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Résumé Justificatif Les données relatives à la pneumonie à Pneumocystis en Afrique sub-saharienne ne sont pas bien connues. La faiblesse du plateau technique et l’utilisation d’outils de diagnostic biologique peu sensibles sont parmi les raisons évoquées. L’objectif de cette étude est de réactualiser les données de l’affection au centre hospitalier universitaire de Fann à Dakar et d’évaluer les méthodes de diagnostic biologique utilisées. Matériel et méthodes Une étude prospective descriptive est réalisée du 5 janvier 2009 au 31 octobre 2011 au service de parasitologie-mycologie du centre hospitalier universitaire de Fann à Dakar. Les prélèvements du liquide de lavage broncho-alvéolaire reçus au laboratoire sont examinés au microscope par immunofluorescence indirecte ou après coloration au Giemsa ou au bleu de toluidine O pour la mise en évidence de Pneumocystis jirovecii. Résultats Cent quatre-vingt-trois prélèvements de liquide de lavage broncho-alvéolaire provenant de 183 patients sont reçus au laboratoire. Seize sont positifs pour la recherche de P. jirovecii , soit une fréquence de 9 %. Quatre parmi eux sont infectés par le VIH. L’immunofluorescence indirecte a permis de retrouver P. jirovecii chez les 16 patients alors que la coloration au Giemsa n’a détecté P. jirovecii que chez un seul patient. Aucun cas n’est diagnostiqué par le bleu de toluidine O. Conclusion La pneumonie à Pneumocystis au laboratoire de parasitologie-mycologie du centre hospitalier universitaire de Fann à Dakar est majoritairement diagnostiquée chez des patients infectés par le VIH. Summary Background Data relative to Pneumocystis pneumonia in sub-Saharan Africa are not well known. Weakness of the technical material and use of little sensitive biological tools of diagnosis are among the evoked reasons. The objective of this study is to update the data of the disease at the Fann Teaching Hospital in Dakar and to estimate biological methods used in diagnosis. Materials and methods A descriptive longitudinal study was carried out from January 5th, 2009 to October 31st, 2011 in the parasitology and mycology laboratory of the Fann Teaching Hospital in Dakar. The bronchoalveolar lavages received in the laboratory were examined microscopically for Pneumocystis jirovecii by indirect fluorescent assay or after Giemsa or toluidine blue O staining. Results One hundred and eighty-three bronchoalveolar lavages withdrawn from 183 patients were received in the laboratory. Sixteen were positive for P. jirovecii at 9% frequency. Four among these patients were HIV positive. Indirect fluorescent assay allowed finding of P. jirovecii among 16 patients while Giemsa staining discovered P. jirovecii only in a single patient. No case was diagnosed by toluidine blue O staining. Conclusion Pneumocystis pneumonia in Parasitology and Mycology Laboratory of Fann Teaching Hospital at Dakar was mainly diagnosed among HIV patients. [ABSTRACT FROM AUTHOR]

Résumé: La pneumocystose est une infection opportuniste fréquente chez les patients immunodéprimés, en particulier les sidéens. Le diagnostic de cette pneumonie présente plusieurs difficultés vu la faible sensibilité des colorations classiques et l’absence de milieux de culture pour Pneumocystis. Les techniques de biologie moléculaire et spécialement la PCR ont permis d’améliorer la détection de l’ADN de ce champignon dans les prélèvements invasifs et non invasifs et même dans l’environnement, ce qui a mis en valeur la transmission interhumaine et l’existence d’une source environnementale de Pneumocystis. Par ailleurs, différentes techniques de biologie moléculaire ont été employées pour le typage des souches de Pneumocystis et surtout P. jirovecii qui est caractérisé par une importante biodiversité génétique. Enfin, l’utilisation très large du cotrimoxazole pour le traitement et surtout pour la prophylaxie de la pneumocystose pose le problème de l’augmentation des résistances aux sulfamides chez P. jirovecii. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Medical Mycology / Journal de Mycologie Médicale is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: We report 3 cases of pneumocystis pneumonia (PCP) in 2 female and 1 male patients (mean age=50 years) free of human immunodeficiency virus (HIV) infection. One female patient presented with breast neoplasm the other with Wegener’s granulomatosis, the male patient with lymphoma. All patients were taking immunosuppressive treatment at the time of infection. Persistent cough, dyspnea, and severe hypoxemia were the most characteristic clinical signs. All patients presented with lymphopenia (average CD4-cell count=275/mm3), two with hypoalbuminemia, and one with renal failure. In all cases, the microscopic analysis of bronchoalveolar lavage was used to establish the diagnosis. All patients were treated with trimethoprim and sulfamethoxazole and a tapering dose of corticosteroids. Outcome was favorable for 1 patient, 1 was transferred to the intensive care unit for acute respiratory failure, and 1 died. [Copyright &y& Elsevier]

Abstract: Pneumocystis Jiroveci pneumonia (PJP) is a rare opportunistic infection in immunodeficient patients in Tunisia, as well as in other Africain countries including those with a high prevalence of AIDS. In the literature, PJP has been reported in primary immunodeficiency diseases (PID) namely SCID T–B– or T–B+ or X-linked hyper-IgM syndrome. Objective: To evaluate the prevalence of PJP in the different PID observed in Tunisia. Patients and methods: This retrospective study concerned 290 cases of PID confirmed by immunological investigation including the study of specific and/or non-pecific humoral and cellular immunity. The identification of P. Jiroveci in patients suspected of pneumocystosis was achieved by parasitological investigation in bronchoalveolar lavages. Results: A PID associated to a parasitologically confirmed pneumocystic infection was found in 9 out of 290 patients (3%) among whom the majority (7 patients) had an HLA class II combined immunodeficiency. The latter is an autosomic recessive disease which has been reported mainly in North African families. Indeed, this population is characterized by a high rate of consanguinity. Interestingly, no PJP has been observed neither in SCID T–B– or T–B+ nor in X-linked hyper-IgM syndrome. Discussion and conclusion: PJP seems to be particularly frequent in HLA class II deficiency patients, since 7 out of 22 patients with this deficiency had a PJP (31%). Due to this defect, antigen presenting cells are unable to present the antigen to T lymphocytes demonstrating the critical role of CD4+ T lymphocytes responses in the immune response to this pathogen. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Quantitative PCR to detect Pneumocystis jirovecii (Pj) is a new tool for the diagnosis of Pneumocystis jirovecii pneumonia (PJP). The yield of this technique, in cases of low fungal burden, when the standard technique using immunofluorescence (IF) is negative, needs to be evaluated., Methods: We retrospectively reviewed the charts of all patients with a positive PCR but negative IF test (PCR+/IF-) in bronchoalveolar lavage (BAL) fluid performed over one year. We used an algorithm based on underlying immunosuppression, clinical picture, thoracic CT scan appearances, existence of an alternative diagnosis and the patient's outcome on treatment. Using this, each case was classified as probable PJP, possible PJP or colonization., Results: Among the 416 BAL performed, 48 (12%) were PCR+/IF- and 43 patients were analyzed. Patients were mostly male (56%) with a median age of 60 years. Thirty-five (84%) were immunocompromised: 4 (9%) HIV-infected patients, 26 (60%) with hematologic or solid organ cancer, 3 (7%) were renal transplant recipients. Seven (16%) were classified as probable PPJ and 9 (21%) as possible PJP. Patients with a probable or possible PJP were more frequently admitted to the ICU (P<0.02) and had higher risk of death (P<0.01) when compared to those with colonization. Median PCR levels were very low and were not different between PJP or colonized patients (P=0.23)., Conclusions: Among patients with a positive Pj PCR in BAL but with negative IF, only 37% had probable or possible PJP and PCR could not discriminate PJP from colonization., (Copyright © 2020. Published by Elsevier Masson SAS.)

Background: Dermatomyositis associated with anti-MDA-5 autoantibodies is a recently-described clinical entity. Herein we report two lethal cases involving pneumocystis pneumonia., Patients and Methods: Case n o  1. A 56-year-old male patient developed cutaneous symptoms consistent with dermatomyositis without muscular involvement. Antinuclear antibodies were present and anti-MDA5 auto-antibodies were identified. The scan showed interstitial lung disease without infection. Significant improvement was obtained with corticosteroids. One month later, the patient presented acute respiratory illness (hypoxemia: PaO 2 60mmHg, exacerbation of lung disease evidenced by a scan, and diagnosis of pneumocystis pneumonia on bronchoalveolar lavage). He died despite appropriate antibiotic therapy and immunosuppressant therapy. Case n o  2. The second case concerned a 52-year-old Vietnamese man who developed more atypical cutaneous symptoms of dermatomyositis without muscular involvement. ANAb responses were positive (1/400) and MDA5 was present. The patient was treated with corticosteroids (40mg/d), hydroxychloroquine, and intravenous immunoglobulin. After significant improvement, the patient developed an acute respiratory illness due to superinfection with pneumocystis and he died despite specific treatment and cyclophosphamide bolus., Conclusion: In dermatomyositis, anti-MDA5 antibody screening is essential for the prognosis since the disease carries a risk of complication with severe lung disease. Bronchial fibroscopy with bronchoalveolar lavage should be considered at the time of diagnosis. Our two cases suggest the need for early screening for pneumocystis pneumonia in the event of respiratory distress and possibly for prophylactic treatment at the start of immunosuppressant therapy., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Data relative to Pneumocystis pneumonia in sub-Saharan Africa are not well known. Weakness of the technical material and use of little sensitive biological tools of diagnosis are among the evoked reasons. The objective of this study is to update the data of the disease at the Fann Teaching Hospital in Dakar and to estimate biological methods used in diagnosis., Materials and Methods: A descriptive longitudinal study was carried out from January 5th, 2009 to October 31st, 2011 in the parasitology and mycology laboratory of the Fann Teaching Hospital in Dakar. The bronchoalveolar lavages received in the laboratory were examined microscopically for Pneumocystis jirovecii by indirect fluorescent assay or after Giemsa or toluidine blue O staining., Results: One hundred and eighty-three bronchoalveolar lavages withdrawn from 183 patients were received in the laboratory. Sixteen were positive for P. jirovecii at 9% frequency. Four among these patients were HIV positive. Indirect fluorescent assay allowed finding of P. jirovecii among 16 patients while Giemsa staining discovered P. jirovecii only in a single patient. No case was diagnosed by toluidine blue O staining., Conclusion: Pneumocystis pneumonia in Parasitology and Mycology Laboratory of Fann Teaching Hospital at Dakar was mainly diagnosed among HIV patients., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Abstract: We report two cases of pneumocystis pneumonia in patients receiving chemotherapy for breast cancer. These case series emphasize the frailty of the patients as the causative role for occurrence of this uncommon complication of chemotherapy in breast cancer. We remind the importance of screening for unusual adverse events in frail patients receiving chemotherapy. [Copyright &y& Elsevier]

Introduction et objectifs: Évaluation de la prévalence et des déterminants de la colonisation àPneumocystis jirovecii (Pj) chez des patients avec une maladie auto immune systémique (MAIs). Matériels et méthodes: Étude prospective sur 4 mois chez des patients porteurs de MAIs. Critères d’éligibilité : âge > 18 ans, avoir une MAIs, hospitalisation de jour au cours de la période, accepter de réaliser une expectoration induite (EI). Exclusion : symptomatologie respiratoire aigue. La PCR Pj était réalisée sur une EI. Résultats: 67 patients ont été explorés, 21 hommes et 56 femmes, d’âge médian 54 ans. 11 patients sur 67 avaient une PCR Pj positive (16,4 %). En analyse univariée, les facteurs associés à une PCR+ étaient : le sexe masculin (63 %), un taux de CD4 plus bas (528 vs 765/mm3), les doses de corticoïdes plus importantes (25 vs 15mg/j) et totales (9,4g vs 5,5g). En analyse multivariée seul le sexe masculin était un facteur associé à la colonisation. En raison du faible effectif de colonisation chez les femmes nous avons réalisé une étude stratifiée selon le sexe qui retrouvait les facteurs suivants associés à la colonisation chez les hommes : la dose journalière de corticoïdes et la lymphopénie. Conclusion: Peu d’études portent sur la colonisation par Pj dans cette population. Seule une étude réalisée chez des patients avec une polyarthrite rhumatoïde retrouvait une prévalence de 10 %. Cette prévalence est estimée entre 0 à 58 % chez des patients VIH négatifs. L’importance de la colonisation chez l’homme dans notre étude, reflète peut être la gravité plus importante des MAI chez les sujets de sexe masculin. L’importance de la colonisation doit faire envisager le dépistage dans cette population en particulier en cas de surenchère thérapeutique par les biothérapies. L’intérêt d’une prophylaxie primaire est à évaluer. [Copyright &y& Elsevier]

Introduction et objectifs: Décrire une série de patients atteints de pneumocystose pulmonaire (PCP), en dehors de l’infection par le VIH. Matériels et méthodes: Étude rétrospective multicentrique concernant 28 patients adultes séronégatifs pour le VIH, atteints de PCP, suivis de 1998 à 2008. Résultats: Le sex-ratio était de 3,1 hommes pour 1 femme, l’âge moyen de 52,8 ans. Vingt et un patients souffraient d’une hémopathie (dont 9 greffés de moelle osseuse), 2 d’une vascularite systémique, 4 d’une maladie auto-immune, 1 d’une cirrhose. Au moment de la PCP, 10 patients étaient traités par corticoïdes, 10 par immunosuppresseur ou biothérapie, 1 par chimiothérapie. Les antécédents étaient marqués par une corticothérapie (23 cas), des immunosuppresseurs (10 cas), une biothérapie (5 cas), une chimiothérapie anticancéreuse (20 cas). Six patients avaient une prophylaxie primaire de la PCP (cotrimoxazole 2 ; pentamidine 4). Le début était progressif dans 25 cas, brutal dans 3 cas (fièvre : 26 cas ; dyspnée : 20 cas ; toux : 14 cas) avec un délai diagnostique moyen de 13,5 jours. Les leucocytes étaient à 5 611/mm3 (PNN 3 643/mm3, lymphocytes 781/mm3), les LDH à 716UI/l, la CRP à 86,8mg en moyenne. La radio pulmonaire était typique dans 22 cas, atypique dans 5 cas, normale dans 1 cas. Le diagnostic était porté sur l’examen direct du LBA dans 26 cas, et sur la PCR dans 2 cas. Douze patients avaient une PCP grave, dont 9 nécessitant une ventilation mécanique ; 26 ont été traités par cotrimoxazole, 1 par pentamidine, 1 par atovaquone, 15 par corticothérapie. Huit cas d’intolérance au cotrimoxazole étaient observés, dont 5 en entraînant l’arrêt. L’évolution était fatale dans 15 cas (7 décès attribuables à la PCP). 13 patients bénéficiaient d’une prophylaxie secondaire, avec une seule rechute observée. Conclusion: Le diagnostic de PCP doit être évoqué plus précocement chez l’immunodéprimé non VIH, afin d’en diminuer la mortalité. [Copyright &y& Elsevier]

During the last 30 years pulmonary involvement has played a major role in the history of HIV infection. Initially, the unexplained occurrence of pneumocystis revealed the emergence of AIDS and the suspicion of its African origin. Before the era of triple therapy the natural history of AIDS was dominated by the occurrence of repeated lung infections and respiratory physicians were at the forefront of their diagnosis, treatment and prophylaxis. With the provision of antiretroviral therapy (ART), the natural history of AIDS has been transformed in those patients who benefit from it. In addition to paradoxical reactions observed following the introduction of ART, the pulmonologist is also facing a chronic stage of controlled HIV infection, and unexpected events, the incidence of which increases with time: pulmonary arterial hypertension and lung cancer certainly, COPD and fibrosis perhaps… but this story remains to be written., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)