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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pneumocystis carinii characteristically causes pneumonia in patients with immunodeficiency disorders. It occurs most often in patients with malignancy or renal transplants whose immune response has been suppressed by corticosteroids or cytotoxic agents. Individuals with connective tissue disease who receive immunosuppressive drugs become susceptible to Pneumocystis. The incidence of Pneumocystis infection in connective tissue disease is low but may increase if immunosuppressive drugs are used more often. Our patient acquired Pneumocystis pneumonia after immunosuppressive therapy for polyarteritis nodosa. Prompt recognition of this condition is essential now that specific therapy is available. Untreated Pneumocystis infection is usually fatal.
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PMID:Arthritis rounds. Pneumocystis carinii associated with polyarteritis and immunosuppressive therapy. 1 12

To determine if examination of respiratory secretions is useful in diagnosing Pneumocystis carinii pneumonia, smear preparations of expectorated sputum, tracheal aspirates, and transtracheal aspirates stained by the Gomori methenamine silver nitrate method were examined. Pneumocysts were observed more frequently in material obtained by transtracheal aspiration than in secretions obtained by the other methods. Transtracheal aspiration yielded material containing pneumocysts in 8 (13%) of 60 patients; each had pulmonary infiltrates and clinical courses consistent with P carinii pneumonia. Of 330 smear preparations examined from expectorated sputum, three patients had pneumocysts in their sputum and one had organisms in both transtracheal aspiration and expectorated sputum; all three had pneumonia. This study provides evidence that transtracheal aspiration is a useful initial step in the approach to the diagnosis of P carinii pneumonia.
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PMID:Pneumocystis carinii pneumonia. Diagnosis by examination of pulmonary secretions. 6 65

Unlike most pneumonias, the diagnosis of Pneumocystis carinii pneumonia is based solely on identifying organisms by stain, usually with methenamine-silver. Because of technical problems involved with adequate staining, control samples usually are done concurrent with tissue specimens to be examined. Lung containing fungi often is used as a control. We recently observed false-negative biopsy specimens in a case of P carinii pneumonia where the Pneumocystis organism failed to stain with methenamine-silver on several occasions, although fungal controls were positive. This report emphasizes the importance of using P carinii as a control whenever attempting to diagnose P carinii pneumonia.
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PMID:False negative biopsy in Pneumocystis carinii pneumonia. 8 33

The air bronchogram classically signals an end-air-space or "alveolar" filling process such as alveolar proteinosis and bronchioloalveolar-cell carcinoma. However, it can also occur in interstitial diseases, possibly leading to compressive atelectasis and causing crowding of tissue around open airways. In addition, such disease processes may encroach on distal airways, producing obstructive pneumonia which may then surround open proximal airways, as in sarcoidosis and lymphoma. In mixed "alveolar" and interstitial processes such as Pneumocystis carinii pneumonia and the late stages of hemosiderosis, "alveolar" filling may mask the interstitial disease.
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PMID:The air bronchogram in interstitial disease of the lungs. A radiological-pathological correlation. 16 9

Thirty-eight children were evaluated for interstitial pneumonia by open lung biopsy. In most instances the patients were immunosuppressed as a result of cancer chemotherapy and irradiation. Pneumocystis carinii infection was the most common cause of pneumonitis (60.4%), especially in children with leukemia (78.3%). The clinical triad of hypoxemia, tachypnea, and a diffuse interstitial infiltrate on chest x-ray, is an indication for early open lung biopsy. Survival was 91.7% in cases of acute pneumocystis pneumonia, a significant improvement over previous reports. These observations strongly support the concept of early open lung biopsy in the management of diffuse interstitial pneumonitis in patients who are immunosuppressed.
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PMID:Interstitial pneumonitis in the immunologically suppressed child: an urgent surgical condition. 30 27

Fifty patients with P. carinii pneumonitis were randomized to receive either pentamidine isethionate or trimethoprim-sulfamethoxazole therapy. Those not responding favorably to the first drug after three or more days of therapy were changed to the alternate drug. Of the 26 patients initially treated with TMP-SMZ, 20 recovered (0.77)-17 after TMP-SMZ alone and three of nine who were crossed over to pentamidine. Of the 24 patients initially treated with pentamidine, 18 recovered (0.75)-14 of 15 who received only pentamidine and four of nine who were crossed over to TMP-SMZ. Abnormal values for blood urea nitrogen, creatinine, or glucose; inflammation at injection sites; or combination of these effects occurred in 14 of the 15 patients treated with pentamidine alone. Only one of the 17 patients treated with TMP-SMZ alone developed any of these abnormalities. This study shows that TMP-SMZ is as effective as pentamidine in the treatment of PCP, and that it offers the advantages of minimal adverse effects, oral administration, and ready availability.
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PMID:Comparison of pentamidine isethionate and trimethoprim-sulfamethoxazole in the treatment of Pneumocystis carinii pneumonia. 30 78

Treatment with either pentamidine isethionate or trimethoprim-sulfamethoxazole significantly reduces the mortality of Pneumocystis carinii pneumonia. It is not known whether a combination might act in an additive, synergistic, or antagonistic manner. We studied the interaction of these two agents in the steroid-conditioned rat model of pneumocystosis. Of animals receiving pentamidine alone, 48% died and 45% had P. carinii cysts at autopsy. Trimethoprim-sulfamethoxazole alone resulted in 21% mortality, and cysts were found in 28%. Both agents in full doses resulted in 45% deaths and cysts in 37%. Animals treated with half-dosages of pentamidine plus trimethroprim-sulfamethoxazole had mortality of 35%, and 21% had cysts. Trimethoprim alone, in two dosages, was ineffective in eradicating P. carinii cysts. The data suggest that combination therapy is no more effective than trimethoprim-sulfamethoxazole alone in the treatment of P. carinii pneumonia.
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PMID:Combination of pentamidine and trimethoprim-sulfamethoxazole in therapy of Pneumocystis carinii pneumonia in rats. 30 41

A 39-year-old man with Pneumocystis carinii pneumonia responded poorly to oral trimethoprim-sulfamethoxazole (TMP-SMX) therapy, despite excellent serum concentrations of the drug. He developed severe thrombocytopenia when pentamidine was added to the regimen. This case illustrates problems of drug efficacy and toxicity in the treatment of P carinii pneumonia and suggests caution in the use of TMP-SMX and pentamidine in combination.
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PMID:Treatment of Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole and pentamidine: efficacy and toxicity. 31 94

Pneumonia caused by Pneumocystis carinii in two unrelated Miniature Dachshunds is reported. The clinical findings, gross- and histopathology and some diagnostic transmission and scanning electron microscopic features of the condition are described. Although pneumocystosis has been reported from a human and a domestic goat in the Republic of South Africa, these are probably the first reported cases of the canine disease in this country.
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PMID:Pneumocystosis: a chronic respiratory distress syndrome in the dog. 31 32

Thirty-three marrow transplant patients with Pneumocystis carinii pneumonia were studied to determine the usefulness of antibody and antigen detection in the diagnosis of pneumocystis infection. Antibody against P. carinii was present in one half of all patients tested, and changes in antibody titer were not helpful diagnostically. P. carinii antigen was detected by counterimmunoelectrophoresis in the serum of 22 of 28 patients tested. Fifteen of 28 patients had antigen detected before or within 72 h after diagnosis. However, antigen was also present in 35 of 52 marrow transplant patients with viral or idiopathic pneumonia, in 11 of 25 transplant patients with no pneumonia, and in 22 of 28 other patients with pulmonary infiltrates. Only 1 of 50 normal marrow donors had detectable antigenemia. Detection of this antigen does not appear to establish the diagnosis of P. carinii pneumonia in the absence of other clinical or histologic data. The data may suggest that subclinical infection with this agent is more common than was previously recognized.
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PMID:The value of Pneumocystis carinii antibody and antigen detection for diagnosis of Pneumocystis carinii pneumonia after marrow transplantation. 39 Nov 11


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