Pneumocystis

Jiroveci

TAGEL GETACHEW
 Pneumocystis jiroveci pneumonitis (PJP) is
a common opportunistic disease that occurs
almost exclusively in persons who have
profound immunodeficiency.

=PJP was and still is the most common life-

threatening opportunistic infection occurring
in patients with HIV disease.
The taxonomy of P.jiroveci has not been established.
It is either a protozoan or a fungus. Recent studies
show P.jiroveci more closely resemble fungi than
protozoa.
• rRNA sequences
• thymidylate synthase
• dihydrofolate reductase
• beta tubulin
• mitochondrial DNA
• chitin in the cell wall

O E Eriksson has a treatise which places P.

carinii in a new family, Pneumocystidaceae,
and in a new order, Pneumocystidales
(Ascomycota).
The mode of replication
 The mode of replication of P.jiroveci has not
been established. However, the stages in its
life cycle have been characterized.
=Sporozoites excyst through breaks in the
cyst wall and then are termed trophozoites.
The means by which the trophozoite form
progresses to the cyst phase is not known.
Portal of entery
 The portal of entry of P. carinii has been
found only in the lung, inhalation is
a likely mode of transmission.
= In most individuals, the organism is
dormant in the lung, with no apparent
host response (latent infection).
>In susceptible (immunocompromised)
hosts, the organism occurs in massive
numbers.
 P. carinni causes disease only when natural
mechanisms of host defense are compromised.

Pneumonitis tends to occur in patients with=

~impaired cell-mediated immunity, and AIDS.
~ Severe protein- malnutrition alone may
provoke the disease.
~ Immunosuppressive drugs users are
susceptible to P. carinii pneumonitis.
  Pneumocystis carinii has been
found in the lungs of d|f animal.
= The organism has been reported in lower
animals and humans.
=Animal to animal transmission by the
airborne route has been demonstrated.
~ Because about 70 percent of healthy
individuals may have humoral antibody to P.
carinii, subclinical infection must be highly
prevalent.
Laboratory Diagnosis
 Diagnosis requires the identification of
P.carinii in pulmonary tissue or lower airway
fluids. Such specimens may be obtained by
lung biopsy, inducement of sputum,
bronchoalveolar lavage, or needle aspiration
of the lung.
The Gomori, Giemsa, fluorescence-labelled
antibody, or toluidine blue O stains may be
used to identify the organism.
 Pneumocystis carinii
http://www.doctorfungus.org

• Genus/Species: Pneumocystis carinii • Title: EM Image of Pneumocystis carinii

• Image Type: Microscopic Morphology • Disease(s): Pneumocystis pneumonia

• Legend: An electron micrograph of P. carinii cyst from rat lung tissue.

 Pneumocystis carinii
http://www.doctorfungus.org

• Genus/Species: Pneumocystis carinii • Title: Pneumocystis carinii-infected

• Image Type: Microscopic Morphology Rat Lung Tissue  
• Disease(s): Pneumocystis pneumonia
• Legend: An H&E stain of a rat lung infected with P. carinii. It does not show any organisms, but shows the
proteinaceous exudate which results from Pneumocystis infection, and ultimately causes reduced gas exchange.
 Pneumocystis carinii
http://www.doctorfungus.org

• Genus/Species: Pneumocystis carinii • Title: Pneumocystis carinii Silver Stain

• Image Type: Microscopic Morphology Disease(s): Pneumocystis pneumonia

• Legend: A silver stain of P. carinii cysts from rat lung tissue showing the typical 'deflated ball' shape.
 Pneumocystis carinii
http://www.doctorfungus.org

• Genus/Species: Pneumocystis carinii • Title: EM Image of Pneumocystis carinii

• Image Type: Microscopic Morphology Disease(s): Pneumocystis pneumonia
• Legend: An electron micrograph of a P. carinii troph from rat lung tissue, showing its binding
to a type I pneumocyte.
Treatment
•Four drugs currently available for therapy of
P carinii pneumonitis are:

• pentamidine isethionate
• trimethoprim-sulfamethoxazole
• atovaquone
• trimetrevate

Trimethoprim-sulfamethoxazole is
preferred because of its low toxicity
and greater efficacy.
Information obtained from:

• UTMB Graduate School of

Biomedical Sciences
http://gsbs.utmb.edu
• Dr Fungus
http://www.doctorfungus.org
• HIV Insite
http://hivinsite.ucsf.edu
THANK YOU