(PCP)

BY: Arjhay Hipolito

PN-IA (Group 2)

Pneumocystis carinii is a
cause of diffuse pneumonia in
immunocompromised hosts.
Even in fatal cases, the
organism and the disease
remain localized to the lung.
The pneumonia rarely, if ever,
occurs in healthy individuals.

Pneumocystis carinii, an extracellular

protozoan, has been observed in
three forms. Diagnosis requires
identification of P carinii in lung
tissue, obtained by invasive
techniques, or in lower airway fluids.
Experimental studies have shown
that the organism can be transmitted
by inhalation.

 Causes Pneumonitis, Pneumocystis

pneumonia (PCP)
Lung epithelium becomes desquamated
alveoli fill with foamy exudate containing
parasites
Fever, non productive cough, breathing
difficulty on exertion, respiratory failure,
cyanosis
Death by asphyxia

It is not yet established whether

P carinii is a fungus or a
protozoan. Antigenic differences
have been found in strains
derived from the various
mammalian hosts.

The spherical, oval, cup-shaped,

thick-walled cyst, 6 to 8 m in
diameter, contains up to eight
intracystic pleomorphic
sporozoites. The extra-cystic
trophozoite is thin-walled and
varies in size from 2 to 6 m.

Geographic Distribution
Worldwide
Most children exposed by the
age of 3-4 years
Commonly found in the lungs
of healthy individuals, but no
disease occurs
Widespread in mammals

Hosts...
Humans
Pneumocystis jiroveci(i) alternate names
Pneumocystis carinii hominis
Elderly, malnourished children, primary
immunodeficiency disorders, AIDS
Patients receiving cytotoxic or
immunosupressive drugs for
lymphoresticular cancers or transplants


Life cycle is not fully known
Asexual and sexual reproduction (CDC)
Four general morphological forms in mammals
Trophozoite (has amoeboid trophozoite form)

Precysts and Cysts

Sporozoites (intracystic bodies)

Cyst (diagnostic form)

chitinous membrane and 8 intracystic bodies
Pore in cyst wall used for releasing sporozoites.
Can be spherical or collapsed.

Life Cycle

In normal individuals, asymptomatic

infection of the lungs occurs in early
life. The organism persists in an
inactive or latent state unless the
host becomes
immunocompromised. Organisms
attached to the alveolar septal wall
replicate resulting in diffuse alveolitis
and impaired oxygenation.

 Aerosol droplets
Direct contact
Congenital infection
Household pets
Reactivation of latent infection
when immunocompromised

A cell-mediated immune
response is the major defense
mechanism.
Other mammals: rabbits, dogs,
goats, swine, cats,
chimpanzees, owl monkeys,
horses

Pneumocystis carinii has been

found in the lungs of rats, rabbits,
mice, dogs, sheep, goats, ferrets,
chimpanzees, guinea pigs, horses,
and monkeys.
P carinii infection is nonseasonal
and worldwide. The organism is
probably acquired by the respiratory
route.

 Clinical symptoms
Sputum or bronchial lavage
Special staining with toluidine blue,
methenamine silver
Gram-Weigert stain for cysts
ELISA, immunofluorescence assay, DNA
amplification being developed

Four drugs currently available for

therapy of P carinii pneumonitis are
pentamidine isethionate, trimethoprimsulfamethoxazole, atovaquone and
trimetrevate.
Trimethoprim-sulfamethoxazole is the
preferred drug for treatment and prophylaxis.

Sample pictures
Trophozoites in
BAL material.

Cysts in BAL
material

 Trimethoprim-sulfamethoxazole (TMPSMZ)
Pentamidine isethionate inhalant
Treatments can be toxic and patient must
be monitored closely
Prophylactic treatment if CD4 count is low
(<200)
HAART regimen to boost immune system
function, corticosteroids