Alveolar macrophages in AIDS patients: increased spontaneous tumour necrosis factor-alpha production in Pneumocystis carinii pneumonia.

In order to assess the role of alveolar macrophages and their products in the control of Pneumocystis carinii pneumonia (PCP) and other infections in AIDS, bronchoalveolar lavage cells and peripheral blood mononuclear cells from HIV-positive AIDS/ARC patients (with and without PCP) and HIV-negative patients were counted and cultured in vitro; spontaneous and LPS-induced tumour necrosis factor-alpha (TNF-alpha) production was measured. Markedly increased spontaneous TNF-alpha production by alveolar macrophages and, to a lesser extent, peripheral blood monocytes was found in HIV-positive patients with active PCP but not in patients without the infection. Higher TNF production was associated with lower counts of Pneumocystis in the bronchoalveolar lavage fluid. These results suggest that TNF-alpha production by macrophages may play an important role in the control of Pn. carinii infection in AIDS.     

Cryptococcus neoformans-Meningoencephalitis und Mehrfachinfektionen bei AIDS

Summary A 40-year old homosexual AIDS patient recovering from a Pneumocystis carinii pneumonia developed a Cryptococcus neoformans infection with involvement of the central nervous system (CNS) which could be treated successfully with amphotericin B and flucytosine. After a symptomfree interval of 4 1/2 months, a new acute fatal disease of the CNS did not reveal a cryptococcosis relapse but a necrotizing Toxoplasma encephalitis, a cytomegalovirus infection and striking cultural findings of Staphylococcus aureus in all organs examined. Neither by culture nor by histology Cr. neoformans could be detected in the CNS or in the other organs examined. The temporal course of the Cr. neoformans infection and its specific diagnosis are commented. It is demonstrated that (during or after successful therapy of Pneumocystis carinii pneumonia) a specific cultural examination of specimens from the respiratory tract for Cr. neoformans is needed, in order to recognize a Cr. neoformans infection in its primary stage, i. e. before hematogenous dissemination of Cr. neoformans leading to the secondary stage of the infection.

     

艾滋病与非艾滋病病例合并卡氏肺孢子菌肺炎的临床特征对比研究

目的:比较艾滋病相关性卡氏肺孢子菌肺炎与非艾滋病相关性卡氏肺孢子菌肺炎的临床特征及辅助检查,以提高临床医师诊疗水平。方法:收集2018年1月至2021年7月在某三甲医院确诊的卡氏肺孢子菌肺炎17例,按照不同基础疾病将病例分为艾滋病组（7例）与非艾滋病组（10例）,比较两组病例的人口学特征、临床表现、实验室检查、病原学以...     

Pneumocystis carinii in FNA of the thyroid.

We report the diagnosis of Pneumocystis carinii (PC) in a fine-needle aspirate (FNA) from the thyroid of a human immunodeficiency virus infected (HIV+) male receiving aerosolized pentamidine as prophylaxis for Pneumocystis carinii pneumonia (PCP). The clinical diagnosis prior to FNA was multinodular goiter. The patient did not have pulmonary symptoms nor previous diagnosis of PCP at the time of the aspirate diagnosis. Recently, extrapulmonary Pneumocystis carinii (EPC) has been reported with increasing frequency in HIV+ patients receiving prophylactic aerosolized pentamidine. Awareness of extrapulmonary presentations of Pneumocystis carinii infection is a prerequisite for accurate cytologic diagnosis.     

Meeting Abstracts From the NSH Convention,October 20-25, 1985

Abstract

Pneumocystis carinii (P. carinii), a microorganism often associated with AIDS patients, stains a brilliant rose-purple with cresyl echt violet. The original procedure used solutions that were unstable, giving irreproducible results. This modification produces a short reliable method. It is the preferred method used in our laboratory over Grocott's methenamine silver (GMS) and Giemsa to differentiate P. carinii from fungal spores. (The J Histotechnol 12:39, 1989).     

Observations favouring Pneumocystis carinii pneumonia as a primary infection: a monoclonal antibody study on paraffin sections

Pneumocystis carinii pneumonia is characteristic of immunodeficiency and the organism is probably acquired during early childhood. Since infection is only manifest in the lungs, it has been presumed that the organism lies dormant in these tissues following the primary infection. Conventional staining procedures have, however, failed in the absence of pneumonia to demonstrate consistently any forms of Pneumocystis carinii. To study this problem further, lung sections and hilar lymph nodes from immunodepressed adults with and without Pneumocystis carinii pneumonia as well as lung sections from presumed immunocompetent patients were examined for the cyst and trophozoite forms of Pneumocystis carinii using a monoclonal antibody. The organism was only identified in areas of pneumonia, and the source of the organism in these patients may therefore be a new infection with a different human subtype and not, as previously thought, reactivation of a primary infection.     

Disseminated Pneumocystis Carinii Infection in a Hemophiliac Patient with Acquired Immunodeficiency Syndrome

A case of disseminated Pneumocystis carinii (PC) infection in a 28 year old Japanese male hemophiliac with acquired immunodeficiency syndrome (AIDS) is reported. The patient had displayed a high fever and diffuse faint interstitial infiltrates on chest X-ray films without dyspnea three months before his death. At that time, no PC was detected after four consecutive induced sputum tests. Serum anti-cytomegalovirus (CMV) IgM was positive by EIA. No treatment for PC and CMV was given at the patient's request. Autopsy findings disclosed disseminated PC infection consisting of granulomas with caseation like necrosis and frothy exudate in the lungs and disseminated organized calcification in the blood vessels of extrapulmonary organs. PC cysts and/or trophozoites were detected in these lesions. Acta Pathol Jpn 42: 262-266, 1992.     

双氢青蒿素对卡氏肺孢子虫肺炎大鼠肺泡巨噬细胞凋亡的影响

目的：检测双氢青蒿素对卡氏肺孢子虫肺炎（PCP）大鼠肺泡巨噬细胞凋亡的影响。方法：以醋酸可的松皮下洲Wistar大鼠建立PCP动物模型，对60mg/kg双氢青蒿素治疗实验大鼠，杀鼠取肺，用胶原酶消化法分离肺泡巨噬细胞，可PI和TUNEL法检测其凋亡，同时设有正常大鼠对照组。结果：感染组和治疗组大鼠肺泡巨噬．细胞凋亡率显著高于正常对照组，治疗组大鼠肺泡巨噬细胞凋亡率明显低于感染组。结论：卡氏肺孢子虫感染引起大鼠肺泡巨噬细胞发生凋亡，经双氢青蒿素治疗后PCP大鼠肺泡巨噬细胞凋亡降低。     

Clinical significance of nested polymerase chain reaction and immunofluorescence for detection of Pneumocystis carinii pneumonia

Objective   To study the clinical significance of a nested polymerase chain reaction (PCR) method compared to immunofluorescence (IF) for detection of Pneumocystis carinii .
Methods   The medical records of 89 patients with 91 episodes of pneumonia were scrutinised retrospectively. The pneumonia episodes were divided into categories according to the likelihood that the patient had had clinical Pneumocystis carinii pneumonia (PCP). All respiratory tract samples from the 89 patients (34 broncho-alveolar lavage (BAL) and 57 sputa) were tested for Pneumocystis carinii by IF and nested PCR.
Results   Fifteen episodes, as diagnosed by IF, were classified as true PCP (combination of the groups with definite and probable PCP; sensitivity 60%, specificity 97%). Among the P. carinii DNA-positive episodes, detected with nested PCR, 24 were classified as true PCP (combination of the groups with definite and probable PCP; sensitivity 96%, specificity 59%), since all IF-positive samples were nested PCR positive. Only one pneumonia episode classified as a probable PCP, was negative with both methods, as applied to a BAL sample.
Conclusions   IF applied to BAL or sputum seems to be the most specific method for diagnosis of clinical PCP. Additional clinical cases can be found by nested PCR, although this then gives a high risk of detecting subclinical colonisation of P. carinii .     

加味补中益气汤治疗大鼠肺孢子虫肺炎的疗效观察

目的探讨加味补中益气汤治疗大鼠肺孢子虫肺炎（PCP）的疗效。方法按国内公认的PCP造模方法，建立大鼠PCP动物模型。设中药治疗组和预防组，同时建立西药对照组、PCP模型对照组及正常对照组。通过观察各组大鼠存活率、体重、肺内肺孢子虫包囊的数量和肺组织病理学变化考核药物疗效。结果中药组大鼠存活率高于PCP模型组，但低于正常组；中药治疗组和预防组大鼠平均体重高于PCP模型组，包囊数低于PCP模型对照组；中药治疗组和预防组大鼠肺组织炎症反应明显轻于PCP模型对照组。结论加味补中益气汤对大鼠肺孢子虫肺炎，有一定的疗效。     

瑞香素联合母牛分支菌治疗大鼠卡氏肺孢子菌肺炎的实验研究

目的探讨瑞香素和母牛分支菌联合对大鼠卡氏肺孢子菌肺炎(PcP)的治疗作用。方法地塞米松腹股沟皮下注射SD大鼠8周,建立PcP大鼠模型,将其随机分为模型对照组,瑞香素组,母牛分支菌组,瑞香素与母牛分支菌联合用药组,并设立正常对照组。观察肺病理切片、肺印片中每视野肺孢子菌包囊均数、脾细胞增殖能力及血清INF-γ水平变化。结果治疗组肺孢子菌包囊数较模型组明显减少,肺组织损伤较模型组减轻或修复,脾细胞增殖能力及血清INF-γ水平治疗组较模型组有不同程度的提高,其中联合用药组较单用组效果显著。结论瑞香素和母牛分支菌联合用药治疗卡氏肺孢子菌肺炎大鼠较单用疗效显著。     

卡氏肺孢子虫肺炎大、小鼠低死亡率动物模型的建立

为建立低死亡率卡氏肺孢子虫肺炎 (PCP)SD大鼠和ICR小鼠动物模型 ,本试验将雌性SD大鼠和ICR小鼠分别随机分为实验组和对照组 ,实验组采用按体重定量皮下注射地塞米松的方法 ,免疫抑制诱导建立PCP动物模型 ,对照组注射与地塞米松等体积的生理盐水。分别制作肺印片 ,经瑞 姬氏复合染色后 ,检查卡氏肺孢子虫包囊。制作肺组织病理切片 ,经HE染色后观察肺组织病理变化。用地塞米松诱导后 ,实验组SD大鼠和ICR小鼠死亡率均为 0 ,肺印片阳性率均为 76 7% (2 3 30和 2 3 30 )。肺组织出现典型的病理变化 ,并可观察到Pc包囊。实验组SD大鼠体重下降明显 ,与对照组体重比较具有极显著性差异 (P <0 0 1)。ICR小鼠经诱导后 ,体重变化不显著。采用按体重定量皮下注射地塞米松的方法可建立低死亡率PCP动物模型     

补中益气汤对肺孢子虫肺炎模型大鼠细胞免疫影响的实验研究

目的观察补中益气汤煎剂对卡氏肺孢子虫肺炎模型大鼠的免疫调节作用。方法Waster雌性大鼠60只,随机分成正常对照组、模型对照组、西药治疗对照组、中药治疗组及中药预防组。除正常组外其他4组均参照国内外公认的造模方法建立肺孢子虫肺炎模型。模型对照组生理盐水灌胃：西药治疗对照组与中药治疗组于实验第5周起至第6周分别给予复方新诺明及补中益气汤煎剂灌胃;中药预防组于实验第1周起以补中益气汤煎剂灌胃。于实验第6周末处死各组大鼠并检测各组大鼠淋巴细胞转化率和T细胞亚群百分比。结果正常组大鼠淋巴细胞转化率、CD4＋T细胞数量和CD4＋／CD8＋的值高于模型组,其差异具有统计学意义。中药预防组大鼠淋巴细胞转化率、CD4CF细胞数量和CD4＋／CD8＋的值高于西药治疗组和模型组。预防组大鼠CD4＋、CD4＋／CD8＋的值与正常组差异无统计学意义。西药治疗组CD4＋、CD4＋／CD8＋的值与模型组无差异。结论正常组与中药预防组大鼠T淋巴细胞转化率高于模型组,CD4＋T细胞数量的减少与PCP的发生具有密切关系,正常组与中药预防组CD4＋T细胞数量高于模型组,补中益气汤能够提高卡氏肺孢子虫肺炎模型大鼠淋巴细胞转化率和CD4＋T细胞的数量,在本实验中中药预防组的效果尤为显著,证实该方剂对大鼠肺孢子虫肺炎具有防治作用。     

Foamy alveolar casts: diagnostic specificity for Pneumocystis carinii pneumonia in bronchoalveolar lavage fluid cytology

Pneumocystis carinii pneumonia (PCP) is a major infectious complication of immunodeficiency states, including the acquired immunodeficiency syndrome (AIDS). Bronchoalveolar lavage (BAL) is a safe and effective procedure for making this diagnosis. In addition to the characteristic organisms, both histologic and cytologic material often reveals exudate in the form of foamy alveolar casts (FACs). To test the diagnostic utility of FACs in BAL fluids, we compared 20 PCP-positive and 28 PCP-negative fluids as assessed by silver stains. All PCP-positive fluids contained FACs on Papanicolaou-stained material. Only one PCP-negative lavage contained FACs, and transbronchial biopsy in this case revealed PCP. We suggest that FACs in BAL fluids are highly sensitive and specific for the diagnosis of PCP.     

Autopsy case of alcoholic hepatitis and cirrhosis treated with corticosteroids and affected by Pneumocystis carinii and cytomegalovirus pneumonia

A case of the very early phase of Pneumocystis carinii pneumonia in a human immunodeficiency virus (HIV)-negative man with alcoholic hepatitis and cirrhosis treated with steroids is presented. A 40-year-old man with a 10-year history of alcohol abuse was admitted to hospital with jaundice, fever and macrohematuria. Laboratory examinations revealed neutrophilic leukocytosis and a serum bilirubin level of 13.9 mg/dL. The serum bilirubin level rose to 28.5 mg/dL over 1 month. Prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever. After an interval of a week, it was resumed and maintained for 22 days (total dose, 1555 mg) until the patient died of a massive hemorrhage from ruptured vessels of a gastric ulcer. An autopsy disclosed P. carinii pneumonia in the lower lobe of the left lung, cytomegalovirus infection in both lungs and the esophagus, and esophageal candidiasis. To our knowledge, this is the first report of P. carinii pneumonia together with cytomegalovirus infection in an HIV-negative alcoholic patient. The present case suggests that a rare opportunistic infection such as P. carinii pneumonia might be caused by treating cirrhosis and alcoholic hepatitis with corticosteroids, even if only for a relatively short period.     

Identification of Pneumocystis carinii by Quick Hematoxy in and Eosin Smear

Abstract

Intraoperative identification of Pneumocystic carinii generally involves the use of special stains, which are time consuming and require expertise. The hematoxylin-eosin (H & E) stain readily demonstrates the organism in smears but not in tissue sections. The method described affords identification of these organisms within 5-10 min. A smear obtained from bisected lung biopsy tissue is immediately fixed with cytosol spray, dried for a few sec, and stained with H & E. When slides are examined with either high dry or oil immersion objectives, the smear shows foamy amorphous clusters of organisms, macrophages, and epithelial cells. The method stains both the cysts and the trophozoites, and the results correlate with those from special stains on tissue sections. It is rapid, simple to perform, low in cost, and easy to interpret. (The J Histotechnol 14:179, 1991)     

Cefotaxime desensitization

Summary We report the successful desensitization to cefotaxime in a patient with severe lumbar osteomyelitis of unknown bacteriology and hypersentivity to the drug. Desensitization was carried out because of the unknown bacteriology, the favorable response to cefotaxime at that time, and hypersensitivity to other antibiotics. On the first day the patient received 1 mg cefotaxime intravenously. The dose was increased for 13 successive days to 4 g cefotaxime intravenously per day. No allergic reaction occurred during densitization or within 4 weeks of observation under this therapy. Patients with severe infections of unknown bacteriology might benefit from desensitization if therapy with a second-choice antibiotic is impossible.Dedicated to Prof. Dr. N. Zöllner on the occasion of his 70th birthday     

Survival of patients receiving zidovudine before or after AIDS diagnosis: results of a German multicenter study

While efficacy of zidovudine (ZDV) in the acquired immunodeficiency syndrome (AIDS) is well established, the issue of survival after early ZDV treatment is still controversial. To assess survival benefits of ZDV treatment prior to AIDS, as compared to treatment after the onset of AIDS, we used an observational analysis of infected individuals infected with human immunodeficiency virus treated with ZDV and/or prophylaxis against Pneumocystis carinii pneumonia prior to or after AIDS in comparison to patients never treated with ZDV Nine German AIDS treatment centers entered case reports dating from January 1988 to January 1992. A total of 1425 HIV-infected patients were included, mainly homo-/bisexuals: 1338 males and 87 females, with a mean age of 38.9 years. Of these, 262 had received ZDV prior to AIDS, 376 after AIDS, and 787 had never received ZDV Survival from a first CD4 lymphocyte count below 0.200 × 10⁹/1 (or below 0.500 × 10⁹/1) to death was assessed by means of Kaplan-Meier analysis. Survival did not differ significantly when the first CD4 count below 0.200 × 10⁹/1 was taken as baseline. The median survival of patients receiving ZDV prior to AIDS was 662 days as compared to 572 days in patients treated after AIDS. Patients with earlier therapy showed longer survival in a subset of patients who were observed from their first CD4 count below 0.500 × 10⁹/1. Additional PcP prophylaxis significantly improved survival in all groups. We conclude that survival from the first CD4 count below 0.200 × 10⁹/1 to death does not differ in patients receiving ZDV prior to or after AIDS. Additional PcP prophylaxis improves survival in ZDV-treated patients and patients without ZDVParticipating centers (order according to number of patient's files in the study): Kamps B, Brodt HR: Zentrum der Inneren Medizin, Universität Frankfurt; Arastéh K, Heise W: II. Innere Abteilung, Auguste-Viktoria-Krankenhaus, Berlin; Sadri 1, Goebel F-D: Medizinische Poliklinik, Universität München; Schedel I: Abteilung Immunologie, Medizinische Hochschule Hannover; Runge J, Schwander S: Bernhard Nocht Institut für Tropenmedizin, Hamburg; Jablonowski H, Szelenyi H: Medizinische Klinik and Poliklinik, Universität Düsseldorf; Emminger C, Loch O: IV Medizinische Abteilung, Krankenhaus München-Schwabing; Schöfer H, Hochscheid I: Zentrum der Dermatologie, Universität Frankfurt; Baumgarten R: Krankenhaus Prenzlauer Berg, Berlin     

A search for Pneumocystis carinii in post-mortem lungs by DNA amplification.

DNA amplification of specific sequences and subsequent oligonucleotide hybridization were used to search for Pneumocystis carinii in post-mortem lung samplings from non-immunosuppressed individuals ranging from 15 to 70 years of age. No P. carinii-specific DNA was detected in 45 DNA amplification reactions from 15 lungs.