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ID 6.3


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Pneumocystis (carinii) jiroveci
First discovered c 1900 in institutionalized patients/debilitated infant. The introduction of transplants and AIDS fortified pneumocystis' role in immunocompromized hosts
Pneumocystis and AIDS patients
W/out prophylaxis, majority will develop pneumocystis pneumonia
P. carinii vs. jiroveci
Carinii = rat pathogen
Jiroveci = human pathogen
Pneumocystis jiroveci
Ubiquitous fungus. Vast majority of children are serotype positive before kindergarten. Suspected airborn pathogen, transient carriage, but continual exposure
Pneumocystis and host immunity
Humoral immunity < cell-mediated immunity
Direct correlation between T-cell count and developing illness in AIDS patients
Pathophysiology of pneumocystis infection
"Foamy," eosinophilic exudate resulting in hypoxemia (broader A-a gap) and impaired CO2 diffusion capacity
Pneumocystic infections
(clinical manifestations)
Debilitated infants: interstitual plasma cell pneumonia (insidious onset)
Immunocompromized adults: pneumonia (shortness of breath, dry-cough, dyspnea w/exertion)
Late stage AIDS w/aerosolized vs. systemic prophylaxis: extrapulmonary pneumocytosis
Pneumocystic infections
Chest X-ray (diffuse, bilateral INTERSTITIAL pneumonia - but may possibly look normal!); blood-gases; sputum stains (immunofluorescence esp.)
Pneumocystic infections
AIDS patients: prophylaxis if CD4 < 200
Budding, oval/round yeasts
No special growth requirements
~150 species, but ~10 significant (important in susceptibility/pathogenicity)
Ubiquitous in environoment
Generally endogenous source (some nosocomial infections)
(virulence factors)
(1) Adherence, i.e. to fibronectin, epithelia (oral and vaginal)/endothelial surfaces, and prosthetic devices
(2) extracellular proteases (enable invasion of epithelium)
(susceptible patient populations)
Immunocompromized, altered flora (i.e. broad antibiotic use), prosthetic devices
Candida infections
(mucus membranes)
Oral candidiasis (thrush, erythmatous, leukoplakia, chronic atrophic), esophagitis, vaginitis
Pseudomembraneouos oral candidiasis
Curd-like patches on tongue and oral mucosa
Erythematous Oral Candidiasis
Acute atrophic candiasis
Red patches
Chronic atrophic candidiasis
Oral candidiasis
Denture/angular cheilitis
Inflammation of lips
Radiates from angles of mouth
Cutaneous Candidiasis Infections
Chronic mucocutaneous candidiasis, paronychia, onychomycosis, intertrigo
"yeasts cause COPIous cutaneouos infections"
Chronic Mucocutaneous Candidiasis
Failure of T cells to respond to candida antigen
(presents infancy, early childhood)
Cutaneouos yeast infection due to frequent immersion of hands in water (i.e. dishwashers)
Direct (yeast) infection of finger/toe-nails
Yeast infection of warm, close-proximity skin (i.e. under breasts)
Deep organ Candida infections
Rare, but possible
CNS (due to dissemination)
Pneumonia (direct inoculation or dissemination)
Endocarditis (IV drug use, prosthetic devices)
Candida in urine
Indwelling urinary catheter
Cystitis (from previous urinary catheter)
Upper urinary tract infection (hematogenous or ascending spread)
Candida infections
CULTURE body fluids, then stain
Candida infections
Amphotericin B and fluconazole

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