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Extrapulmonary Pneumocystis carinii infections
E E Telzak1, R J Cote, J W Gold
1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Abstract:
A case of disseminated infection with Pneumocystis carinii is presented, and the English-language literature is reviewed for cases of documented extrapulmonary infection with this organism. In this case--with P. carinii diffusely replacing the bone marrow and causing hepatic, adrenal, and glomerular tuft necrosis--the clinical illness and multiple-organ dysfunction attributed to disseminated P. carinii were more severe than had previously been described. Because the rate of extrapulmonary P. carinii infection found at autopsy in patients with AIDS is at least 2.5% at our institution, we caution against the routine use of aerosol rather than parenteral pentamidine for treatment of P. carinii pneumonia until additional data are available.
Insights
Disseminated Pneumocystis carinii infection can cause severe multi-organ dysfunction, even in the bone marrow. Researchers caution against aerosolized pentamidine for Pneumocystis pneumonia in AIDS patients due to extrapulmonary spread risks.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Host Pathogens
Background:
- Pneumocystis carinii pneumonia (PCP) is a significant opportunistic infection, particularly in individuals with compromised immune systems.
- Extrapulmonary dissemination of P. carinii, while documented, is less commonly described than pulmonary involvement.
- Understanding the full spectrum of P. carinii infections is crucial for effective patient management.
Observation:
- A severe case of disseminated Pneumocystis carinii infection is presented, involving extensive bone marrow replacement and necrosis in the liver, adrenal glands, and glomerular tufts.
- The clinical presentation and multi-organ dysfunction in this case were more severe than previously reported instances of extrapulmonary P. carinii.
- Autopsy data from the institution revealed a significant rate (at least 2.5%) of extrapulmonary P. carinii infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
Findings:
- Disseminated P. carinii infection can lead to profound and widespread organ damage.
- The severity of illness in this case highlights the potential for P. carinii to cause extensive extrapulmonary disease.
- Extrapulmonary P. carinii is a notable finding in AIDS patients, occurring more frequently than previously assumed.
Implications:
- The findings suggest that P. carinii pneumonia (PCP) management requires careful consideration of potential extrapulmonary spread.
- Routine use of aerosolized pentamidine for PCP treatment in immunocompromised patients, especially those with AIDS, may warrant re-evaluation due to the risk of dissemination.
- Further research is needed to establish optimal treatment strategies and diagnostic approaches for disseminated P. carinii infections.