Current issues in the epidemiology, transmission, and reactivation of Pneumocystis carinii

Issues related to the epidemiology, transmission, and reactivation of Pneumocystis carinii remain controversial. In this article, current studies related to geographic variations in the prevalence of P. carinii pneumonia are reviewed. In addition, extensive investigations show that exposure to P. carinii occurs early in life, followed by seemingly complete clearance of the organisms. Recent molecular techniques show that P. carinii pneumonia during periods of immune suppression can occur either by reactivation or by acquisition of new organisms. These studies are analyzed and a composite model of P. carinii infection is proposed.