1. Pneumocystis carinii Katrina Kittleson Steda Lundak Parasitology 2007

2. Introduction Fungus or Protozoan?? Orphan organism, phylogenic position has not yet been established Opportunistic Parasite Severe pathology in immunodeficient hosts Severely malnourished newborns One of the initial signs of AIDS emergence Lives in interstitial tissue of lungs Rarely disseminates to spleen, lymph nodes, bone marrow, eyes

3. Fungus vs. Protozoan Fungus from nucleic acid and biochemical analysis rRNA homologous to that found in fungi stains with some fungal stains Affinity for Grocott’s methenamine silver stain Produces chitin has ultrastructural characteristics similar to some fungi Protozoan other structures similar to Toxoplasma and Plasmodium is sensitive to a variety of antiprotozoal agents. It’s membrane properties resemble those of amebas Shows surface antigenic variation which occurs in protozoa and has not been established in fungi

4. Geographic Distribution Worldwide Most children exposed by the age of 3-4 years Commonly found in the lungs of healthy individuals, but no disease occurs Widespread in mammals

5. Hosts Humans Pneumocystis jiroveci(i) alternate names Pneumocystis carinii hominis Elderly, malnourished children, primary immunodeficiency disorders, AIDS Patients receiving cytotoxic or immunosupressive drugs for lymphoresticular cancers or transplants Other mammals: rabbits, dogs, goats, swine, cats, chimpanzees, owl monkeys, horses

6. Transmission Aerosol droplets Direct contact Congenital infection Household pets Interspecies transmission? Reactivation of latent infection when immunocompromised Or, new infection?

7. Life Cycle Life cycle is not fully known Asexual and sexual reproduction (CDC) Four general morphological forms in mammals Trophozoite (has amoeboid trophozoite form) Precysts Cysts Sporozoites (intracystic bodies) Cyst (diagnostic form) chitinous membrane and 8 intracystic bodies Pore in cyst wall used for releasing sporozoites. Can be spherical or collapsed.

8. Life Cycle

10. Clinical Presentation Causes Pneumonitis, Pneumocystis pneumonia (PCP) Lung epithelium becomes desquamated alveoli fill with foamy exudate containing parasites Fever, non productive cough, breathing difficulty on exertion, respiratory failure, cyanosis Death by asphyxia

11. Diagnosis Clinical symptoms Sputum or bronchial lavage Special staining with toluidine blue, methenamine silver Gram-Weigert stain for cysts ELISA, immunofluorescence assay, DNA amplification being developed

12. Diagnosis

13. Pictures Trophozoites in BAL material. Cysts in BAL material

14. Treatments Trimethoprim-sulfamethoxazole (TMP-SMZ) Pentamidine isethionate inhalant Treatments can be toxic and patient must be monitored closely Prophylactic treatment if CD4 count is low (<200) HAART regimen to boost immune system function, corticosteroids

15. Pneumocystis carinii Infection: Update and Review Questions Relationship with immunosupression Taxonomic classification Morphology Latent infection or new infection? Diagnosis, treatment, prophylaxis Research into a vaccine

17. More information/References Parasitology textbook Discussion article Familydoctor.org Aafp.org National Library of Medicine http://www.nlm.nih.gov/ http://www.nlm.nih.gov/ Center for Disease Control and Prevention http://www.cdc.gov http://www.cdc.gov