Episode Of Pneumocystis Carinii Pneumonia Research Articles

Rising incidence of Pneumocystis pneumonia: A population-level descriptive ecological study in England

Pneumocystis pneumonia (PCP) is an opportunistic infection that causes significant morbidity and mortality in the immunocompromised population. This population is growing and diversifying, yet contemporary epidemiology is lacking. We investigated the population-level incidence of PCP over the past decade. We conducted a descriptive study of all hospital admissions in England from April 2012 to March 2022. PCP episodes, age, median length of stay, gender and episodes of other respiratory fungal infections were collected. Consumption of Trimethoprim-Sulfamethoxazole was obtained between January 2019 and May 2022. The incidence of PCP increased from 2·2-4·5/100,000 population between 2012/2013 and 2019/2020 (p<0·0001). There was a drop in 2020/2021 to 2·7/100,000 before returning to 3.9/100,000 in 2021/2022. PCP episodes rose as a proportion of all-cause admissions as well as a proportion of episodes due to other fungal infections. The proportion of PCP patients aged 75+increased from 14% to 26%. The median length of stay was 13.5 days. Consumption of intravenous Trimethoprim-Sulfamethoxazole increased from 0.24×100,000 to 0.30 ×100,000 defined daily doses. The incidence of PCP is rising rapidly and represents a significant burden to the healthcare system. Further study into who is at risk of PCP is needed to better determine who should be given prophylaxis.

Perbandingan Diagnosis Klinis dan Radiologis Pneumocystis Carinii Pneumonia pada Pasien HIV/AIDS di RSUP Sanglah Denpasar

Background: Pneumocystis carinii pneumonia (PCP) is a lung infection caused by fungus Pneumocystis carinii. More than half (70 - 80%) of people with AIDS get at least one episode of PCP on their clinical course, with mortality ranging from 10% to 40%. Usually, there is no abnormality in pulmonary physical examination. Chest radiographic examination is one of the non-invasive examinations to make the diagnosis of PCP. Radiographic examination may find an abnormal picture or normal picture.Purpose: To compare the diagnosis of PCP in HIV/AIDS patients made by clinical versus radiology examination at Sanglah Hospital.Method: Type of this research is descriptive cross sectional study. The number of samples in this study were 51 samples obtained by total sampling technique. Data obtained from secondary data is from medical record.Result: After univariate and bivariate analyze, from 51 samples, 68.8% of the samples were radiologic diagnose with PCP and 76.5% were clinical diagnose with PCP. From bivariate analysis 82.9% were diagnosed PCP radiologically and clinically.Conclusion: Thorax imaging is a good imaging modality in early diagnosis and excludes the differential diagnosis of PCP.

Novel dihydropteroate synthase gene mutation in Pneumocystis jirovecii among HIV-infected patients in India: Putative association with drug resistance and mortality.

Pneumocystis pneumonia (PCP) remains a debilitating cause of death among HIV-infected patients. The combination trimethoprim/sulfamethoxazole (SXT) is the most effective anti-Pneumocystis treatment and prophylaxis. However, long-term use of this combination has raised alarms about the emergence of resistant organisms. This study was performed to investigate mutations in the dihydropteroate synthase (DHPS) gene and their clinical consequences in HIV-infected patients with PCP. A total of 76 clinically suspected cases of PCP among HIV-seropositive adult patients from March 2014 to March 2017 were included. Clinical samples (bronchoalveolar lavage fluid and sputum) were investigated for the detection of Pneumocystis jirovecii using both microscopy and nested PCR. DHPS genotyping and mutational analyses were performed and the data were correlated with clinical characteristics. Among the 76 enrolled HIV-positive patients, only 17 (22.4%) were positive for P. jirovecii. DHPS gene sequencing showed a novel nucleotide substitution at position 288 (Val96Ile) in three patients (3/12; 25.0%). Patients infected with the mutant P. jirovecii genotype had severe episodes of PCP, did not respond to SXT and had a fatal outcome (P=0.005). All three patients had a CD4+ T-cell count <100 cells/μL, and two also had co-infections. This study suggests that the emergence of a mutant P. jirovecii genotype is probably associated with drug resistance and mortality. The data also suggest that DHPS mutational analyses should be performed in HIV-seropositive patients to avoid treatment failure and death due to PCP. However, the role of underlying disease severity and co-morbidities should not be underestimated.

Recurrent Pneumocystis Pneumonia with Uncommon Radiographic Presentation

Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection of the pulmonary parenchyma seen in the immunocompromised host. The clinical presentation and radiographic findings are varied, with the latter ranging from normal to bilateral ground-glass opacities with cyst formation. We present a case of a 46-year-old woman with a history of human immunodeficiency virus (HIV) with multiple treated prior episodes of PCP, who was found to have an impressive presentation on high-resolution chest computed tomography (HRCT).

Correlation of CT Findings and Clinical Characteristics of Pneumocystis Pneumonia in Patients with Acquired Immunodeficiency Syndrome

Background: Pneumocystis pneumonia (PCP) is the most common opportunistic infection, and it is difficult to diagnose as PCP. The aim of this study was to assess whether CT findings or clinical characteristics contribute to early diagnosis of PCP. Method: Twenty-six patients with AIDS and PCP received medical treatment at the Kurume University Hospital between 1999 and 2018. None of the patients with AIDS had been diagnosed as HIV positive until the episode of PCP. In this study, the correlation between computed tomography (CT) findings and clinical characteristics were analyzed in patients with AIDS and PCP. The number of patients with PCP is not that high in Japan; therefore, it is difficult to diagnose patients with PCP in the clinic. Results: This study included 24 men and 2 women, and the mean age was 47.8 years. The mean CD4 cell count was 65.7 cells/μl, HIV-viral load was 680 × 104 copy, β-D-glucan (βDG) level was 234 pg/ml, and mean time till diagnosis was 41.3 days; 14 patients had hypoxemia. Twelve patients had PCP, 10 had cytomegalovirus (CMV) infection, 2 had Cryptococcus infection, 1 had Entamoeba histolytica infection, 1 had non-tuberculous mycobacteria infection, and 1 had Toxoplasma infection. CT images of the patients showed 10 cases with ground-glass opacity (GGO), 13 with consolidation, 1 with small nodules, 2 with a cavity, and 1 with cyst formation. Nine cases revealed peripheral distribution with peripheral sparing, 1 had pleural fluid, and 6 had lymph node enlargement. The mean time till diagnosis and cough were significantly correlated with lymphadenopathy. Patients with consolidation were more likely to be infected with CMV. Conclusion: GGO, combined with peripheral distribution and peripheral sparing, was the most common CT finding. When consolidation was present in PCP patients as shown in CT images, the patients were more likely to be infected with CMV.

Circulating genotypes of Pneumocystis jirovecii and its clinical correlation in patients from a single tertiary center in India.

The present study was carried out with the objectives of genotyping Pneumocystis jirovecii at three distinct loci, to identify the single nucleotide polymorphisms (SNPs), and to study its clinical implications in patients with Pneumocystis pneumonia (PCP). Analysis of genetic diversity in P. jirovecii from immunocompromised patients was carried out by genotyping at three distinct loci encoding mitochondrial large subunit rRNA (mtLSU rRNA), cytochrome b (CYB), and superoxide dismutase (SOD) using polymerase chain reaction (PCR) assays followed by direct DNA sequencing. Of the 300 patients enrolled in the present study, 31 (10.33%) were positive for PCP by a specific mtLSU rRNA nested PCR assay, whereas only 15 P. jirovecii could be amplified at the other two loci (SOD and CYB). These positives were further subjected to sequence typing. Important genotypic combinations between four SNPs (mt85, SOD110, SOD215, and CYB838) and clinical outcomes could be observed in the present study, and mt85A, mt85T, and SOD110C/SOD215T were frequently associated with "negative follow-up". These SNPs were also noted to be relatively more prevalent amongst circulating genotypes in our study population. The present study is the first of its kind from the Indian subcontinent and demonstrated that potential SNPs of P. jirovecii may possibly be attributed to the clinical outcome of PCP episodes in terms of severity or fatality in different susceptible populations likely to develop PCP during their course of illness.

High Prevalence of Pneumocystis jirovecii Dihydropteroate Synthase Gene Mutations in Patients with a First Episode of Pneumocystis Pneumonia in Santiago, Chile, and Clinical Response to Trimethoprim-Sulfamethoxazole Therapy.

Mutations in the dihydropteroate synthase (DHPS) gene of Pneumocystis jirovecii are associated with the failure of sulfa prophylaxis. They can develop by selection in patients receiving sulfa drugs or be acquired via person-to-person transmission. DHPS mutations raise concern about the decreasing efficacy of sulfa drugs, the main available therapeutic tool for Pneumocystis pneumonia (PCP). The prevalence of Pneumocystis DHPS mutations was examined in Pneumocystis isolates from 56 sulfa-prophylaxis-naive adults with a first episode of PCP from 2002 to 2010 in Santiago, Chile. Their clinical history was reviewed to analyze the effect of these mutations on response to trimethoprim-sulfamethoxazole (TMP-SMX) therapy and outcome. Mutant genotypes occurred in 22 (48%) of 46 HIV-infected patients and in 5 (50%) of 10 HIV-uninfected patients. Compared to patients with a wild-type genotype, those with mutant genotypes were more likely to experience sulfa treatment-limiting adverse reactions and to have a twice-longer duration of mechanical ventilation if mechanically ventilated. Specific genotypes did not associate with death, which occurred in none of the HIV-infected patients and in 50% of the non-HIV-infected patients. Chile has a high prevalence of DHPS mutations, which were presumably acquired through interhuman transmission because patients were not on sulfa prophylaxis. These results contrast with the low prevalence observed in other Latin American countries with similar usage of sulfa drugs, suggesting that additional sources of resistant genotypes may be possible. The twice-longer duration of mechanical ventilation in patients with mutant DHPS genotypes suggests a decreased efficacy of TMP-SMX and warrants collaborative studies to assess the relevance of DHPS mutations and further research to increase therapeutic options for PCP.

Clinical characteristics of hospital-onset Pneumocystis pneumonia and genotypes of Pneumocystis jirovecii in a single tertiary centre in Korea.

BackgroundPneumocystis pneumonia (PCP) may develop as a clinical manifestation of nosocomial pneumonia by means of either reactivation of resident P. jirovecii or de novo infection. However, there have been no studies describing the clinical characteristics of hospital-onset PCP.MethodsA retrospective review of medical records was performed to identify episodes of hospital-onset PCP in a tertiary care centre in Korea between May 2007 and January 2013. We investigated whether human-to-human contact during hospitalisation contributed to PCP development by molecular analysis of the genes encoding mitochondrial large ribosomal subunit (mtLSU) rRNA and dihydropteroate synthase (DHPS) and a review of hospitalisation history.ResultsDuring the study period, 129 patients (130 episodes) were diagnosed with PCP. Of these, respiratory specimens from 94 patients during 95 PCP episodes were available for analysis. Sixteen episodes (16.8%) were categorised as hospital-onset PCP. There was a trend toward a higher proportion of haematological malignancy (43.8% [7/16] vs. 20.3% [16/79]; P = 0.058) in patients with hospital-onset PCP compared to patients with community-onset PCP. mtLSU genotype 1 was the most common, occurring in 41 (43.2%) patients. There were four possible cases of nosocomial transmission. Mutation in DHPS was not observed in any PCP episode.ConclusionsPCP can be one of the causes of nosocomial pneumonia, although the mode of acquisition and transmission of P. jirovecii remains uncertain. mtLSU genotype 1 is the predominant P. jirovecii strain in Korea.

Prevalence of dihydropteroate synthase genotypes before and after the introduction of combined antiretroviral therapy and their influence on the outcome of Pneumocystis pneumonia in HIV-1–infected patients

The objective of this study was to determine whether the prevalence of Pneumocystis jirovecii dihydropteroate synthase (DHPS) gene mutations has changed since the introduction of combined antiretroviral therapy (cART) and whether the mutations are associated with poor outcome in Spanish HIV-1–infected patients with Pneumocystis pneumonia (PcP). We studied 167 PcP episodes in HIV-1–infected patients diagnosed during the pre-cART (1989–1995) and cART (2001–2004) periods. Molecular genotyping of DHPS was successfully performed in 98 patients (43 pre-cART and 55 cART). Seventeen patients (17/98, 17%; 95% confidence interval [CI], 10–25%) had mutations in the DHPS gene: 14 patients (14/43, 33%; 95% CI, 19–49%) from the pre-cART period and 3 patients (3/55, 5.5%; 95% CI, 1.3–16%) from the cART period ( P < 0.01). In the multivariate analysis, the pre-cART period, previous PcP prophylaxis with sulfa drugs, and homosexuality as an HIV risk factor were found to be associated with a higher risk of presenting DHPS mutations. Overall, 95% of patients were treated with trimethoprim and sulfamethoxazole (TMP–SMX). In-hospital mortality was similar in patients with (out) mutations (6% versus 11%, P = 0.84). DHPS gene mutations were more common during the pre-cART period and were associated with previous sulfa exposure and homosexuality. However, their presence did not worsen prognosis of PcP. The response to TMP–SMX with therapeutic doses was successful in most cases.

Identification of relevant single-nucleotide polymorphisms in Pneumocystis jirovecii: relationship with clinical data

Pneumocystis jirovecii is a poorly understood pathogen that causes opportunistic pneumonia (Pneumocystis pneumonia (PcP)) in patients with AIDS. The present study was aimed at correlating genetic differences in P. jirovecii isolates and clinical patient data. A description of genetic diversity in P. jirovecii isolates from human immunodeficiency virus-positive patients, based on the identification of multiple single-nucleotide polymorphisms (SNPs) at five distinct loci encoding mitochondrial large-subunit rRNA (mtLSU rRNA), cytochrome b (CYB), superoxide dismutase (SOD), dihydrofolate reductase (DHFR), and dihydropteroate synthase (DHPS), was achieved using PCR with DNA sequencing and restriction fragment length polymorphism analysis. The statistical analysis revealed several interesting correlations among the four most relevant SNPs (mt85, SOD110, SOD215, and DHFR312) and specific clinical parameters: mt85C was associated with undiagnosed or atypical PcP episodes and favourable follow-up; SOD215C was associated with favourable follow-up; and DHFR312T was associated with PcP cases presenting moderate to high parasite burdens. The Geno-Types mt85C/SOD215C and SOD110T/SOD215C were found to be associated with less virulent P. jirovecii infections, whereas the Geno-Type SOD110T/SOD215T was found to be related to more virulent PcP episodes. The present work demonstrated that potential P. jirovecii haplotypes may be related to the clinical data and outcome of PcP.

Pneumocystis pneumonia in an HIV-negative patient with no overt risk factors on presentation

To the Editors : Pneumocystis pneumonia (PCP) is a potentially life-threatening opportunistic infection that can occur in HIV-positive and HIV-negative individuals. The most significant risk factor for PCP in HIV-negative patients is chemotherapy, with a median time from cancer diagnosis to the first episode of PCP of 2 yrs. We report here a case of PCP in an adult male who had no identifiable risk factors on presentation. 3 weeks after the first signs and symptoms of PCP, he manifested blast crisis of acute myeloid leukaemia. This would be the first case demonstrating PCP as the sole presentation of an underlying occult leukaemia. Our patient was a 55-yr-old homosexual male nonsmoker who presented with a 7-day history of progressive dyspnoea, dry cough, fever and chills. On examination, the patient's blood pressure was 130/70 mmHg, heart rate was 95 beats·min−1, respiratory rate 25 breaths·min−1, oxygen saturation 95% (3 L nasal oxygen), and temperature 37.9°C (100.2° F). The remainder of the physical examination was unremarkable. Chest radiograph (CXR) showed bilateral reticular markings with no pleural effusions (fig. 1a⇓). Pertinent laboratory results (normal values in parentheses) included a white blood cell (WBC) count of 8.1×10 …

Taenia-crassiceps-Infektion bei AIDS

A 33-year-old patient with AIDS, and a history of episodes of Pneumocystis carinii pneumonia and cerebral toxoplasmosis, developed a subcutaneous paravertebral infiltrate, which at first resembled a haematoma. Over a period of several weeks, the lesion spread to cover almost the entire back. Initially, numerous investigations failed to reveal the aetiology. His general condition worsened progressively, and intermittent bleeding into the soft tissue of the back occurred, requiring transfusion. This was associated with the development of an isolated deficiency of clotting factor V and a fall in Quick values to 10%. On the 22nd day after admission, the infiltrate ruptured spontaneously, releasing blood and a large number of whitish spherical masses 2-3 mm in diameter. These were identified as Cysticerci longicolles, the larval form of Taenia crassiceps, a tapeworm occurring in Canidae. The blood clotting values returned to normal within two days of incision of the infiltrate and commencement of therapy with mebendazole (6 g/day) and praziquantel (3.6 g/day). The infiltrate subsequently regressed almost completely. After combination treatment for 2 weeks, treatment was continued with praziquantel alone, which, however, the patient stopped himself after 10 weeks. A recurrence at the same site 4 months later was successfully treated with a further course of mebendazole and praziquantel.

Development and evaluation of a real-time PCR assay for detection of Pneumocystis jirovecii DNA in bronchoalveolar lavage fluid of HIV-infected patients

Background: Pneumocystis pneumonia (PCP) is conventionally diagnosed by identifying Pneumocystis jirovecii in lower respiratory tract samples using cytochemical stains. Molecular diagnosis of PCP is potentially more sensitive. Methods: A study...

Severe Food Allergy as a Variant of IPEX Syndrome Caused by a Deletion in a Noncoding Region of the FOXP3 Gene

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX; OMIM 304930) syndrome is a congenital syndrome characterized by autoimmune enteropathy, endocrinopathy, dermatitis, and other autoimmune phenomena. In the present work, we aimed to uncover the molecular basis of a distinct form of IPEX syndrome presenting at the edge of autoimmunity and severe allergy. The FOXP3 gene was sequenced, FOXP3 messenger RNA (mRNA) was quantified by real-time polymerase chain reaction (PCR), and protein expression in peripheral blood lymphocytes was analyzed by flow cytometry after intracellular staining. In coculture experiments (CD4(+)CD25(-) and CD4(+)CD25(+) cells), the functions of regulatory T cells were analyzed. Expression of interferon gamma and interleukin 2 and 4 mRNA within the inflamed intestinal mucosa was quantified by real-time PCR. Here, we describe a distinct familial form of IPEX syndrome that combines autoimmune and allergic manifestations including severe enteropathy, food allergies, atopic dermatitis, hyper-IgE, and eosinophilia. We have identified a 1388-base pair deletion (g.del-6247_-4859) of the FOXP3 gene encompassing a portion of an upstream noncoding exon (exon -1) and the adjacent intron (intron -1). This deletion impairs mRNA splicing, resulting in accumulation of unspliced pre-mRNA and alternatively spliced mRNA. This causes low FOXP3 mRNA levels and markedly decreased protein expression in peripheral blood lymphocytes of affected patients. Numbers of CD4(+)CD25(+)FOXP3(+) regulatory T cells are extremely low, and the CD4(+)CD25(+) T cells that are present exhibit little regulatory function. A new mutation within an upstream noncoding region of FOXP3 results in a variant of IPEX syndrome associating autoimmune and severe immunoallergic symptoms.

Pneumocystis pneumonia – a retrospective study 1991–2001 in Gothenburg, Sweden

Pneumocystis pneumonia (PCP) is a severe opportunistic infection in immunosuppressed patients, caused by Pneumocystis jiroveci. The incidence among HIV negative patients is considered to have increased during the last decade. We collected data retrospectively from the cases with PCP diagnosed at Sahlgrenska University Hospital between January 1991 and December 2001. 118 episodes of PCP were registered in 108 patients. The most common underlying immunosuppressions were HIV and solid organ transplantation with 29 and 26 cases, respectively. The number of PCP cases did not increase during the study period. Out of the 118 episodes of PCP 89 (75%) were in patients not infected with HIV. No clusters were found among HIV positive patients. We found 5 smaller clusters among non-HIV patients. Among the cases with proven PCP, 17% were on prophylaxis: 30% of the HIV infected patients and 13% of the non-HIV patients. The number of PCP cases is not increasing, 75% of the patients are HIV negative, Only 17% of the patients were on prophylaxis before the episode of PCP, indicating that not all patients at risk are identified.

Severity and outcome of HIV-associated Pneumocystis pneumonia containing Pneumocystis jirovecii dihydropteroate synthase gene mutations

The impact of Pneumocystis jirovecii (formerly P. carinii) dihydropteroate synthase (DHPS) gene mutations on morbidity and mortality of Pneumocystis pneumonia (PCP) in HIV-positive patients is unclear. To determine whether severity and outcome of HIV-associated PCP differs according to DHPS genotype. A prospective, observational study in a university-affiliated county hospital. The study included 197 patients with 215 microscopically confirmed PCP episodes and successfully sequenced DHPS genotypes; 175 (81%) episodes displayed mutant genotypes. All-cause mortality within 60 days. The majority of patients (86%) with PCP containing Pneumocystis DHPS mutations survived. Although severity of PCP was comparable, there was a trend for more patients with mutant genotypes than patients with wild-type to require mechanical ventilation (14.3% versus 2.5%; P = 0.056) and to die (14.3% versus 7.5%, P = 0.31). Independent predictors of mortality at baseline were low serum albumin levels [odds ratio (OR), 4.62; 95% confidence interval (CI), 1.63-13.1; P = 0.004] and requiring intensive care within 72 h of hospitalization (OR, 5.06; 95% CI, 1.43-18.0; P = 0.012). The majority of HIV-infected patients with PCP containing mutant Pneumocystis DHPS genotypes survived. Mortality was related primarily to the underlying severity of illness. However, a trend towards increased mortality in episodes of PCP containing mutant DHPS genotypes was observed and this warrants further study.

Pneumocystis carinii Pneumonia : The Time Course of Clinical and Radiographic Improvement

The purpose of this study was to compare the time course of clinical and radiographic improvement in patients with Pneumocystis carinii pneumonia (PCP), and evaluate the usefulness of early follow-up chest radiographs (CXRs) in these patients. Retrospective, chart review. The medical records of 36 episodes of confirmed PCP among 28 patients were reviewed. Clinical parameters of improvement were defined as follows: (1) a decrease in temperature by 0.5 degrees C, (2) a decrease in respiratory rate by 25%, and (3) a 2% improvement in arterial oxygen saturation, as measured by pulse oximetry, in the setting of an unchanged amount of supplemental oxygen or a reduction in supplemental oxygen. A patient was defined as clinically improving when all three of these criteria were met. All CXRs were graded by radiologists, specifically for the study, as normal or abnormal and improved, worsened, or unchanged from the initial CXR. Clinical improvement was noted during 30 of 36 episodes of PCP (83%) at a mean of 4.5 +/- 2.5 days (+/- SD). There was improvement in the CXR finding during the hospital stay during 15 of 36 episodes (42%), at a mean of 7.7 +/- 4.5 days. Radiographic resolution preceded clinical resolution in only four cases (11%). Excluding seven patients who received ventilatory support, the median number of CXRs per patient was four (range, two to nine CXRs). We conclude that radiographic improvement of PCP lags behind clinical improvement.

Limited asymptomatic carriage of Pneumocystis jiroveci in human immunodeficiency virus-infected patients.

Forty-seven bronchoalveolar lavage fluid samples from 16 human immunodeficiency virus (HIV)-infected patients were used to test the latency model of Pneumocystis infection in the human host. Identification of DNA sequence polymorphisms at 4 independent loci were used to genotype Pneumocystis jiroveci from the 35 samples that contained detectable P. jiroveci DNA. Eighteen of those 35 samples came from patients who did not have Pneumocystis pneumonia (PCP) and had confirmed alternative diagnoses. Seven patients had asymptomatic carriage of P. jiroveci over periods of < or = 9.5 months after an episode of PCP, and in all 7 cases, a change in genotype from that in the original episode of PCP was observed. The absence of P. jiroveci DNA in one-fourth of the 47 samples and the observed changes in genotype during asymptomatic carriage do not support the latency model of infection. Asymptomatic carriage in HIV-infected patients may play a role in transmission of P. jiroveci and may even supply a reservoir for future infections.

Multiple Pulmonary Nodules in an HIV-Positive Man on Highly Active Antiretroviral Therapy

38-year-old man with AIDS and a prior episode of Pneumocystis carinii pneumonia (PCP) presented with a 2-month history of progressive dyspnea, nonproductive cough, night sweats, and weight loss. Medications included nelfinavir, 750 mg three times daily; stavudine, 40 mg twice daily; didanosine, 200 mg twice daily; and trimethoprim/ sulfamethoxazole (TMP/SMX) prophylaxis once daily. However, according to the pharmacy records, the patient had not been compliant with the TMP/SMX therapy. He denied tuberculosis exposure or recent travel. On physical examination, the patient was afebrile

Serologic responses to epitopes of the major surface glycoprotein of Pneumocystis jiroveci differ in human immunodeficiency virus-infected and uninfected persons.

The major surface glycoprotein (Msg) of Pneumocystis jiroveci (P. jiroveci) is important in the immunopathogenesis of Pneumocystis pneumonia (PcP), but is difficult to study in humans. We generated 3 overlapping recombinant Msg fragments (MsgA, MsgB and MsgC), and analyzed their reactivity with serum samples from 95 healthy blood donors and 94 human immunodeficiency virus (HIV)-infected persons. Reactivity to the Msg fragments varied with HIV infection and prior episodes of PcP but not with geographic origin. Recognition of MsgA was lower-and recognition of MsgB was significantly lower-in HIV(+) serum compared with donor serum. Serum samples from HIV-positive patients with prior PcP recognized MsgC more frequently than did serum samples from those without PcP. None of the serum samples drawn from 9 patients before they had developed PcP recognized MsgC. These data suggest that these novel recombinant proteins are useful for the analysis of antibody responses to Msg.