Pneumocystis jirovecii

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Pneumocystis jirovecii
Pneumocystis jirovecii

Pneumocystis jirovecii

Systematics
Subdivision : Taphrinomycotina
Class : Pneumocystidomycetes
Order : Pneumocystidales
Family : Pneumocystidaceae
Genre : Pneumocystis
Type : Pneumocystis jirovecii
Scientific name
Pneumocystis jirovecii
Frenkel

Pneumocystis jirovecii (or P. jiroveci) is a fungus from the genus Pneumocystis, it occurs ubiquitously and is the causative agent of interstitial pneumonia ( pneumocystis pneumonia , PCP ), which occurs particularly in infants , immunocompromised and AIDS sufferers . PCP is the most common first manifestation with 50% and the most common opportunistic infection in AIDS patientswith 85%. The pathogen is no longer assigned to the protozoa , but to the hose fungi (Ascomycota) and is named after Otto Jírovec .

In the past, Pneumocystis jirovecii was called Pneumocystis carinii . This designation, which can still be found sporadically today, is no longer formally permitted. It was shown that the occurring in the human pathogens from that in rats discovered Pneumocystis carinii is different.

features

The trophozoites have a diameter of approx. 1 µm. Their shape is oval to oblong. Repeated division results in cysts with six to eight spores (diameter: approx. 5–7 µm). The species differs from other mushrooms, among other things, in that the cell membrane does not contain ergosterol , but cholesterol .

nomenclature

The name Pneumocystis jiroveci is often used for the species . However, the correct name is jirovecii (International Code of Nomenclature for Algae, Fungi and Plants).

clinic

X-ray of Pneumocystis jirovecii pneumonia

Infected patients often complain of shortness of breath, tachypnea and dry cough. Usually there is a fever. The auscultation is unremarkable, the X-ray image of the lungs is only in the course changes i. S. of reticulo-nodular thickening of the interstitium. An increase in the LDH in the blood is also typical .

proof

Evidence is provided by microscopy of a direct specimen of induced sputum , a bronchoalveolar lavage (BAL) or a transbronchial biopsy . A staining method is used to better visualize the pneumocysts (e.g. with optical brighteners , toluidine blue or immunofluorescence ). Alternatively, quantitative real-time PCR is increasingly being used as a detection method, whereby a positive detection is not always easy to interpret here, as the fungus can colonize the respiratory tract in small amounts even in healthy people. Pneumocystis jirovecii cannot be grown on the usual culture media .

therapy

For therapy and prophylaxis (e.g. in AIDS patients), the antibiotic cotrimoxazole, which is actually effective against bacteria, is used as standard (for therapy in very high doses). Alternatively, primaquine and clindamycin or antiparasitic agents such as pentamidine or atovaquone can be used. Echinocandins such as caspofungin could in principle also be used to treat Pneumocystis jirovecii infections, but this has so far been very unusual. Antimycotics from the classes of polyenes and triazoles are ineffective against Pneumocystis because they inhibit the synthesis of ergosterol, which does not occur in this species (see above).

See also

Web links

Commons : Pneumocystis jirovecii  - Collection of images, videos and audio files

Individual evidence

  1. ^ Stringer, JR et al .: A new name (Pneumocystis jiroveci) for Pneumocystis from humans . In: Emerg Infect Dis . 8, No. 9, 2002, pp. 891-898. PMID 12194762 .
  2. ^ Index Fungorum
  3. Herold G. "Internal Medicine 2017", p. 387.
  4. Reinhard Rüchel: Pneumocystis jiroveci. In: Birgid Neumeister, Heinrich K. Geiss, Rüdiger W. Braun, Peter Kimmig (eds.): Microbiological diagnostics . 2nd Edition. Thieme, Stuttgart - New York 2009, ISBN 978-3-13-743602-7 . Pp. 668-672.
  5. ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 222 f. and 293.