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Pneumocystis carinii Infection. Update and Review
Javed F. Wazir, MBBS, PhD, MRCPath, and Naseem A. Ansari,
MBBS, MRCPath
From the Department of Pathology, Arabian Gulf University, Kingdom
of Bahrain.
Reprints: Javed F. Wazir, MBBS, PhD, MRCPath, Department of Pathology, Arabian
Gulf University, PO Box-22979, Kingdom of Bahrain (E-mail: javedfw@agu.edu.br
or E-mail: jfwazir@hotmail.com).
Accepted May 11, 2004.
Objective. To review and update the literature on current trends
with regard to Pneumocystis
carinii (jiroveci) diagnosis, treatment modalities, and its role
in human disease processes.
Data Sources.Bibliographic databases (PubMed and Ovid) were
searched for material and data between 1980 and September 2003 relevant to the
review.
Indexing terms used were “Pneumocystis carinii pneumonia,” and
“Pneumocystis jiroveci,” with the English language as a constraint.
Other
sources were the PhD thesis of one of the authors (J.F.W., London University,
1993) and the library at the Arabian Gulf University in the Kingdom of Bahrain.
Study Selection. Acquired immunodeficiency syndrome and organ
transplant cases with Pneumocystis
carinii pneumonia.
Data Extraction. Independent extraction by 2 observers.
Data Synthesis. We reviewed the major characteristics of P
carinii (jiroveci) with special emphasis on the more recently
acquired data including the presence of a round pore in the cyst wall, which
appears to be used for the release of sporozoites, supporting the hypothesis of
sexual reproduction in P
carinii (jiroveci).
Conclusions.Opportunistic infection with P
carinii (jiroveci) remains a significant cause of morbidity and
mortality in human immunodeficiency virus and non-human immunodeficiency
virus–associated immunosuppressed patients.
Diagnosis may be achieved in the
majority of cases by routine cytochemical stains and specialized techniques such
as immunocytochemistry and polymerase chain reaction.
The incidence of P
carinii pneumonia can significantly be reduced with effective use of
prophylaxis and early detection of cases at high risk.
Immunization for P
carinii pneumonia is in the early stages and presents a challenging area
for research.
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