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[Extrapulmonary and disseminated pneumocystosis in HIV infection]
1Service des Maladies infectieuses, parasitaires et tropicales-Réanimation médicale, CHRU, Caen.
Abstract:
Three cases of extrapulmonary disseminated Pneumocystis carinii infection are reported. All 3 patients had HIV infection with less than 50 CD4 lymphocytes per cubic millimeter and were having aerosols of pentamidine as prophylactic treatment of pneumocystosis. P. carinii may invade numerous organs and in particular the liver, spleen and bone marrow. Extrapulmonary lesions, often pan-symptomatic, are to be feared in deeply immunodepressed patients receiving prophylactic aerosols of pentamidine. Infection of the choroid can be detected by systematic ophthalmoscopy. An early diagnosis raises hopes of a good, if temporary, response to treatment.
Insights
Extrapulmonary Pneumocystis carinii infection can occur in severely immunocompromised HIV patients using inhaled pentamidine. Early detection through methods like ophthalmoscopy is crucial for managing these disseminated infections.
Area of Science:
- Infectious Diseases
- Immunology
- HIV/AIDS Research
Background:
- Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in individuals with advanced HIV.
- Prophylactic inhaled pentamidine is frequently used to prevent PCP in immunocompromised patients.
- Severely diminished CD4+ T-cell counts (<50 cells/mm³) increase the risk of opportunistic infections.
Observation:
- Three cases of disseminated extrapulmonary Pneumocystis carinii infection were observed.
- All patients had advanced HIV infection with severe CD4+ T-cell depletion.
- Patients were undergoing prophylactic aerosolized pentamidine treatment for pneumocystosis.
Findings:
- Pneumocystis carinii can disseminate to multiple organs, including the liver, spleen, and bone marrow.
- Extrapulmonary lesions can be widespread and symptomatic.
- Choroidal involvement is a potential manifestation detectable by ophthalmoscopy.
Implications:
- Deeply immunocompromised patients on prophylactic inhaled pentamidine are at risk for extrapulmonary Pneumocystis carinii infections.
- Systematic ophthalmoscopy should be considered for early diagnosis of ocular involvement.
- Prompt diagnosis may lead to temporary but favorable treatment responses.