Association of Chronic Obstructive Pulmonary Disease Severity and Pneumocystis Colonization

M.S., Division of Pulmonary and Critical Care Medicine, 2011 Zonal Avenue, Los Angeles, CA 90033, USA.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 09/2004; 170(4):408-13. DOI: 10.1164/rccm.200401-094OC
Source: PubMed


Factors modulating the variable progression of chronic obstructive pulmonary disease (COPD) are largely unknown, but infectious agents may play a role. Because Pneumocystis has previously been shown to induce a CD8(+) lymphocyte- and neutrophil-predominant response similar to that in COPD, we explored the association of the organism with accelerated disease progression. We examined Pneumocystis colonization rates in lung tissue obtained during lung resection or transplantation in smokers with a range of airway obstruction severity and in a control group with lung diseases other than COPD. Using nested polymerase chain reaction, Pneumocystis colonization was detected in 36.7% of patients with very severe COPD (Global Health Initiative on Obstructive Lung Disease [GOLD] Stage IV) compared with 5.3% of smokers with normal lung function or less severe COPD (Stages 0, I, II, and III) (p = 0.004) and with 9.1% of control subjects (p = 0.007). Colonized subjects exhibited more severe airway obstruction (median FEV(1) = 21% predicted versus 62% in noncolonized subjects, p = 0.006). GOLD IV was the strongest predictor of Pneumocystis colonization (odds ratio = 7.3, 95% confidence interval = 2.4-22.4, p < 0.001) and was independent of smoking history. We conclude that there is a strong association between Pneumocystis colonization and severity of airflow obstruction in smokers, suggesting a possible pathogenic link with COPD progression.

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    • "Pneumocystis infection is acquired by inhalation of organisms from a yet unknown source (Keely et al., 1995; reviewed in Kelly and Shellito, 2010). Most Pneumocystis infections occur in immunosuppressed individuals due to either HIV or chronic obstructive pulmonary disease (Leigh et al., 1993; Nevez et al., 1999; Huang et al., 2003; Calderon et al., 1996; Morris et al., 2004; Norris et al., 2006; Davis et al., 2008; Morris et al., 2008a; Morris et al., 2008b; Kling et al., 2009). Similarly, infection with Rhizopus typically occurs in individuals who are immune compromised, such as organ transplant recipients (Kontoyiannis, 2010; Pappas et al., 2010). "

    Full-text · Chapter · Mar 2012
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    • "For example, if upper lobe samples had been used exclusively, only 10.5% of subjects would have been considered colonized. This observation could partly explain the differences in colonization detection in the COPD literature which varies between 7–41% [Calderón et al., 1996, Morris et al., 2004]. While differences in respiratory sample used (i.e. "
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    ABSTRACT: Pneumocystis jirovecii has been detected in lung tissue from patients with chronic obstructive pulmonary disease (COPD) and is associated with disease severity. The regional distribution of the organism in lungs is unknown, but differences in distribution of Pneumocystis could affect estimates of colonization prevalence. We examined the distribution of Pneumocystis in the lungs of 19 non-HIV-infected patients with COPD who were undergoing lung transplantation. DNA was extracted from explanted lungs. We found Pneumocystis colonization in lung tissue of 42.1% of patients with advanced COPD; however, there was significant regional variation in colonization between lung segments of individual patients. Colonization was detected more commonly in the lower and middle lobes than in the upper lobes. These findings suggest that single samples from an individual may underestimate the prevalence of Pneumocystis colonization and future studies may obtain a higher yield of Pneumocystis colonization detection when sampling the lower lobes.
    Full-text · Article · Sep 2011 · Diagnostic microbiology and infectious disease
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    • "Colonization with Pneumocystis has also been associated with airways obstruction and chronic obstructive pulmonary disease (COPD) and possibly with other pulmonary diseases as well (Vidal et al., 2006). In one study, Pneumocystis colonization was detected in 36.7% of HIV-negative patients with very severe COPD (Global Health Initiative on Obstructive Lung Disease [GOLD] Stage IV) compared with 5.3% of smokers with normal lung function or less severe COPD (GOLD Stages 0, I, II, and III) (p = 0.004) and with 9.1 % of control subjects (p = 0.007) (Morris et al., 2004). Pneumocystis colonized subjects exhibited more severe airway obstruction (median FEV1 = 21% predicted vs 62% predicted in non-colonized subjects, p = 0.006). "
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    ABSTRACT: Pneumocystis pneumonia (PcP) remains a significant cause of morbidity and mortality in immunocompromised persons, especially those with human immunodeficiency virus (HIV) infection. Pneumocystis colonization is described increasingly in a wide range of immunocompromised and immunocompetent populations and associations between Pneumocystis colonization and significant pulmonary diseases such as chronic obstructive pulmonary disease (COPD) have emerged. This mini-review summarizes recent advances in our clinical understanding of Pneumocystis and PcP, describes ongoing areas of clinical and translational research, and offers recommendations for future clinical research from researchers participating in the "First centenary of the Pneumocystis discovery".
    Full-text · Article · Feb 2011 · Parasite
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