Diagnosis Of Pneumocystis Carinii Research Articles

Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies.

ObjectiveTo evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries.DesignSystematic review and meta-analysis.Study selectionObservational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries.Data sourcesMedline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014Risk of bias assessmentQuality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias.ResultsOut of 10655 papers retrieved, 77 studies from 39 countries (198359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37‒13.92); age below two months (5.22, 1.70‒16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67 ‒ 8.61), chronic underlying diseases (4.76, 3.27‒ 6.93); HIV/AIDS (4.68, 3.72‒5.90); and severe malnutrition (OR 4.27, 3.47‒5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03‒3.31); low maternal education (1.43, 1.13‒1.82); low socio-economic status (1.62, 1.32‒2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11‒4.31). Immunisation (0.46, 0.36‒0.58) and good antenatal practices (0.50, 0.31‒0.81) were associated with decreased odds of death.ConclusionsHost and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.

Gastrectomy and chemotherapy with S-1 for gastric cancer in a patient with acquired immunodeficiency syndrome

Total gastrectomy and chemotherapy with S-1 after surgery were performed in a 50-year-old woman with gastric cancer associated with acquired immunodeficiency syndrome (AIDS). She was given a diagnosis of gastric cancer at the lesser curvature of the body of the stomach, and distal gastrectomy was performed in December 2004. The postoperative course was eventful, with persistent high fever of unknown origin after surgery and infiltrative shadows in the bilateral lung fields showing on CT scan. Polymerase chain reaction (PCR) for pneumocystis carinii on bronchoscopy was positive, serum HIV antibody was positive, HIV-RNA was 2.2×10(5)copies/ml, and the serum CD4 lymphocyte level was 25/mm(3) on postoperative day 28. She was given a diagnosis of pneumocystis carinii with AIDS. Pneumocystis carinii and fever improved immediately when ST mixture and highly active antiretroviral therapy (HAART) were performed. After 3months, the serum CD4 lymphocyte level was elevated to 125/mm(3), and she underwent total gastrectomy because cancer cells at the cut end of the resected stomach were positive microscopically. The postoperative course was uneventful, and she underwent adjuvant chemotherapy with S-1 because the serum CD4 lymphocyte level was 568/mm(3). S-1 therapy was continued for 2years (each course consisting of 2weeks of administration followed by 2weeks off) while performing HAART and monitoring CD4 lymphocyte levels. No side effects such as decreases in white blood cell counts or CD4 lymphocyte levels were seen during S-1 therapy. She is alive and well without recurrence of gastric cancer 5years after initial gastrectomy.

Diabetes Mellitus Following Intravenous Pentamidine Administration in a Patient With HIV Infection

It is known that pentamidine can cause severe pancreatic toxicity in patients with the acquired immunodeficiency syndrome.1The most frequent and severe adverse event is hypoglycemia that occurs in 6% to 35% of patients assuming pentamidine with a higher incidence in those who are seropositive for the human immunodeficiency virus.2Occasionally, hyperglycemia and acute pancreatitis have also been reported.3Diabetes mellitus is a much less commonly recognized complication. Only a few cases have been reported in the literature and the real incidence of diabetes mellitus developing after intravenous pentamidine therapy is unknown.2,4,5 We describe a case of transient diabetes mellitus presenting after pentamidine therapy in a patient with the acquired immunodeficiency syndrome. Report of a Case. A 29-year-old man who was an intravenous drug user became infected with the human immunodeficiency virus in 1986. He was admitted to our hospital with a diagnosis ofPneumocystis carinii

Fluorescence microscopy for Pneumocystis carinii.

Diagnoses of benign diseases are rare in diagnostic cytology and of less importance in daily routine than the proof of malignant cells. However, there was a recent change in lung cytology concerning the diagnosis of Pneumocystis carinii, made possible by fluorescence microscopy.

Optimal use of the cytocentrifuge for recovery and diagnosis of Pneumocystis carinii in bronchoalveolar lavage and sputum specimens

To facilitate the diagnosis of Pneumocystis carinii from bronchoalveolar lavage and sputum specimens, we have defined conditions for optimal use of the cytocentrifuge for this purpose. Centrifugation in the cytocentrifuge at 1,200 rpm for 10 min yielded the best recovery of P. carinii. To reliably ensure complete absorption of the fluid specimen from the cytocentrifuge chamber, it was necessary to use two absorption filters simultaneously. Different methods of treating induced sputum with mucolytic agents to process sputum with the cytocentrifuge were tried. Results of these studies and our current method for treating sputa are discussed. Comparisons of slides prepared by traditional centrifugation and by cytocentrifuge processing showed the latter to be equally effective for detecting P. carinii. The most prominent advantage of the cytocentrifuge was the much smaller area to review and consequently the shortened time required to read the slides.