Article

Pneumocystis Pneumonia in HIV-positive Adults, Malawi

University of Malawi College of Medicine, Blantyre, Malawi.
Emerging infectious diseases (Impact Factor: 7.33). 03/2007; 13(2):325-8. DOI: 10.3201/eid1302.060462
Source: PubMed

ABSTRACT In a prospective study of 660 HIV-positive Malawian adults, we diagnosed Pneumocystis jirovecii pneumonia (PcP) using clinical features, induced sputum for immunofluorescent staining, real-time PCR, and posttreatment follow-up. PcP incidence was highest in patients with the lowest CD4 counts, but PcP is uncommon compared with incidences of pulmonary tuberculosis and bacterial pneumonia.

0 Followers
 · 
104 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine the prevalence of Pneumocystis pneumonia (PCP), a major opportunistic infection in AIDS patients in Europe and the USA, in Cameroon.Materials and methodsInduced sputum samples from 237 patients without pulmonary symptoms (126 HIV-positive and 111 HIV-negative outpatients) treated at a regional hospital in Cameroon were examined for the prevalence of Pneumocystis jirovecii by specific nested polymerase chain reaction (nPCR) and staining methods. CD4 counts and the history of antiretroviral therapy of the subjects were obtained through the ESOPE database system.Results and conclusionSeventy-five of 237 study participants (31.6%) were colonised with Pneumocystis, but none showed active PCP. The Pneumocystis colonisation rate in HIV-positive subjects was more than double that of HIV-negative subjects (42.9% vs. 18.9%, P < 0.001). In the HIV-positive group, the colonisation rate corresponds to the reduction in the CD4 lymphocyte counts. Subjects with CD4 counts >500 cells/μl were colonised at a rate of 20.0%, subjects with CD4 counts between 200 and 500 cells/μl of 42.5%, and subjects with CD4 counts <200 cells/μl of 57.1%. Colonisation with Pneumocystis in Cameroon seems to be comparable to rates found in Western Europe. Prophylactic and therapeutic measures against Pneumocystis should be taken into account in HIV care in western Africa.
    Tropical Medicine & International Health 03/2014; 19(6). DOI:10.1111/tmi.12299 · 2.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A molecular diagnostic technique based on Real Time PCR was developed for the simultaneous detection of three of the most frequent causative agents of fungal opportunistic pneumonia in AIDS patients; Pneumocystis jirovecii, Histoplasma capsulatum and Cryptoccocus neoformans/gattii. This technique was tested in cultured strains and clinical samples from HIV patients. The methodology used was species-specific molecular beacon probes targeting the ITS region from the rDNA. An internal control was also included in each assay. The Multiplex Real Time PCR assay was tested in 24 clinical strains and 43 clinical samples from AIDS patients with proven fungal infection. The technique developed showed a high reproducibility (r(2) > 0.98) and specificity (100%). For H. capsulatum and Cryptococcus spp., the detection limit of the method was 2 fg of genomic DNA/20 μl of reaction while for P. jirovecii it was 2.92 Log10 copies/20 μl of reaction. The sensitivity in vitro was 100% for clinical strains and 90.7% for clinical samples. The assay was positive for 92.5% of the patients. For one of the patients with proven histoplasmosis, P. jirovecii was also detected in a bronchoalveolar lavage. No PCR inhibition was detected. This multiplex real time PCR technique is fast, sensitive and specific, and may have clinical applications.
    Journal of clinical microbiology 01/2014; 52(4). DOI:10.1128/JCM.02895-13 · 4.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the considerable morbidity and mortality associated with fungal diseases in sub-Saharan Africa, it is notable that these diseases have been omitted from an expanded list of neglected tropical diseases. Inextricably tied together with HIV/AIDS and tuberculosis in sub-Saharan Africa, important fungal diseases such as cryptococcal meningitis and Pneumocystis jirovecii pneumonia (PCP) manifest as relatively common and deadly AIDS-defining opportunistic infections, often masked by and comorbid with tuberculosis. Others, such as mycetoma, which manifest as a debilitating and deforming illness primarily affecting rural adults, directly affect the socioeconomic productivity of rural communities. Lack of adequate diagnostic tests makes identifying the true disease burden due to fungal diseases difficult. To highlight the devastating impact of fungal diseases on the health and socioeconomic circumstances of sub-Saharan Africa’s poorest people and to increase the profile of efforts to control and prevent these diseases, we propose that the following fungal diseases be added to the list of neglected tropical diseases: cryptococcal meningitis, PCP, mycetoma, histoplasmosis, sporotrichosis, and blastomycosis. By outlining the prevalence, distribution, and disease burden of these fungal diseases in sub-Saharan Africa in this review, we hope to provide information to prioritize strategies for detection, control, and prevention of the neglected fungal diseases.
    Current Fungal Infection Reports 12/2011; 5(4). DOI:10.1007/s12281-011-0072-8

Full-text (2 Sources)

Download
35 Downloads
Available from
Jun 4, 2014