatening infectious complication in HIV-infected patients. Trimethoprim/sulfamethoxazole (cotrimoxazole) remains the first-line agent for effective therapy and chemoprophylaxis, and corticosteroids represent an important adjunctive agent in the treatment of moderate-to-severe P. jiroveci pneumonia. However, problems of chemoprophylaxis and treatment failures, high rates of adverse drug reactions and drug intolerance to first-line antimicrobials, high rates of relapse or recurrence with second-line agents, and newer concerns about the development of P. jiroveci drug resistance represent formidable challenges to the management and treatment of AIDS-related P. jiroveci pneumonia. With the expanding global problem of HIV infection, the intolerance or unavailability of HAART to many individuals and limited access to healthcare for HIV-infected patients, P. jiroveci pneumonia will remain a major worldwide problem in the HIV-infected population. New drugs under development as anti-Pneumocystis agents such as echinocandins and pneumocandins, which inhibit beta-glucan synthesis, or sordarins, which inhibit fungal protein synthesis, show promise as effective agents. Continued basic research into the biology and genetics of P. jiroveci and host defense response to P. jiroveci will allow the development of newer antimicrobials and immunomodulatory therapeutic agents to more effectively treat life-threatening pneumonia caused by this organism.     

Adjunctive corticosteroids for <Emphasis Type="Italic">Pneumocystis jiroveci</Emphasis> pneumonia in patients with HIV infection: a meta-analysis of randomised controlled trials

Background  

The objective of this study was to review the effects of adjunctive corticosteroids on overall mortality and the need for mechanical ventilation in HIV-infected patients with Pneumocystis jiroveci pneumonia (PCP) and substantial hypoxemia (arterial oxygen partial pressure <70 mmHg or alveolar-arterial gradient >35 mmHg on room air).     

Asymptomatic carriage of <Emphasis Type="Italic">Pneumocystis jiroveci</Emphasis> in elderly patients with rheumatoid arthritis in Japan: a possible association between colonization and development of <Emphasis Type="Italic">Pneumocystis jiroveci</Emphasis> pneumonia during low-dose MTX therapy

Low-dose methotrexate (MTX) has been used effectively for rheumatoid arthritis (RA) because of its favorable risk-benefit ratio. One of the recent concerns arising from this therapy is a possible increase in the rate of opportunistic infections, particularly Pneumocystis jiroveci pneumonia (PCP). In this study, we report two cases of PCP occurring during low-dose methotrexate therapy for RA and review 13 additional cases from the literature on Japanese patients with RA. The average age of these patients was 67.7 years, and most were over the age of 60. MTX-associated PCP appears to occur more frequently in elderly individuals in Japan. To identify individuals with a high risk of PCP, we performed a polymerase chain reaction on specimens from induced sputum or bronchoalveolar lavage fluids from 55 patients with RA. At that point in time, they showed no evidence of PCP development. We found six patients (10.9%) having asymptomatic carriage of P. jiroveci. The mean age of the P. jiroveci-positive patients was 74.7 years, which was significantly older than the P. jiroveci-negative patients (mean age 63.6 years). Of the RA patients over the age of 65, 18.8% (6 cases out of 32) were carriers of P. jiroveci. There were no significant differences in RA duration or counts of white blood cells or lymphocytes between the positive and negative groups. Notably, we encountered a case of PCP occurring in an asymptomatic carrier of P. jiroveci during low-dose MTX therapy for RA. This case appeared to be a reactivation of latent infection. By careful follow-up on the carriers of P. jiroveci, we succeeded in promptly diagnosing PCP, and we employed the appropriate therapeutic strategies for this possibly life-threatening complication.     

Granulomatous hepatitis due to <Emphasis Type=Italic>Bartonella henselae</Emphasis> infection in an immunocompetent patient

Background  

Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis. Due to the fastidious growth characteristics of the bacteria, the limited sensitivity of histopathological stains, and the non-specific histological findings on liver biopsy, the diagnosis of hepatic bartonellosis can be difficult to establish. Furthermore, the optimal treatment of established hepatic bartonellosis remains controversial.     

Erythema caused by a localised skin infection with <Emphasis Type=Italic>Arthrobacter mysorens</Emphasis>

Background  

Skin erythemas of unknown origin are a frequent reason for consulting the general practitioner or dermatologist.     

10 Jahre <Emphasis Type=Italic>Der Pneumologe</Emphasis>

There are currently about 8,000 individuals with cystic fibrosis (CF) living in Germany. This disease is the most common fatal congenital metabolic disorder in the Caucasian population. The first causal therapy is now available for CF patients with the G551D mutation. Rapidly developing diagnostic and therapeutic options have led to a significant increase in life expectancy and more than half of CF patients are older than 18 years. Nevertheless, in 2010, 42.8% of adult CF patients were still being treated in pediatric institutions. This requires a prompt development of adequate models of care as well as of transitional structures, both of which still constitute a problem. The transition process with the goal of professional adult care is insufficiently defined; therefore, models allowing a successful transition with sustainable professional care and a positive effect on the long-term course of the disease and the prognosis are being developed. Several transition models have been tested in Germany. A uniform, comprehensive model is unlikely to be applicable for all institutions, whereas structural developments considering local conditions and supported by participating stakeholders on both sides (pediatrics and internal medicine) are realistic. Two different transitional models tested locally are described.     

<Emphasis Type=Italic>Ureaplasma parvum</Emphasis> infection alters filamin a dynamics in host cells

Background  

Ureaplasmas are among the most common bacteria isolated from the human urogenital tract. Ureaplasmas can produce asymptomatic infections or disease characterized by an exaggerated inflammatory response. Most investigations have focused on elucidating the pathogenic potential of Ureaplasma species, but little attention has been paid to understanding the mechanisms by which these organisms are capable of establishing asymptomatic infection.     

<Emphasis Type=Italic>Aphelenchus avenae</Emphasis> (Nematoda: Aphelenchidae) under the rhizosphere of <Emphasis Type=Italic>Brassica napus</Emphasis>

Soil samples under the rhizosphere of Brasicca napus were collected from three localities (Bílé Podolí, Prague, Kylešovice). All three localities were positive for the presence of Aphelenchus avenae. Morphological and molecular features of A. avenae are presented in this research note.     

Effective <Emphasis Type=Italic>in vivo</Emphasis> and <Emphasis Type=Italic>ex vivo</Emphasis>gene transfer to intestinal mucosa by VSV-G-pseudotyped lentiviral vectors

Background  

Gene transfer to the gastrointestinal (GI) mucosa is a therapeutic strategy which could prove particularly advantageous for treatment of various hereditary and acquired intestinal disorders, including inflammatory bowel disease (IBD), GI infections, and cancer.     

The enigma of <Emphasis Type=Italic>Helicobacter pylori</Emphasis> infection and gastric cancer

Although H. pylori has been recognized as a class I carcinogen, incongruence between infection prevalence and cancer incidence has been reported. Holcombe called attention to the high prevalence of infection in the face of low cancer rates, which he called “The African Enigma”. Similar observations have now been made in other geographic areas. Gastric carcinoma should be considered an infectious disease, for which the classical epidemiologic model of causality applies. The model proposes that tissue injury inflicted by the infectious agent is modulated by its interactions with host and environmental factors. Although approximately half of the world’s population is infected, only a small proportion of people develop cancer. The African enigma is a striking example of the major contrasts in cancer risk among populations with similarly high prevalence of infection. The mechanisms involved in reducing the risk of cancer in infected individuals are explored in this article, which may lead to the design of effective prevention strategies.     

Pathology associated with <Emphasis Type=Italic>Contracaecum rudolphii</Emphasis> (Nematoda: Anisakidae) infection in the great cormorant <Emphasis Type=Italic>Phalacrocorax carbo</Emphasis> (L. 1758)

This is a report of lesions associated with the nematode Contracaecum rudolphii (Nematoda: Anisakidae) from the proventriculus of the great cormorant, Phalacrocorax carbo (L. 1758). The study was undertaken as part of a health monitoring program for P. carbo, which is endangered and thus protected within the European continent. Cormorants were collected by gun-shot from north-eastern Poland in the spring of 2006, four birds were necropsied on site and the gastrointestinal tract was examined for the presence of nematodes. The birds came from a region with noted increases in the cormorant population over the last decade. Esophageal and gastric sections with parasites in situ were fixed in formalin and processed routinely for paraffin embedding, stained with H&E and examined by brightfield microscopy. Parasite associated lesions consisted of severe, ulcerative gastritis at the attachment sites, and diffuse granulomatous gastritis in adjacent areas. Eosinophilic material speculated to be the parasite-derived excretory-secretory product was consistently forming the parasite-host boundry at the attachment points. Although the parasite-associated gastric lesions were focally severe, all examined birds appeared in good body condition. Because only four birds were investigated in this study, the potential contribution of C. rudolphii to morbidity and mortality in great cormorants needs to be examined further.