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. 1990 Apr;34(4):499–504. doi: 10.1128/aac.34.4.499

Recent advances in the diagnosis, treatment, and prevention of Pneumocystis carinii pneumonia.

R T Davey Jr 1, H Masur 1
PMCID: PMC171632  PMID: 2140495

Abstract

In summary, recent advances in our ability to diagnose, treat, and prevent recurrences of pneumocystis pneumonia have significantly improved the clinical management of this infection, especially in HIV-1-infected individuals. As current investigations allow our therapeutic armamentarium in this disease to be strengthened even further, it is likely that pneumocystis pneumonia will pose a diminishing threat to those patients currently most susceptible to this infection.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allegra C. J., Chabner B. A., Tuazon C. U., Ogata-Arakaki D., Baird B., Drake J. C., Simmons J. T., Lack E. E., Shelhamer J. H., Balis F. Trimetrexate for the treatment of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1987 Oct 15;317(16):978–985. doi: 10.1056/NEJM198710153171602. [DOI] [PubMed] [Google Scholar]
  2. Bigby T. D., Margolskee D., Curtis J. L., Michael P. F., Sheppard D., Hadley W. K., Hopewell P. C. The usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. Am Rev Respir Dis. 1986 Apr;133(4):515–518. doi: 10.1164/arrd.1986.133.4.515. [DOI] [PubMed] [Google Scholar]
  3. Brenner M., Ognibene F. P., Lack E. E., Simmons J. T., Suffredini A. F., Lane H. C., Fauci A. S., Parrillo J. E., Shelhamer J. H., Masur H. Prognostic factors and life expectancy of patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. Am Rev Respir Dis. 1987 Nov;136(5):1199–1206. doi: 10.1164/ajrccm/136.5.1199. [DOI] [PubMed] [Google Scholar]
  4. Broaddus C., Dake M. D., Stulbarg M. S., Blumenfeld W., Hadley W. K., Golden J. A., Hopewell P. C. Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Jun;102(6):747–752. doi: 10.7326/0003-4819-102-6-747. [DOI] [PubMed] [Google Scholar]
  5. Conte J. E., Jr, Hollander H., Golden J. A. Inhaled or reduced-dose intravenous pentamidine for Pneumocystis carinii pneumonia. A pilot study. Ann Intern Med. 1987 Oct;107(4):495–498. doi: 10.7326/0003-4819-107-4-495. [DOI] [PubMed] [Google Scholar]
  6. Edman J. C., Kovacs J. A., Masur H., Santi D. V., Elwood H. J., Sogin M. L. Ribosomal RNA sequence shows Pneumocystis carinii to be a member of the fungi. Nature. 1988 Aug 11;334(6182):519–522. doi: 10.1038/334519a0. [DOI] [PubMed] [Google Scholar]
  7. Fischl M. A., Dickinson G. M., La Voie L. Safety and efficacy of sulfamethoxazole and trimethoprim chemoprophylaxis for Pneumocystis carinii pneumonia in AIDS. JAMA. 1988 Feb 26;259(8):1185–1189. doi: 10.1001/jama.259.8.1185. [DOI] [PubMed] [Google Scholar]
  8. Frenkel J. K., Good J. T., Shultz J. A. Latent Pneumocystis infection of rats, relapse, and chemotherapy. Lab Invest. 1966 Oct;15(10):1559–1577. [PubMed] [Google Scholar]
  9. Golden J. A., Hollander H., Stulbarg M. S., Gamsu G. Bronchoalveolar lavage as the exclusive diagnostic modality for Pneumocystis carinii pneumonia. A prospective study among patients with acquired immunodeficiency syndrome. Chest. 1986 Jul;90(1):18–22. doi: 10.1378/chest.90.1.18. [DOI] [PubMed] [Google Scholar]
  10. Golden J. A., Sjoerdsma A., Santi D. V. Pneumocystis carinii pneumonia treated with alpha-difluoromethylornithine. A prospective study among patients with the acquired immunodeficiency syndrome. West J Med. 1984 Nov;141(5):613–623. [PMC free article] [PubMed] [Google Scholar]
  11. Hopewell P. C. Pneumocystis carinii pneumonia: diagnosis. J Infect Dis. 1988 Jun;157(6):1115–1119. doi: 10.1093/infdis/157.6.1115. [DOI] [PubMed] [Google Scholar]
  12. Hughes W. T., Feldman S., Chaudhary S. C., Ossi M. J., Cox F., Sanyal S. K. Comparison of pentamidine isethionate and trimethoprim-sulfamethoxazole in the treatment of Pneumocystis carinii pneumonia. J Pediatr. 1978 Feb;92(2):285–291. doi: 10.1016/s0022-3476(78)80028-6. [DOI] [PubMed] [Google Scholar]
  13. Hughes W. T., Rivera G. K., Schell M. J., Thornton D., Lott L. Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med. 1987 Jun 25;316(26):1627–1632. doi: 10.1056/NEJM198706253162604. [DOI] [PubMed] [Google Scholar]
  14. Kagawa F. T., Kirsch C. M., Yenokida G. G., Levine M. L. Serum lactate dehydrogenase activity in patients with AIDS and Pneumocystis carinii pneumonia. An adjunct to diagnosis. Chest. 1988 Nov;94(5):1031–1033. doi: 10.1378/chest.94.5.1031. [DOI] [PubMed] [Google Scholar]
  15. Kelley J., Landis J. N., Davis G. S., Trainer T. D., Jakab G. J., Green G. M. Diagnosis of pneumonia due to Pneumocystis by subsegmental pulmonary lavage via the fiberoptic bronchoscope. Chest. 1978 Jul;74(1):24–28. doi: 10.1378/chest.74.1.24. [DOI] [PubMed] [Google Scholar]
  16. Kovacs J. A., Allegra C. J., Beaver J., Boarman D., Lewis M., Parrillo J. E., Chabner B., Masur H. Characterization of de novo folate synthesis in Pneumocystis carinii and Toxoplasma gondii: potential for screening therapeutic agents. J Infect Dis. 1989 Aug;160(2):312–320. doi: 10.1093/infdis/160.2.312. [DOI] [PubMed] [Google Scholar]
  17. Kovacs J. A., Gill V., Swan J. C., Ognibene F., Shelhamer J., Parrillo J. E., Masur H. Prospective evaluation of a monoclonal antibody in diagnosis of Pneumocystis carinii pneumonia. Lancet. 1986 Jul 5;2(8497):1–3. doi: 10.1016/s0140-6736(86)92555-9. [DOI] [PubMed] [Google Scholar]
  18. Kovacs J. A., Hiemenz J. W., Macher A. M., Stover D., Murray H. W., Shelhamer J., Lane H. C., Urmacher C., Honig C., Longo D. L. Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med. 1984 May;100(5):663–671. doi: 10.7326/0003-4819-100-5-663. [DOI] [PubMed] [Google Scholar]
  19. Kovacs J. A., Ng V. L., Masur H., Leoung G., Hadley W. K., Evans G., Lane H. C., Ognibene F. P., Shelhamer J., Parrillo J. E. Diagnosis of Pneumocystis carinii pneumonia: improved detection in sputum with use of monoclonal antibodies. N Engl J Med. 1988 Mar 10;318(10):589–593. doi: 10.1056/NEJM198803103181001. [DOI] [PubMed] [Google Scholar]
  20. Leoung G. S., Mills J., Hopewell P. C., Hughes W., Wofsy C. Dapsone-trimethoprim for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Ann Intern Med. 1986 Jul;105(1):45–48. doi: 10.7326/0003-4819-105-1-45. [DOI] [PubMed] [Google Scholar]
  21. Masur H., Kovacs J. A. Treatment and prophylaxis of Pneumocystis carinii pneumonia. Infect Dis Clin North Am. 1988 Jun;2(2):419–428. [PubMed] [Google Scholar]
  22. Masur H., Ognibene F. P., Yarchoan R., Shelhamer J. H., Baird B. F., Travis W., Suffredini A. F., Deyton L., Kovacs J. A., Falloon J. CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med. 1989 Aug 1;111(3):223–231. doi: 10.7326/0003-4819-111-3-223. [DOI] [PubMed] [Google Scholar]
  23. Mills J., Leoung G., Medina I., Hopewell P. C., Hughes W. T., Wofsy C. Dapsone treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Antimicrob Agents Chemother. 1988 Jul;32(7):1057–1060. doi: 10.1128/aac.32.7.1057. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mills J. Pneumocystis carinii and Toxoplasma gondii infections in patients with AIDS. Rev Infect Dis. 1986 Nov-Dec;8(6):1001–1011. doi: 10.1093/clinids/8.6.1001. [DOI] [PubMed] [Google Scholar]
  25. Montgomery A. B., Debs R. J., Luce J. M., Corkery K. J., Turner J., Brunette E. N., Lin E. T., Hopewell P. C. Aerosolised pentamidine as sole therapy for Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome. Lancet. 1987 Aug 29;2(8557):480–483. doi: 10.1016/s0140-6736(87)91794-6. [DOI] [PubMed] [Google Scholar]
  26. O'Brien R. F., Quinn J. L., Miyahara B. T., Lepoff R. B., Cohn D. L. Diagnosis of Pneumocystis carinii pneumonia by induced sputum in a city with moderate incidence of AIDS. Chest. 1989 Jan;95(1):136–138. doi: 10.1378/chest.95.1.136. [DOI] [PubMed] [Google Scholar]
  27. Ognibene F. P., Masur H., Rogers P., Travis W. D., Suffredini A. F., Feuerstein I., Gill V. J., Baird B. F., Carrasquillo J. A., Parrillo J. E. Nonspecific interstitial pneumonitis without evidence of Pneumocystis carinii in asymptomatic patients infected with human immunodeficiency virus (HIV). Ann Intern Med. 1988 Dec 1;109(11):874–879. doi: 10.7326/0003-4819-109-11-874. [DOI] [PubMed] [Google Scholar]
  28. Ognibene F. P., Shelhamer J., Gill V., Macher A. M., Loew D., Parker M. M., Gelmann E., Fauci A. S., Parrillo J. E., Masur H. The diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome using subsegmental bronchoalveolar lavage. Am Rev Respir Dis. 1984 Jun;129(6):929–932. doi: 10.1164/arrd.1984.129.6.929. [DOI] [PubMed] [Google Scholar]
  29. Pass H. I., Potter D., Shelhammer J., Macher A., Ognibene F. P., Longo D. L., Gelmann E., Masur H., Roth J. A. Indications for and diagnostic efficacy of open-lung biopsy in the patient with acquired immunodeficiency syndrome (AIDS). Ann Thorac Surg. 1986 Mar;41(3):307–312. doi: 10.1016/s0003-4975(10)62776-2. [DOI] [PubMed] [Google Scholar]
  30. Pitchenik A. E., Ganjei P., Torres A., Evans D. A., Rubin E., Baier H. Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Am Rev Respir Dis. 1986 Feb;133(2):226–229. doi: 10.1164/arrd.1986.133.2.226. [DOI] [PubMed] [Google Scholar]
  31. Sattler F. R., Cowan R., Nielsen D. M., Ruskin J. Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective, noncrossover study. Ann Intern Med. 1988 Aug 15;109(4):280–287. doi: 10.7326/0003-4819-109-4-280. [DOI] [PubMed] [Google Scholar]
  32. Soulez B., Dei-Cas E., Charet P., Mougeot G., Caillaux M., Camus D. The young rabbit: a nonimmunosuppressed model for Pneumocystis carinii pneumonia. J Infect Dis. 1989 Aug;160(2):355–356. doi: 10.1093/infdis/160.2.355. [DOI] [PubMed] [Google Scholar]
  33. Stahl-Bayliss C. M., Kalman C. M., Laskin O. L. Pentamidine-induced hypoglycemia in patients with the acquired immune deficiency syndrome. Clin Pharmacol Ther. 1986 Mar;39(3):271–275. doi: 10.1038/clpt.1986.38. [DOI] [PubMed] [Google Scholar]
  34. Stover D. E., Meduri G. U. Pulmonary function tests. Clin Chest Med. 1988 Sep;9(3):473–479. [PubMed] [Google Scholar]
  35. Stover D. E., White D. A., Romano P. A., Gellene R. A., Robeson W. A. Spectrum of pulmonary diseases associated with the acquired immune deficiency syndrome. Am J Med. 1985 Mar;78(3):429–437. doi: 10.1016/0002-9343(85)90334-1. [DOI] [PubMed] [Google Scholar]
  36. Stringer S. L., Stringer J. R., Blase M. A., Walzer P. D., Cushion M. T. Pneumocystis carinii: sequence from ribosomal RNA implies a close relationship with fungi. Exp Parasitol. 1989 May;68(4):450–461. doi: 10.1016/0014-4894(89)90130-6. [DOI] [PubMed] [Google Scholar]
  37. Toma E., Fournier S., Poisson M., Morisset R., Phaneuf D., Vega C. Clindamycin with primaquine for Pneumocystis carinii pneumonia. Lancet. 1989 May 13;1(8646):1046–1048. doi: 10.1016/s0140-6736(89)92446-x. [DOI] [PubMed] [Google Scholar]
  38. Tuazon C. U., Delaney M. D., Simon G. L., Witorsch P., Varma V. M. Utility of gallium67 scintigraphy and bronchial washings in the diagnosis and treatment of Pneumocystis carinii pneumonia in patients with the acquired immune deficiency syndrome. Am Rev Respir Dis. 1985 Nov;132(5):1087–1092. doi: 10.1164/arrd.1985.132.5.1087. [DOI] [PubMed] [Google Scholar]
  39. Walmsley S., Salit I. E., Brunton J. The possible role of corticosteroid therapy for pneumocystis pneumonia in the acquired immune deficiency syndrome (AIDS). J Acquir Immune Defic Syndr. 1988;1(4):354–360. [PubMed] [Google Scholar]
  40. Walzer P. D., Perl D. P., Krogstad D. J., Rawson P. G., Schultz M. G. Pneumocystis carinii pneumonia in the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med. 1974 Jan;80(1):83–93. doi: 10.7326/0003-4819-80-1-83. [DOI] [PubMed] [Google Scholar]
  41. Walzer P. D., Schnelle V., Armstrong D., Rosen P. P. Nude mouse: a new experimental model for Pneumocystis carinii infection. Science. 1977 Jul 8;197(4299):177–179. doi: 10.1126/science.301657. [DOI] [PubMed] [Google Scholar]
  42. Zaman M. K., White D. A. Serum lactate dehydrogenase levels and Pneumocystis carinii pneumonia. Diagnostic and prognostic significance. Am Rev Respir Dis. 1988 Apr;137(4):796–800. doi: 10.1164/ajrccm/137.4.796. [DOI] [PubMed] [Google Scholar]
  43. Zaman M. K., Wooten O. J., Suprahmanya B., Ankobiah W., Finch P. J., Kamholz S. L. Rapid noninvasive diagnosis of Pneumocystis carinii from induced liquefied sputum. Ann Intern Med. 1988 Jul 1;109(1):7–10. doi: 10.7326/0003-4819-109-1-7. [DOI] [PubMed] [Google Scholar]

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