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42 - Pneumocystis carinii pneumonia (PCP)

from Part V - Infectious problems in pediatric HIV disease

Published online by Cambridge University Press:  03 February 2010

By
L. K. Serchuck
Edited by
Steven L. Zeichner  and
Jennifer S. Read
L. K. Serchuck
Affiliation:
Pediatric, Adolescent and Maternal AIDS Branch, NICHD/NIH, Rockville MD
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Cancer Institute, Bethesda, Maryland
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Summary

Pneumocystis carinii pneumonia (PCP) is the most common AIDS-defining condition and most life-threatening opportunistic infection in children infected with HIV in developed countries. The incidence of PCP has decreased dramatically with the introduction of highly active antiretroviral therapy (HAART) and with routine use of prophylaxis regimens.

Biology and taxonomy

In 1909 and 1910, Chagas and Carini first described Pneumocystis carinii, incorrectly, as the sexual state of Trypanosoma cruzi [1, 2]. The organism was identified as a unique microbe in 1912 in Parisian sewer rats and named after Carini. It was recognized as a human pathogen in 1952 by the Czech parasitologist, Jirovec [3] who causally related the organism to plasma cell pneumonia in 3 to 6-month-old preterm and malnourished infants living in European orphanages after World War II. From that time until the 1980s, PCP was uncommon, occurring primarily in patients who were immunocompromised because of cancer therapy or congenital immune deficiencies [4].

Pneumocystis is a unicellular eukaryotic organism with a nuclear membrane and intracellular organelles. It exists in three morphologic forms: sporozoites, trophozoites, and cysts. Trophozoites (2–5 μm) adhere to alveolar epithelium where they multiply and mature into cysts (5–8 μm). These cysts are round or crescent-shaped thick-walled structures that contain up to 8 sporozoites (1–2 μm) which when released mature to become trophozoites. The cyst and trophozoite forms are found in lung and pleural fluid.

Pneumocystis organisms were initially thought to be a single strain that infected a broad range of hosts.

Type
Chapter
Information
Textbook of Pediatric HIV Care , pp. 620 - 632
Publisher: Cambridge University Press
Print publication year: 2005

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References

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