Download PDF
Semin Respir Crit Care Med 2020; 41(01): 141-157
DOI: 10.1055/s-0039-3399559
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pneumocystis jiroveci

Jay A. Fishman
1   Department of Medicine, Harvard Medical School, Boston, Massachusetts
2   Transplant Infectious Disease and Immunocompromised Host Program, Massachusetts General Hospital, Boston, MA
3   MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
30 January 2020 (online)

    Permissions and Reprints

Abstract

Pneumocystis jiroveci remains an important fungal pathogen in a broad range of immunocompromised hosts. The natural reservoir of infection remains unknown. Pneumocystis jiroveci Pneumonia (PJP) develops via airborne transmission or reactivation of inadequately treated infection. Nosocomial clusters of infection have been described among immunocompromised hosts. Subclinical infection or colonization may occur. Pneumocystis pneumonia occurs most often within 6 months of organ transplantation and with intensified or prolonged immunosuppression, notably with corticosteroids. Infection is also common during neutropenia and low-lymphocyte counts, with hypogammaglobulinemia, and following cytomegalovirus (CMV) infection. The clinical presentation generally includes fever, dyspnea with hypoxemia, and nonproductive cough. Chest radiographic patterns are best visualized by computed tomography (CT) scan with diffuse interstitial processes. Laboratory examination reveals hypoxemia, elevated serum lactic dehydrogenase levels, and elevated serum (1→3) β-D-glucan assays. Specific diagnosis is achieved using respiratory specimens with direct immunofluorescent staining; invasive procedures may be required and are important to avoid unnecessary therapies. Quantitative nucleic acid amplification is a useful adjunct to diagnosis but may be overly sensitive. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the drug of choice for therapy; drug allergy should be documented before resorting to alternative therapies. Adjunctive corticosteroids may be useful early in the clinical course; aggressive reductions in immunosuppression may provoke immune reconstitution syndromes. Pneumocystis pneumonia (PJP) prophylaxis is recommended and effective for immunocompromised individuals in the most commonly affected risk groups.

Keywords

Pneumocystis jiroveci - Pneumocystis pneumonia - fungal infection - cytomegalovirus - HIV - AIDS - Corticosteroids - organ transplantation - hematopoietic stem cell transplantation
 

  • References

  • 1 Cordonnier C, Cesaro S, Maschmeyer G. , et al; Fifth European Conference on Infections in Leukemia (ECIL-5), a joint venture of The European Group for Blood and Marrow Transplantation (EBMT), The European Organization for Research and Treatment of Cancer (EORTC), the Immunocompromised Host Society (ICHS) and The European LeukemiaNet (ELN). Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother 2016; 71 (09) 2379-2385
    CrossrefPubMedSearch in Google Scholar
  • 2 Gryzan S, Paradis IL, Zeevi A. , et al. Unexpectedly high incidence of Pneumocystis carinii infection after lung-heart transplantation. Implications for lung defense and allograft survival. Am Rev Respir Dis 1988; 137 (06) 1268-1274
    CrossrefPubMedSearch in Google Scholar
  • 3 Lufft V, Kliem V, Behrend M, Pichlmayr R, Koch KM, Brunkhorst R. Incidence of Pneumocystis carinii pneumonia after renal transplantation. Impact of immunosuppression. Transplantation 1996; 62 (03) 421-423
    CrossrefPubMedSearch in Google Scholar
  • 4 Maini R, Henderson KL, Sheridan EA. , et al. Increasing Pneumocystis pneumonia, England, UK, 2000-2010. Emerg Infect Dis 2013; 19 (03) 386-392
    PubMedSearch in Google Scholar
  • 5 Rodriguez M, Fishman JA. Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients. Clin Microbiol Rev 2004; 17 (04) 770-782 table of contents.
    CrossrefPubMedSearch in Google Scholar
  • 6 Maertens J, Cesaro S, Maschmeyer G. , et al; 5th European Conference on Infections in Leukaemia (ECIL-5), a joint venture of the European Group for Blood and Marrow Transplantation (EBMT), the European Organisation for Research and Treatment of Cancer (EORTC), the Immunocompromised Host Society (ICHS) and the European LeukemiaNet (ELN). ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother 2016; 71 (09) 2397-2404
    CrossrefPubMedSearch in Google Scholar
  • 7 Fischl MA, Richman DD, Causey DM. , et al; AZT Collaborative Working Group. Prolonged zidovudine therapy in patients with AIDS and advanced AIDS-related complex. JAMA 1989; 262 (17) 2405-2410
    CrossrefPubMedSearch in Google Scholar
  • 8 Delanoe P, Delanoe M. Sur les rapports des kystes de carinii du pneumon des rats avec le Trypanosoma lewisi. C R Acad Sci 1912; 155: 658
    PubMedSearch in Google Scholar
  • 9 Vanek J, Jirovec O. [Parasitic pneumonia. Interstitial plasma cell pneumonia of premature, caused by pneumocystis Carinii]. Zentralbl Bakteriol Parasitenkd Infektionskr Hyg 1952; 158: 120-127
    PubMedSearch in Google Scholar
  • 10 Van der Meer G, Brug S. Infection par Pneumocystis chez l'homme et chez les animaux. Ann Soc Belg Med Trop 1942; 22: 301-307
    PubMedSearch in Google Scholar
  • 11 Walzer PD, Perl DP, Krogstad DJ, Rawson PG, Schultz MG. Pneumocystis carinii pneumonia in the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med 1974; 80 (01) 83-93
    PubMedSearch in Google Scholar
  • 12 Walzer PD, Perl DP, Krogstad DJ, Rawson PG, Schultz MG. Pneumocystis carinii pneumonia in the United States: epidemiologic, diagnostic, and clinical features. Natl Cancer Inst Monogr 1976; 43: 55-63
    PubMedSearch in Google Scholar
  • 13 Cushion MT, Hong ST, Steele PE, Stringer SL, Walzer PD, Stringer JR. Molecular biology of Pneumocystis carinii. Ann N Y Acad Sci 1990; 616: 415-420
    CrossrefPubMedSearch in Google Scholar
  • 14 Stringer JR. Antigenic variation in pneumocystis. J Eukaryot Microbiol 2007; 54 (01) 8-13
    CrossrefPubMedSearch in Google Scholar
  • 15 Smulian AG, Stringer JR, Linke MJ, Walzer PD. Expression cloning of Pneumocystis carinii antigens. J Protozool 1991; 38 (06) 8S-10S
    PubMedSearch in Google Scholar
  • 16 Stringer SL, Hudson K, Blase MA, Walzer PD, Cushion MT, Stringer JR. Sequence from ribosomal RNA of Pneumocystis carinii compared to those of four fungi suggests an ascomycetous affinity. J Protozool 1989; 36 (01) 14S-16S
    CrossrefPubMedSearch in Google Scholar
  • 17 Stringer JR, Cushion MT, Wakefield AE. New nomenclature for the genus Pneumocystis. J Eukaryot Microbiol 2001; ;(Suppl): 184S-189S . doi: 10.1111/j.1550-7408.2001.tb00512.x
    PubMedSearch in Google Scholar
  • 18 Banerji S, Lugli EB, Miller RF, Wakefield AE. Analysis of genetic diversity at the arom locus in isolates of Pneumocystis carinii. J Eukaryot Microbiol 1995; 42 (06) 675-679
    CrossrefPubMedSearch in Google Scholar
  • 19 Sinclair K, Wakefield AE, Banerji S, Hopkin JM. Pneumocystis carinii organisms derived from rat and human hosts are genetically distinct. Mol Biochem Parasitol 1991; 45 (01) 183-184
    CrossrefPubMedSearch in Google Scholar
  • 20 Kim HK, Hughes WT, Feldman S. Studies of morphology and immunofluorescence of Pneumocystis carinii. Proc Soc Exp Biol Med 1972; 141 (01) 304-309
    CrossrefPubMedSearch in Google Scholar
  • 21 Bartlett MS, Fishman JA, Durkin MM, Queener SF, Smith JW. Pneumocystis carinii: improved models to study efficacy of drugs for treatment or prophylaxis of Pneumocystis pneumonia in the rat (Rattus spp.). Exp Parasitol 1990; 70 (01) 100-106
    CrossrefPubMedSearch in Google Scholar
  • 22 Bartlett MS, Fishman JA, Queener SF, Durkin MM, Jay MA, Smith JW. New rat model of Pneumocystis carinii infection. J Clin Microbiol 1988; 26 (06) 1100-1102
    CrossrefPubMedSearch in Google Scholar
  • 23 Walzer PD, Schnelle V, Armstrong D, Rosen PP. Nude mouse: a new experimental model for Pneumocystis carinii infection. Science 1977; 197 (4299): 177-179
    CrossrefPubMedSearch in Google Scholar
  • 24 Walzer PD, Young LS. Clinical relevance of animal models of Pneumocystis carinii pneumonia. Diagn Microbiol Infect Dis 1984; 2 (01) 1-6
    CrossrefPubMedSearch in Google Scholar
  • 25 Barlett MS, Fishman JA, Durkin MM, Queener SF, Smith JW. An improved rat model to study efficacy of drugs for treatment or prophylaxis of Pneumocystis carinii pneumonia. J Protozool 1989; 36 (01) 77S-78S
    CrossrefPubMedSearch in Google Scholar
  • 26 Mirovsky P, Fishman JA. An improved method for the prolonged maintenance of Pneumocystis carinii in vitro. J Infect Dis 1993; 167 (06) 1470-1473
    CrossrefPubMedSearch in Google Scholar
  • 27 Hughes WT. Natural mode of acquisition for de novo infection with Pneumocystis carinii. J Infect Dis 1982; 145 (06) 842-848
    CrossrefPubMedSearch in Google Scholar
  • 28 Pifer LL, Hughes WT, Murphy Jr MJ. Propagation of Pneumocystis carinii in vitro. Pediatr Res 1977; 11 (04) 305-316
    CrossrefPubMedSearch in Google Scholar
  • 29 Kottom TJ, Limper AH. Pneumocystis carinii cell wall biosynthesis kinase gene CBK1 is an environmentally responsive gene that complements cell wall defects of cbk-deficient yeast. Infect Immun 2004; 72 (08) 4628-4636
    CrossrefPubMedSearch in Google Scholar
  • 30 Vohra PK, Park JG, Sanyal B, Thomas Jr CF. Expression analysis of PCSTE3, a putative pheromone receptor from the lung pathogenic fungus Pneumocystis carinii. Biochem Biophys Res Commun 2004; 319 (01) 193-199
    CrossrefPubMedSearch in Google Scholar
  • 31 Stringer SL, Stringer JR, Blase MA, Walzer PD, Cushion MT. Pneumocystis carinii: sequence from ribosomal RNA implies a close relationship with fungi. Exp Parasitol 1989; 68 (04) 450-461
    CrossrefPubMedSearch in Google Scholar
  • 32 Edman JC, Kovacs JA, Masur H, Santi DV, Elwood HJ, Sogin ML. Ribosomal RNA sequence shows Pneumocystis carinii to be a member of the fungi. Nature 1988; 334 (6182): 519-522
    CrossrefPubMedSearch in Google Scholar
  • 33 Furlong ST, Samia JA, Rose RM, Fishman JA. Phytosterols are present in Pneumocystis carinii. Antimicrob Agents Chemother 1994; 38 (11) 2534-2540
    CrossrefPubMedSearch in Google Scholar
  • 34 Fishman JA. Cross-reactive antigens of the rat and human Pneumocystis carinii. J Protozool 1989; 36 (01) 66S-67S
    CrossrefPubMedSearch in Google Scholar
  • 35 Fishman JA, Ullu E, Armstrong MY, Richards FF. Organization of DNA and RNA from rat Pneumocystis carinii. J Protozool 1989; 36 (01) 4S-5S
    CrossrefPubMedSearch in Google Scholar
  • 36 Fishman JA. , inventor; General Hospital Corp, assignee. Molecular cloning of antigens shared by rat- and human-derived Pneumocystis Carinii. US patent 5,442,050A. 1995
    PubMedSearch in Google Scholar
  • 37 Bogucki MS, Fishman JA, Radding JA, Armstrong MY, Richards FF. Characterization of Pneumocystis carinii monoclonal antibodies. J Protozool 1989; 36 (01) 41S-43S
    CrossrefPubMedSearch in Google Scholar
  • 38 Kovacs JA, Gill V, Swan JC. , et al. Prospective evaluation of a monoclonal antibody in diagnosis of Pneumocystis carinii pneumonia. Lancet 1986; 2 (8497): 1-3
    PubMedSearch in Google Scholar
  • 39 Walzer PD, Linke MJ. A comparison of the antigenic characteristics of rat and human Pneumocystis carinii by immunoblotting. J Immunol 1987; 138 (07) 2257-2265
    PubMedSearch in Google Scholar
  • 40 Kovacs JA, Halpern JL, Lundgren B, Swan JC, Parrillo JE, Masur H. Monoclonal antibodies to Pneumocystis carinii: identification of specific antigens and characterization of antigenic differences between rat and human isolates. J Infect Dis 1989; 159 (01) 60-70
    CrossrefPubMedSearch in Google Scholar
  • 41 Kovacs JA, Halpern JL, Swan JC, Moss J, Parrillo JE, Masur H. Identification of antigens and antibodies specific for Pneumocystis carinii. J Immunol 1988; 140 (06) 2023-2031
    PubMedSearch in Google Scholar
  • 42 Keely SP, Wakefield AE, Cushion MT. , et al. Detailed structure of Pneumocystis carinii chromosome ends. Infect Immun 2001; 69 (02) 627-639 . doi: 10.1128/IAI.69.2.627-639.2001
    CrossrefPubMedSearch in Google Scholar
  • 43 Stringer JR, Keely SP. Genetics of surface antigen expression in Pneumocystis carinii. Infect Immun 2001; 69 (02) 627-639
    CrossrefPubMedSearch in Google Scholar
  • 44 Wright TW, Bissoondial TY, Haidaris CG, Gigliotti F, Haidaris PJ. Isoform diversity and tandem duplication of the glycoprotein A gene in ferret Pneumocystis carinii. DNA Res 1995; 2 (02) 77-88
    CrossrefPubMedSearch in Google Scholar
  • 45 Linke MJ, Smulian AG, Stringer JR, Walzer PD. Characterization of multiple unique cDNAs encoding the major surface glycoprotein of rat-derived Pneumocystis carinii. Parasitol Res 1994; 80 (06) 478-486
    CrossrefPubMedSearch in Google Scholar
  • 46 Gigliotti F, Ballou LR, Hughes WT, Mosley BD. Purification and initial characterization of a ferret Pneumocystis carinii surface antigen. J Infect Dis 1988; 158 (04) 848-854
    CrossrefPubMedSearch in Google Scholar
  • 47 Radding JA, Armstrong MY, Ullu E, Richards FF. Identification and isolation of a major cell surface glycoprotein of Pneumocystis carinii. Infect Immun 1989; 57 (07) 2149-2157
    CrossrefPubMedSearch in Google Scholar
  • 48 Kovacs JA, Powell F, Edman JC. , et al. Multiple genes encode the major surface glycoprotein of Pneumocystis carinii. J Biol Chem 1993; 268 (08) 6034-6040
    CrossrefPubMedSearch in Google Scholar
  • 49 Haidaris PJ, Wright TW, Gigliotti F, Haidaris CG. Expression and characterization of a cDNA clone encoding an immunodominant surface glycoprotein of Pneumocystis carinii. J Infect Dis 1992; 166 (05) 1113-1123
    CrossrefPubMedSearch in Google Scholar
  • 50 Bishop LR, Helman D, Kovacs JA. Discordant antibody and cellular responses to Pneumocystis major surface glycoprotein variants in mice. BMC Immunol 2012; 13: 39
    CrossrefPubMedSearch in Google Scholar
  • 51 Smulian AG, Keely SP, Sunkin SM, Stringer JR. Genetic and antigenic variation in Pneumocystis carinii organisms: tools for examining the epidemiology and pathogenesis of infection. J Lab Clin Med 1997; 130 (05) 461-468
    CrossrefPubMedSearch in Google Scholar
  • 52 Sunkin SM, Stringer JR. Residence at the expression site is necessary and sufficient for the transcription of surface antigen genes of Pneumocystis carinii. Mol Microbiol 1997; 25 (01) 147-160
    CrossrefPubMedSearch in Google Scholar
  • 53 Haidaris CG, Medzihradsky OF, Gigliotti F, Simpson-Haidaris PJ. Molecular characterization of mouse Pneumocystis carinii surface glycoprotein A. DNA Res 1998; 5 (02) 77-85
    CrossrefPubMedSearch in Google Scholar
  • 54 Kutty G, Ma L, Kovacs JA. Characterization of the expression site of the major surface glycoprotein of human-derived Pneumocystis carinii. Mol Microbiol 2001; 42 (01) 183-193
    PubMedSearch in Google Scholar
  • 55 Schaffzin JK, Stringer JR. Expression of the Pneumocystis carinii major surface glycoprotein epitope is correlated with linkage of the cognate gene to the upstream conserved sequence locus. Microbiology 2004; 150 (Pt 3): 677-686
    PubMedSearch in Google Scholar
  • 56 Keely SP, Renauld H, Wakefield AE. , et al. Gene arrays at Pneumocystis carinii telomeres. Genetics 2005; 170 (04) 1589-1600
    PubMedSearch in Google Scholar
  • 57 Keely SP, Stringer JR. Sequence diversity of transcripts from Pneumocystis carinii gene families MSR and PRT1. J Eukaryot Microbiol 2003; 50 (Suppl): 627-628
    CrossrefPubMedSearch in Google Scholar
  • 58 Ambrose HE, Keely SP, Aliouat EM. , et al. Expression and complexity of the PRT1 multigene family of Pneumocystis carinii. Microbiology 2004; 150 (Pt 2): 293-300
    PubMedSearch in Google Scholar
  • 59 Huang SN, Angus CW, Turner RE, Sorial V, Kovacs JA. Identification and characterization of novel variant major surface glycoprotein gene families in rat Pneumocystis carinii. J Infect Dis 1999; 179 (01) 192-200
    CrossrefPubMedSearch in Google Scholar
  • 60 Kutty G, Kovacs JA. A single-copy gene encodes Kex1, a serine endoprotease of Pneumocystis jiroveci. Infect Immun 2003; 71 (01) 571-574
    CrossrefPubMedSearch in Google Scholar
  • 61 Ma L, Chen Z, Huang W. , et al. Genome analysis of three Pneumocystis species reveals adaptation mechanisms to life exclusively in mammalian hosts. Nat Commun 2016; 7: 10740 . doi: 10.1038/ncomms10740 PMCID: PMC4764891
    CrossrefPubMedSearch in Google Scholar
  • 62 Sassi M, Kutty G, Ferreyra GA. , et al. The major surface glycoprotein of pneumocystis murina does not activate dendritic cells. J Infect Dis 2018; 218 (10) 1631-1640
    CrossrefPubMedSearch in Google Scholar
  • 63 Bartlett MS, Queener SF, Shaw MM, Richardson JD, Smith JW. Pneumocystis carinii is resistant to imidazole antifungal agents. Antimicrob Agents Chemother 1994; 38 (08) 1859-1861
    CrossrefPubMedSearch in Google Scholar
  • 64 Kottom TJ, Limper AH. Cell wall assembly by Pneumocystis carinii. Evidence for a unique gsc-1 subunit mediating beta -1,3-glucan deposition. J Biol Chem 2000; 275 (51) 40628-40634
    CrossrefPubMedSearch in Google Scholar
  • 65 Ezekowitz RA, Williams DJ, Koziel H. , et al. Uptake of Pneumocystis carinii mediated by the macrophage mannose receptor. Nature 1991; 351 (6322): 155-158
    CrossrefPubMedSearch in Google Scholar
  • 66 Kutty G, Davis AS, Ferreyra GA. , et al. β-Glucans Are Masked but Contribute to Pulmonary Inflammation During Pneumocystis Pneumonia. J Infect Dis 2016; 214 (05) 782-791
    CrossrefPubMedSearch in Google Scholar
  • 67 Roth A, Wecke J, Karsten V, Janitschke K. Light and electron microscopy study of carbohydrate antigens found in the electron-lucent layer of Pneumocystis carinii cysts. Parasitol Res 1997; 83 (02) 177-184
    CrossrefPubMedSearch in Google Scholar
  • 68 De Stefano JA, Myers JD, Du Pont D, Foy JM, Theus SA, Walzer PD. Cell wall antigens of Pneumocystis carinii trophozoites and cysts: purification and carbohydrate analysis of these glycoproteins. J Eukaryot Microbiol 1998; 45 (03) 334-343
    CrossrefPubMedSearch in Google Scholar
  • 69 Nollstadt KH, Powles MA, Fujioka H, Aikawa M, Schmatz DM. Use of beta-1,3-glucan-specific antibody to study the cyst wall of Pneumocystis carinii and effects of pneumocandin B0 analog L-733,560. Antimicrob Agents Chemother 1994; 38 (10) 2258-2265
    CrossrefPubMedSearch in Google Scholar
  • 70 Villegas LR, Kottom TJ, Limper AH. Characterization of PCEng2, a beta-1,3-endoglucanase homolog in Pneumocystis carinii with activity in cell wall regulation. Am J Respir Cell Mol Biol 2010; 43 (02) 192-200
    CrossrefPubMedSearch in Google Scholar
  • 71 Kutty G, Davis AS, Ma L, Taubenberger JK, Kovacs JA. Pneumocystis encodes a functional endo-β-1,3-glucanase that is expressed exclusively in cysts. J Infect Dis 2015; 211 (05) 719-728
    CrossrefPubMedSearch in Google Scholar
  • 72 Smulian AG, Ryan M, Staben C, Cushion M. Signal transduction in Pneumocystis carinii: characterization of the genes (pcg1) encoding the alpha subunit of the G protein (PCG1) of Pneumocystis carinii carinii and Pneumocystis carinii ratti. Infect Immun 1996; 64 (03) 691-701
    CrossrefPubMedSearch in Google Scholar
  • 73 Thomas Jr CF, Kottom TJ, Leof EB, Limper AH. Characterization of a mitogen-activated protein kinase from Pneumocystis carinii. Am J Physiol 1998; 275 (01) L193-L199
    PubMedSearch in Google Scholar
  • 74 Pifer LL, Hughes WT, Stagno S, Woods D. Pneumocystis carinii infection: evidence for high prevalence in normal and immunosuppressed children. Pediatrics 1978; 61 (01) 35-41
    PubMedSearch in Google Scholar
  • 75 Huang L, Crothers K, Morris A. , et al. Pneumocystis colonization in HIV-infected patients. J Eukaryot Microbiol 2003; 50 : Suppl: 616-617
    CrossrefPubMedSearch in Google Scholar
  • 76 Vargas SL, Hughes WT, Santolaya ME. , et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis 2001; 32 (06) 855-861
    CrossrefPubMedSearch in Google Scholar
  • 77 Jacobs JL, Libby DM, Winters RA. , et al. A cluster of Pneumocystis carinii pneumonia in adults without predisposing illnesses. [see comments] N Engl J Med 1991; 324 (04) 246-250
    CrossrefPubMedSearch in Google Scholar
  • 78 Nevez G, Jounieaux V, Linas MD. , et al. High frequency of Pneumocystis carinii sp.f. hominis colonization in HIV-negative patients. J Eukaryot Microbiol 1997; 44 (06) 36S
    CrossrefPubMedSearch in Google Scholar
  • 79 Sassi M, Ripamonti C, Mueller NJ. , et al. Outbreaks of Pneumocystis pneumonia in 2 renal transplant centers linked to a single strain of Pneumocystis: implications for transmission and virulence. Clin Infect Dis 2012; 54 (10) 1437-1444
    CrossrefPubMedSearch in Google Scholar
  • 80 Rostved AA, Sassi M, Kurtzhals JA. , et al. Outbreak of pneumocystis pneumonia in renal and liver transplant patients caused by genotypically distinct strains of Pneumocystis jirovecii. Transplantation 2013; 96 (09) 834-842
    CrossrefPubMedSearch in Google Scholar
  • 81 de Boer MG, Bruijnesteijn van Coppenraet LE, Gaasbeek A. , et al. An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype among renal transplant recipients: interhuman transmission or a common environmental source?. Clin Infect Dis 2007; 44 (09) 1143-1149
    CrossrefPubMedSearch in Google Scholar
  • 82 Schmoldt S, Schuhegger R, Wendler T. , et al. Molecular evidence of nosocomial Pneumocystis jirovecii transmission among 16 patients after kidney transplantation. J Clin Microbiol 2008; 46 (03) 966-971
    CrossrefPubMedSearch in Google Scholar
  • 83 Höcker B, Wendt C, Nahimana A, Tönshoff B, Hauser PM. Molecular evidence of Pneumocystis transmission in pediatric transplant unit. Emerg Infect Dis 2005; 11 (02) 330-332
    CrossrefPubMedSearch in Google Scholar
  • 84 Arichi N, Kishikawa H, Mitsui Y. , et al. Cluster outbreak of Pneumocystis pneumonia among kidney transplant patients within a single center. Transplant Proc 2009; 41 (01) 170-172
    CrossrefPubMedSearch in Google Scholar
  • 85 Yazaki H, Goto N, Uchida K, Kobayashi T, Gatanaga H, Oka S. Outbreak of Pneumocystis jiroveci pneumonia in renal transplant recipients: P. jiroveci is contagious to the susceptible host. Transplantation 2009; 88 (03) 380-385
    CrossrefPubMedSearch in Google Scholar
  • 86 Bartlett MS, Vermund SH, Jacobs R. , et al. Detection of Pneumocystis carinii DNA in air samples: likely environmental risk to susceptible persons. J Clin Microbiol 1997; 35 (10) 2511-2513
    CrossrefPubMedSearch in Google Scholar
  • 87 Olsson M, Lidman C, Latouche S. , et al. Identification of Pneumocystis carinii f. sp. hominis gene sequences in filtered air in hospital environments. J Clin Microbiol 1998; 36 (06) 1737-1740
    CrossrefPubMedSearch in Google Scholar
  • 88 Cushion MT, Collins MS. Susceptibility of Pneumocystis to echinocandins in suspension and biofilm cultures. Antimicrob Agents Chemother 2011; 55 (10) 4513-4518
    CrossrefPubMedSearch in Google Scholar
  • 89 Cushion MT, Collins MS, Linke MJ. Biofilm formation by Pneumocystis spp. Eukaryot Cell 2009; 8 (02) 197-206
    CrossrefPubMedSearch in Google Scholar
  • 90 Yong SJ, Vuk-Pavlovic Z, Standing JE, Crouch EC, Limper AH. Surfactant protein D-mediated aggregation of Pneumocystis carinii impairs phagocytosis by alveolar macrophages. Infect Immun 2003; 71 (04) 1662-1671
    CrossrefPubMedSearch in Google Scholar
  • 91 Fraser IP, Takahashi K, Koziel H, Fardin B, Harmsen A, Ezekowitz RA. Pneumocystis carinii enhances soluble mannose receptor production by macrophages. Microbes Infect 2000; 2 (11) 1305-1310
    CrossrefPubMedSearch in Google Scholar
  • 92 Nandakumar V, Hebrink D, Jenson P, Kottom T, Limper AH. Differential Macrophage Polarization from Pneumocystis in Immunocompetent and Immunosuppressed Hosts: Potential Adjunctive Therapy during Pneumonia. Infect Immun 2017; 85 (03) 85
    PubMedSearch in Google Scholar
  • 93 Evans HM, Simpson A, Shen S, Stromberg AJ, Pickett CL, Garvy BA. The trophic life cycle stage of the opportunistic fungal pathogen pneumocystis murina hinders the ability of dendritic cells to stimulate CD4+ T cell responses. Infect Immun 2017; 85 (10) 85
    PubMedSearch in Google Scholar
  • 94 Steele C, Marrero L, Swain S. , et al. Alveolar macrophage-mediated killing of Pneumocystis carinii f. sp. muris involves molecular recognition by the Dectin-1 beta-glucan receptor. J Exp Med 2003; 198 (11) 1677-1688
    CrossrefPubMedSearch in Google Scholar
  • 95 Kottom TJ, Hebrink DM, Jenson PE. , et al. The Interaction of Pneumocystis with the C-Type Lectin Receptor Mincle Exerts a Significant Role in Host Defense against Infection. J Immunol 2017; 198 (09) 3515-3525
    CrossrefPubMedSearch in Google Scholar
  • 96 Zhang C, Wang SH, Lasbury ME. , et al. Toll-like receptor 2 mediates alveolar macrophage response to Pneumocystis murina. Infect Immun 2006; 74 (03) 1857-1864
    CrossrefPubMedSearch in Google Scholar
  • 97 Hollifield M, Bou Ghanem E, de Villiers WJ, Garvy BA. Scavenger receptor A dampens induction of inflammation in response to the fungal pathogen Pneumocystis carinii. Infect Immun 2007; 75 (08) 3999-4005
    CrossrefPubMedSearch in Google Scholar
  • 98 Ding K, Shibui A, Wang Y, Takamoto M, Matsuguchi T, Sugane K. Impaired recognition by Toll-like receptor 4 is responsible for exacerbated murine Pneumocystis pneumonia. Microbes Infect 2005; 7 (02) 195-203
    CrossrefPubMedSearch in Google Scholar
  • 99 Koziel H, Li X, Armstrong MY, Richards FF, Rose RM. Alveolar macrophages from human immunodeficiency virus-infected persons demonstrate impaired oxidative burst response to Pneumocystis carinii in vitro. Am J Respir Cell Mol Biol 2000; 23 (04) 452-459
    CrossrefPubMedSearch in Google Scholar
  • 100 Beck JM, Warnock ML, Curtis JL. , et al. Inflammatory responses to Pneumocystis carinii in mice selectively depleted of helper T lymphocytes. Am J Respir Cell Mol Biol 1991; 5 (02) 186-197
    CrossrefPubMedSearch in Google Scholar
  • 101 Shellito J, Suzara VV, Blumenfeld W, Beck JM, Steger HJ, Ermak TH. A new model of Pneumocystis carinii infection in mice selectively depleted of helper T lymphocytes. J Clin Invest 1990; 85 (05) 1686-1693
    CrossrefPubMedSearch in Google Scholar
  • 102 Roths JB, Sidman CL. Both immunity and hyperresponsiveness to Pneumocystis carinii result from transfer of CD4+ but not CD8+ T cells into severe combined immunodeficiency mice. J Clin Invest 1992; 90 (02) 673-678
    CrossrefPubMedSearch in Google Scholar
  • 103 Roths JB, Sidman CL. Single and combined humoral and cell-mediated immunotherapy of Pneumocystis carinii pneumonia in immunodeficient scid mice. Infect Immun 1993; 61 (05) 1641-1649
    CrossrefPubMedSearch in Google Scholar
  • 104 Gigliotti F, Hughes WT. Passive immunoprophylaxis with specific monoclonal antibody confers partial protection against Pneumocystis carinii pneumonitis in animal models. J Clin Invest 1988; 81 (06) 1666-1668
    CrossrefPubMedSearch in Google Scholar
  • 105 Gigliotti F, Crow EL, Bhagwat SP, Wright TW. Sensitized CD8+ T cells fail to control organism burden but accelerate the onset of lung injury during Pneumocystis carinii pneumonia. Infect Immun 2006; 74 (11) 6310-6316
    CrossrefPubMedSearch in Google Scholar
  • 106 Wiley JA, Harmsen AG. CD40 ligand is required for resolution of Pneumocystis carinii pneumonia in mice. J Immunol 1995; 155 (07) 3525-3529
    PubMedSearch in Google Scholar
  • 107 McAllister F, Steele C, Zheng M, Shellito JE, Kolls JK. In vitro effector activity of Pneumocystis murina-specific T-cytotoxic-1 CD8+ T cells: role of granulocyte-macrophage colony-stimulating factor. Infect Immun 2005; 73 (11) 7450-7457
    CrossrefPubMedSearch in Google Scholar
  • 108 Lund FE, Schuer K, Hollifield M, Randall TD, Garvy BA. Clearance of Pneumocystis carinii in mice is dependent on B cells but not on P carinii-specific antibody. J Immunol 2003; 171 (03) 1423-1430
    CrossrefPubMedSearch in Google Scholar
  • 109 Koziel H, Kruskal BA, Ezekowitz RA, Rose RM. HIV impairs alveolar macrophage mannose receptor function against Pneumocystis carinii. Chest 1993; 103 (2, Suppl) 111S-112S
    CrossrefPubMedSearch in Google Scholar
  • 110 McAllister F, Steele C, Zheng M. , et al. T cytotoxic-1 CD8+ T cells are effector cells against pneumocystis in mice. J Immunol 2004; 172 (02) 1132-1138
    CrossrefPubMedSearch in Google Scholar
  • 111 Garvy BA, Harmsen AG. Susceptibility to Pneumocystis carinii infection: host responses of neonatal mice from immune or naive mothers and of immune or naive adults. Infect Immun 1996; 64 (10) 3987-3992
    CrossrefPubMedSearch in Google Scholar
  • 112 Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc 1996; 71 (01) 5-13
    CrossrefPubMedSearch in Google Scholar
  • 113 Martin SI, Fishman JA. ; AST Infectious Diseases Community of Practice. Pneumocystis pneumonia in solid organ transplant recipients. Am J Transplant 2009; 9 (Suppl. 04) S227-S233
    CrossrefPubMedSearch in Google Scholar
  • 114 Fishman JA. Prevention of infection due to Pneumocystis carinii. Antimicrob Agents Chemother 1998; 42 (05) 995-1004
    CrossrefPubMedSearch in Google Scholar
  • 115 Hardy AM, Wajszczuk CP, Suffredini AF, Hakala TR, Ho M. Pneumocystis carinii pneumonia in renal-transplant recipients treated with cyclosporine and steroids. J Infect Dis 1984; 149 (02) 143-147
    CrossrefPubMedSearch in Google Scholar
  • 116 Gryzan S, Paradis IL, Hardesty RL, Griffith BP, Dauber JH. Bronchoalveolar lavage in heart-lung transplantation. J Heart Transplant 1985; 4 (04) 414-416
    PubMedSearch in Google Scholar
  • 117 Dummer JS, Montero CG, Griffith BP, Hardesty RL, Paradis IL, Ho M. Infections in heart-lung transplant recipients. Transplantation 1986; 41 (06) 725-729
    CrossrefPubMedSearch in Google Scholar
  • 118 Fischl MA, Richman DD, Grieco MH. , et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med 1987; 317 (04) 185-191
    CrossrefPubMedSearch in Google Scholar
  • 119 Stansell JD, Osmond DH, Charlebois E. , et al; Pulmonary Complications of HIV Infection Study Group. Predictors of Pneumocystis carinii pneumonia in HIV-infected persons. Am J Respir Crit Care Med 1997; 155 (01) 60-66
    CrossrefPubMedSearch in Google Scholar
  • 120 Beard CB, Fox MR, Lawrence GG. , et al. Genetic differences in Pneumocystis isolates recovered from immunocompetent infants and from adults with AIDS: Epidemiological Implications. J Infect Dis 2005; 192 (10) 1815-1818
    CrossrefPubMedSearch in Google Scholar
  • 121 Iriart X, Challan Belval T, Fillaux J. , et al. Risk factors of Pneumocystis pneumonia in solid organ recipients in the era of the common use of posttransplantation prophylaxis. Am J Transplant 2015; 15 (01) 190-199
    CrossrefPubMedSearch in Google Scholar
  • 122 Veronese G, Ammirati E, Moioli MC. , et al. Single-center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients. Transpl Infect Dis 2018; 20 (03) e12880
    CrossrefPubMedSearch in Google Scholar
  • 123 Kovacs JA, Hiemenz JW, Macher AM. , et al. Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 1984; 100 (05) 663-671
    CrossrefPubMedSearch in Google Scholar
  • 124 Alanio A, Hauser PM, Lagrou K. , et al; 5th European Conference on Infections in Leukemia (ECIL-5), a joint venture of The European Group for Blood and Marrow Transplantation (EBMT), The European Organization for Research and Treatment of Cancer (EORTC), the Immunocompromised Host Society (ICHS) and The European LeukemiaNet (ELN). ECIL guidelines for the diagnosis of Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother 2016; 71 (09) 2386-2396
    CrossrefPubMedSearch in Google Scholar
  • 125 Cohen OJ, Stoeckle MY. Extrapulmonary Pneumocystis carinii infections in the acquired immunodeficiency syndrome. Arch Intern Med 1991; 151 (06) 1205-1214
    CrossrefPubMedSearch in Google Scholar
  • 126 Liu YC, Tomashefski Jr JF, Tomford JW, Green H. Necrotizing Pneumocystis carinii vasculitis associated with lung necrosis and cavitation in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med 1989; 113 (05) 494-497
    PubMedSearch in Google Scholar
  • 127 Fujii T, Nakamura T, Iwamoto A. Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features. J Infect Chemother 2007; 13 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 128 Chou CW, Chao HS, Lin FC, Tsai HC, Yuan WH, Chang SC. Clinical usefulness of HRCT in assessing the severity of Pneumocystis jirovecii pneumonia: A Cross-sectional Study. Medicine (Baltimore) 2015; 94 (16) e768
    PubMedSearch in Google Scholar
  • 129 Vogel MN, Vatlach M, Weissgerber P. , et al. HRCT-features of Pneumocystis jiroveci pneumonia and their evolution before and after treatment in non-HIV immunocompromised patients. Eur J Radiol 2012; 81 (06) 1315-1320
    CrossrefPubMedSearch in Google Scholar
  • 130 Diederich S. Chest CT for suspected pulmonary complications of oncologic therapies: how I review and report. Cancer Imaging 2016; 16: 7
    CrossrefPubMedSearch in Google Scholar
  • 131 Vogel M, Weissgerber P, Goeppert B. , et al. Accuracy of serum LDH elevation for the diagnosis of Pneumocystis jiroveci pneumonia. Swiss Med Wkly 2011; 141: w13184
    PubMedSearch in Google Scholar
  • 132 Akamatsu N, Sugawara Y, Kaneko J, Tamura S, Makuuchi M. Preemptive treatment of fungal infection based on plasma (1 --> 3)beta-D-glucan levels after liver transplantation. Infection 2007; 35 (05) 346-351
    CrossrefPubMedSearch in Google Scholar
  • 133 Costa JM, Botterel F, Cabaret O, Foulet F, Cordonnier C, Bretagne S. Association between circulating DNA, serum (1->3)-β-D-glucan, and pulmonary fungal burden in Pneumocystis pneumonia. Clin Infect Dis 2012; 55 (02) e5-e8
    CrossrefPubMedSearch in Google Scholar
  • 134 Damiani C, Le Gal S, Goin N. , et al. Usefulness of (1,3) ß-D-glucan detection in bronchoalveolar lavage samples in Pneumocystis pneumonia and Pneumocystis pulmonary colonization. J Mycol Med 2015; 25 (01) 36-43
    CrossrefPubMedSearch in Google Scholar
  • 135 Karageorgopoulos DE, Qu JM, Korbila IP, Zhu YG, Vasileiou VA, Falagas ME. Accuracy of β-D-glucan for the diagnosis of Pneumocystis jirovecii pneumonia: a meta-analysis. Clin Microbiol Infect 2013; 19 (01) 39-49
    CrossrefPubMedSearch in Google Scholar
  • 136 Tasaka S, Kobayashi S, Yagi K. , et al. Serum (1 → 3) β-D-glucan assay for discrimination between Pneumocystis jirovecii pneumonia and colonization. J Infect Chemother 2014; 20 (11) 678-681
    CrossrefPubMedSearch in Google Scholar
  • 137 Esteves F, Calé SS, Badura R. , et al. Diagnosis of Pneumocystis pneumonia: evaluation of four serologic biomarkers. Clin Microbiol Infect 2015; 21 (04) 379.e1-379.e10
    CrossrefPubMedSearch in Google Scholar
  • 138 Song Y, Ren Y, Wang X, Li R. Recent advances in the diagnosis of Pneumocystis pneumonia. Med Mycol J 2016; 57 (04) E111-E116
    PubMedSearch in Google Scholar
  • 139 Daly KR, Fichtenbaum CJ, Tanaka R. , et al. Serologic responses to epitopes of the major surface glycoprotein of Pneumocystis jiroveci differ in human immunodeficiency virus-infected and uninfected persons. J Infect Dis 2002; 186 (05) 644-651
    CrossrefPubMedSearch in Google Scholar
  • 140 Gingo MR, Lucht L, Daly KR. , et al. Serologic responses to pneumocystis proteins in HIV patients with and without Pneumocystis jirovecii pneumonia. J Acquir Immune Defic Syndr 2011; 57 (03) 190-196
    CrossrefPubMedSearch in Google Scholar
  • 141 Walzer PD, Djawe K, Levin L. , et al. Long-term serologic responses to the Pneumocystis jirovecii major surface glycoprotein in HIV-positive individuals with and without P. jirovecii infection. J Infect Dis 2009; 199 (09) 1335-1344
    CrossrefPubMedSearch in Google Scholar
  • 142 Daly KR, Huang L, Morris A. , et al. Antibody response to Pneumocystis jirovecii major surface glycoprotein. Emerg Infect Dis 2006; 12 (08) 1231-1237
    CrossrefPubMedSearch in Google Scholar
  • 143 Chatzikyrkou C, Clajus C, Haubitz M, Hafer C. Hypercalcemia and pneumocystis Pneumonia after kidney transplantation: report of an exceptional case and literature review. Transpl Infect Dis 2011; 13 (05) 496-500
    CrossrefPubMedSearch in Google Scholar
  • 144 Chen WC, Chang SC, Wu TH, Yang WC, Tarng DC. Hypercalcemia in a renal transplant recipient suffering with Pneumocystis carinii pneumonia. Am J Kidney Dis 2002; 39 (02) E8
    PubMedSearch in Google Scholar
  • 145 Procop GW, Haddad S, Quinn J. , et al. Detection of Pneumocystis jiroveci in respiratory specimens by four staining methods. J Clin Microbiol 2004; 42 (07) 3333-3335
    CrossrefPubMedSearch in Google Scholar
  • 146 Cregan P, Yamamoto A, Lum A, VanDerHeide T, MacDonald M, Pulliam L. Comparison of four methods for rapid detection of Pneumocystis carinii in respiratory specimens. J Clin Microbiol 1990; 28 (11) 2432-2436
    CrossrefPubMedSearch in Google Scholar
  • 147 Sasso M, Chastang-Dumas E, Bastide S. , et al. Performances of four real-time PCR assays for diagnosis of Pneumocystis jirovecii Pneumonia. J Clin Microbiol 2016; 54 (03) 625-630
    CrossrefPubMedSearch in Google Scholar
  • 148 Botterel F, Cabaret O, Foulet F, Cordonnier C, Costa JM, Bretagne S. Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients. J Clin Microbiol 2012; 50 (02) 227-231
    CrossrefPubMedSearch in Google Scholar
  • 149 Alanio A, Desoubeaux G, Sarfati C. , et al. Real-time PCR assay-based strategy for differentiation between active Pneumocystis jirovecii pneumonia and colonization in immunocompromised patients. Clin Microbiol Infect 2011; 17 (10) 1531-1537
    CrossrefPubMedSearch in Google Scholar
  • 150 Damiani C, Le Gal S, Da Costa C, Virmaux M, Nevez G, Totet A. Combined quantification of pulmonary Pneumocystis jirovecii DNA and serum (1->3)-β-D-glucan for differential diagnosis of pneumocystis pneumonia and Pneumocystis colonization. J Clin Microbiol 2013; 51 (10) 3380-3388
    CrossrefPubMedSearch in Google Scholar
  • 151 Fauchier T, Hasseine L, Gari-Toussaint M, Casanova V, Marty PM, Pomares C. Detection of Pneumocystis jirovecii by quantitative PCR to differentiate colonization and pneumonia in immunocompromised HIV-positive and HIV-negative patients. J Clin Microbiol 2016; 54 (06) 1487-1495
    CrossrefPubMedSearch in Google Scholar
  • 152 Esteves F, de Sousa B, Calderón EJ. , et al. Multicentre study highlighting clinical relevance of new high-throughput methodologies in molecular epidemiology of Pneumocystis jirovecii pneumonia. Clin Microbiol Infect 2016; 22 (06) 566.e9-566.e19
    CrossrefPubMedSearch in Google Scholar
  • 153 Rohner P, Jacomo V, Studer R, Schrenzel J, Graf JD. Detection of Pneumocystis jirovecii by two staining methods and two quantitative PCR assays. Infection 2009; 37 (03) 261-265
    CrossrefPubMedSearch in Google Scholar
  • 154 Fan LC, Lu HW, Cheng KB, Li HP, Xu JF. Evaluation of PCR in bronchoalveolar lavage fluid for diagnosis of Pneumocystis jirovecii pneumonia: a bivariate meta-analysis and systematic review. PLoS One 2013; 8 (09) e73099
    CrossrefPubMedSearch in Google Scholar
  • 155 Lu Y, Ling G, Qiang C. , et al. PCR diagnosis of Pneumocystis pneumonia: a bivariate meta-analysis. J Clin Microbiol 2011; 49 (12) 4361-4363
    CrossrefPubMedSearch in Google Scholar
  • 156 Alanio A, Gits-Muselli M, Mercier-Delarue S, Dromer F, Bretagne S. Diversity of Pneumocystis jirovecii during infection revealed by ultra-deep pyrosequencing. Front Microbiol 2016; 7: 733
    PubMedSearch in Google Scholar
  • 157 Montesinos I, Delforge ML, Ajjaham F. , et al. Evaluation of a new commercial real-time PCR assay for diagnosis of Pneumocystis jirovecii pneumonia and identification of dihydropteroate synthase (DHPS) mutations. Diagn Microbiol Infect Dis 2017; 87 (01) 32-36
    CrossrefPubMedSearch in Google Scholar
  • 158 Argy N, Le Gal S, Coppée R. , et al. Pneumocystis cytochrome b mutants associated with atovaquone prophylaxis failure as the cause of pneumocystis infection outbreak among heart transplant recipients. Clin Infect Dis 2018; 67 (06) 913-919
    CrossrefPubMedSearch in Google Scholar
  • 159 Bartlett MS, Queener SF, Durkin MM, Shaw MM, Smith JW. Inoculated mouse model of Pneumocystis carinii pneumonia. J Protozool 1991; 38 (06) 130S-131S
    PubMedSearch in Google Scholar
  • 160 Maschmeyer G, Helweg-Larsen J, Pagano L, Robin C, Cordonnier C, Schellongowski P. ; 6th European Conference on Infections in Leukemia (ECIL-6), a joint venture of The European Group for Blood and Marrow Transplantation (EBMT), The European Organization for Research and Treatment of Cancer (EORTC), the International Immunocompromised Host Society (ICHS) and The European LeukemiaNet (ELN). ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients. J Antimicrob Chemother 2016; 71 (09) 2405-2413
    CrossrefPubMedSearch in Google Scholar
  • 161 Kim T, Sung H, Lee YM. , et al. No recurrence of Pneumocystis jirovecii Pneumonia after solid organ transplantation regardless of secondary prophylaxis. Antimicrob Agents Chemother 2012; 56 (11) 6041-6043
    CrossrefPubMedSearch in Google Scholar
  • 162 Fishman JA. Prevention of infection caused by Pneumocystis carinii in transplant recipients. Clin Infect Dis 2001; 33 (08) 1397-1405
    CrossrefPubMedSearch in Google Scholar
  • 163 Ioannidis JP, Cappelleri JC, Skolnik PR, Lau J, Sacks HS. A meta-analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Arch Intern Med 1996; 156 (02) 177-188
    CrossrefPubMedSearch in Google Scholar
  • 164 Lee I, Barton TD, Goral S. , et al. Complications related to dapsone use for Pneumocystis jirovecii pneumonia prophylaxis in solid organ transplant recipients. Am J Transplant 2005; 5 (11) 2791-2795
    CrossrefPubMedSearch in Google Scholar
  • 165 Thomas Jr CF, Limper AH. Current insights into the biology and pathogenesis of Pneumocystis pneumonia. Nat Rev Microbiol 2007; 5 (04) 298-308
    CrossrefPubMedSearch in Google Scholar
  • 166 Lee CH, Lu JJ, Bartlett MS. , et al. Nucleotide sequence variation in Pneumocystis carinii strains that infect humans. J Clin Microbiol 1993; 31 (03) 754-757
    CrossrefPubMedSearch in Google Scholar
  • 167 Liu Y, Rocourt M, Pan S, Liu C, Leibowitz MJ. Sequence and variability of the 5.8S and 26S rRNA genes of Pneumocystis carinii. Nucleic Acids Res 1992; 20 (14) 3763-3772
    CrossrefPubMedSearch in Google Scholar
  • 168 Fishman JA, Samia JA, Fuglestad J, Rose RM. The effects of extracellular matrix (ECM) proteins on the attachment of Pneumocystis carinii to lung cell lines in vitro. J Protozool 1991; 38 (06) 34S-37S
    PubMedSearch in Google Scholar
  • 169 Roux A, Canet E, Valade S. , et al. Pneumocystis jirovecii pneumonia in patients with or without AIDS, France. Emerg Infect Dis 2014; 20 (09) 1490-1497
    CrossrefPubMedSearch in Google Scholar
  • 170 Byrd JC, Hargis JB, Kester KE, Hospenthal DR, Knutson SW, Diehl LF. Opportunistic pulmonary infections with fludarabine in previously treated patients with low-grade lymphoid malignancies: a role for Pneumocystis carinii pneumonia prophylaxis. Am J Hematol 1995; 49 (02) 135-142
    CrossrefPubMedSearch in Google Scholar
  • 171 Sepkowitz K, Schluger N, Godwin T, Armstrong D, Cerami A, Bucala R. DNA amplification in experimental pneumocystosis: characterization of serum Pneumocystis carinii DNA and potential P. carinii carrier states. J Infect Dis 1993; 168 (02) 421-426
    CrossrefPubMedSearch in Google Scholar
  • 172 Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007; 357 (25) 2601-2614
    CrossrefPubMedSearch in Google Scholar
  • 173 Martin SI, Marty FM, Fiumara K, Treon SP, Gribben JG, Baden LR. Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis 2006; 43 (01) 16-24
    CrossrefPubMedSearch in Google Scholar
  • 174 Oz HS, Hughes WT. Novel anti-Pneumocystis carinii effects of the immunosuppressant mycophenolate mofetil in contrast to provocative effects of tacrolimus, sirolimus, and dexamethasone. J Infect Dis 1997; 175 (04) 901-904
    CrossrefPubMedSearch in Google Scholar
  • 175 Azevedo LS, Castro MC, Paula FJ, Ianhez LE, David-Neto E. Mycophenolate mofetil may protect against Pneumocystis carinii pneumonia in renal transplanted patients. Rev Inst Med Trop São Paulo 2005; 47 (03) 143-145
    CrossrefPubMedSearch in Google Scholar
  • 176 Morelon E, Stern M, Kreis H. Interstitial pneumonitis associated with sirolimus therapy in renal-transplant recipients. N Engl J Med 2000; 343 (03) 225-226
    CrossrefPubMedSearch in Google Scholar
  • 177 Muñoz P, Muñoz RM, Palomo J, Rodríguez-Creixéms M, Muñoz R, Bouza E. Pneumocystis carinii infection in heart transplant recipients. Efficacy of a weekend prophylaxis schedule. Medicine (Baltimore) 1997; 76 (06) 415-422
    PubMedSearch in Google Scholar
  • 178 Arend SM, Westendorp RG, Kroon FP. , et al. Rejection treatment and cytomegalovirus infection as risk factors for Pneumocystis carinii pneumonia in renal transplant recipients. Clin Infect Dis 1996; 22 (06) 920-925
    CrossrefPubMedSearch in Google Scholar
  • 179 Lyytikäinen O, Ruutu T, Volin L. , et al. Late onset Pneumocystis carinii pneumonia following allogeneic bone marrow transplantation. Bone Marrow Transplant 1996; 17 (06) 1057-1059
    PubMedSearch in Google Scholar
  • 180 Masur H, Ognibene FP, Yarchoan R. , et al. CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med 1989; 111 (03) 223-231
    PubMedSearch in Google Scholar
  • 181 Castagnola E, Dini G, Lanino E. , et al. Low CD4 lymphocyte count in a patient with P. carinii pneumonia after autologous bone marrow transplantation. Bone Marrow Transplant 1995; 15 (06) 977-978
    PubMedSearch in Google Scholar
  • 182 Sepkowitz KA. Pneumocystis carinii pneumonia among patients with neoplastic disease. Semin Respir Infect 1992; 7 (02) 114-121
    PubMedSearch in Google Scholar
  • 183 Mansharamani NG, Balachandran D, Vernovsky I, Garland R, Koziel H. Peripheral blood CD4 + T-lymphocyte counts during Pneumocystis carinii pneumonia in immunocompromised patients without HIV infection. Chest 2000; 118 (03) 712-720
    CrossrefPubMedSearch in Google Scholar
  • 184 Fishman JA, Gans H. ; AST Infectious Diseases Community of Practice. Pneumocystis jiroveci in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; (e-pub ahead of print)
    CrossrefPubMedSearch in Google Scholar
  • 185 Stover DE, Zaman MB, Hajdu SI, Lange M, Gold J, Armstrong D. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 1984; 101 (01) 1-7
    PubMedSearch in Google Scholar
  • 186 Bondoc AY, White DA. Granulomatous Pneumocystis carinii pneumonia in patients with malignancy. Thorax 2002; 57 (05) 435-437
    CrossrefPubMedSearch in Google Scholar
  • 187 Studemeister A, Dass S. A patient with dyspnea, cough, and fever. Clin Infect Dis 2006; 43 (11) 1461-1462 , 1490–1491
    CrossrefPubMedSearch in Google Scholar
  • 188 LaRocque RC, Katz JT, Perruzzi P, Baden LR. The utility of sputum induction for diagnosis of Pneumocystis pneumonia in immunocompromised patients without human immunodeficiency virus. Clin Infect Dis 2003; 37 (10) 1380-1383
    CrossrefPubMedSearch in Google Scholar
  • 189 Kovacs JA, Ng VL, Masur H. , et al. Diagnosis of Pneumocystis carinii pneumonia: improved detection in sputum with use of monoclonal antibodies. N Engl J Med 1988; 318 (10) 589-593
    CrossrefPubMedSearch in Google Scholar
  • 190 Thomas Jr CF, Limper AH. Pneumocystis pneumonia: clinical presentation and diagnosis in patients with and without acquired immune deficiency syndrome. Semin Respir Infect 1998; 13 (04) 289-295
    PubMedSearch in Google Scholar
  • 191 Fishman JA. Treatment of infection due to Pneumocystis carinii. Antimicrob Agents Chemother 1998; 42 (06) 1309-1314
    CrossrefPubMedSearch in Google Scholar
  • 192 Schmatz DM, Romancheck MA, Pittarelli LA. , et al. Treatment of Pneumocystis carinii pneumonia with 1,3-beta-glucan synthesis inhibitors. Proc Natl Acad Sci U S A 1990; 87 (15) 5950-5954
    CrossrefPubMedSearch in Google Scholar
  • 193 Powles MA, Liberator P, Anderson J. , et al. Efficacy of MK-991 (L-743,872), a semisynthetic pneumocandin, in murine models of Pneumocystis carinii. Antimicrob Agents Chemother 1998; 42 (08) 1985-1989
    CrossrefPubMedSearch in Google Scholar
  • 194 Annaloro C, Della Volpe A, Usardi P, Lambertenghi Deliliers G. Caspofungin treatment of Pneumocystis pneumonia during conditioning for bone marrow transplantation. Eur J Clin Microbiol Infect Dis 2006; 25 (01) 52-54
    CrossrefPubMedSearch in Google Scholar
  • 195 Utili R, Durante-Mangoni E, Basilico C, Mattei A, Ragone E, Grossi P. Efficacy of caspofungin addition to trimethoprim-sulfamethoxazole treatment for severe pneumocystis pneumonia in solid organ transplant recipients. Transplantation 2007; 84 (06) 685-688
    CrossrefPubMedSearch in Google Scholar
  • 196 Mandujano JF, D'Souza NB, Nelson S, Summer WR, Beckerman RC, Shellito JE. Granulocyte-macrophage colony stimulating factor and Pneumocystis carinii pneumonia in mice. Am J Respir Crit Care Med 1995; 151 (04) 1233-1238
    PubMedSearch in Google Scholar
  • 197 Hughes WT. Use of dapsone in the prevention and treatment of Pneumocystis carinii pneumonia: a review. Clin Infect Dis 1998; 27 (01) 191-204
    CrossrefPubMedSearch in Google Scholar
  • 198 El-Sadr WM, Murphy RL, Yurik TM. , et al; Community Program for Clinical Research on AIDS and the AIDS Clinical Trials Group. Atovaquone compared with dapsone for the prevention of Pneumocystis carinii pneumonia in patients with HIV infection who cannot tolerate trimethoprim, sulfonamides, or both. N Engl J Med 1998; 339 (26) 1889-1895
    CrossrefPubMedSearch in Google Scholar
  • 199 Rodriguez M, Sifri CD, Fishman JA. Failure of low-dose atovaquone prophylaxis against Pneumocystis jiroveci infection in transplant recipients. Clin Infect Dis 2004; 38 (08) e76-e78
    CrossrefPubMedSearch in Google Scholar
  • 200 Barber BA, Pegram PS, High KP. Clindamycin/primaquine as prophylaxis for Pneumocystis carinii pneumonia. Clin Infect Dis 1996; 23 (04) 718-722
    CrossrefPubMedSearch in Google Scholar