Kingdom: Fungi Phylum: Ascomycota Class: Pneumocystidomycetes Order:

Pneumocystidales Family: Pneumocystidaceae Genus: Pneumocystis Species: P.

Jirovecii

Pneumocystis carinii
Intro Extracellular opportunistic organism
Pathogenic tissue parasite in 85% of AIDS patients
disease Pneumocystosis; Parasitic Pneumonial; Interstitial plasma cell pneumonia
In immunocompromised patients (OI)
Increased 1. Chemotherapy
incidence in 2. AIDS
3. Radiation therapy
4. Organ transplantation (immunosuppression)
5. Prematurity
Geo distri WW
Site Mainly lungs
Disseminated in ear, liver & BM
Host AIDS patients or malignant lymphoma
Morphology
Trophozoites 1-5 µ
Thin-walled, pear-shaped crescentic or amoeboid
A nuclear mass, a mitochondrion
Endoplasmic reticulum
Round bodies or vacuoles
Cyst (or capsule) 3-6 µ
Thick-walled, round, ovoid, crescent or cup-shaped
4-8 small intracystic oval bodies
Epidemiology Low virulence
Multiply actively in hosts of lowered resistance
Infection occurs in 2 clinico-pathological forms
i. In infants aged 2- 7 months that suffer from immune deficiency states
ii. Sporadic in immunocompromised children or adults
a. Immune deficiency states
b. Adults secondary to cytotoxic therapy
c. Association w cytomegalic inclusion bodies
d. AIDS patients
Pathology:
Macroscopic Lungs are firm, cut surface gray & airless
Microscopic In adults the disease is predominantly alveolar
In malnourished infants, there is a major interstitial component

In both, the organisms usually intermingle w alveolar macrophages in the alveolar exudates
Clinical picture: Incubation period: about 14-21 days
A. In infantile disease associated w malnutrition. Onset is invasive over week.
B. In immunosuppressed children & adults:-
a. It has a rapid onset over few days
b. Unless diagnosed & treated, fatal
Diagnosis Clinical picture in a risky patient
X-ray
High levels of IgM (MCAb to IgM)
Identification of characteristic organism in pulmonary specimens (table) stained w Gomori
Methenamine silver stain
Immunoflourescence & MCAbs to detect Pneumocystis carinii in sputum specimens

Diagnostic approach for P. Carinii

Technique Yield
Induced sputum 30-85%
BAL Fair (but over 90% in AIDS)
Open lung biopsy Over 95% (all patients)
Treatment 1. Pyrimethamine, sulphadiazine
2. Steroids are contraindicated
3. Prophylaxis by inhalation of aerosolized pentamidin in AIDS patients
Domain: Eukaryota Kingdom: Chromalveolata Superphylum: Alveolata Phylum: Apicomplexa Class: Conoidasida
Subclass: Coccidiasina Order: Eucoccidiorida Family: Sarcocystidae Genus: Toxoplasma Species: T. Gondii

Toxoplasma gondii
Intro An obligate intracellular parasite
Obligate: restricted to a particular function or mode of life
disease Toxoplasmosis
Danger: Can grow in any mammalian or avian organs or tissues, developing in the brain, eye, and skeletal muscles.
Geo distri WW
Host DH: Cat
Accidental or non-specific host:
-mammals, including man
-avian
-cold-blooded vertebrates
Habitat DH: Columnar epithelial cells of small intestine
AH: Develop in vacuoles in any nucleated cell
Specific predilection for brain & retinal cells
Liver
Lymph nodes
Morphology Tachyzoites: Acute infection. can fill up a host cell, develop a parasite membrane, and becomes a cyst
Bradyzoites: Chronic infection, metabolically quiescent [The two r antigenically distinct]
7x3µ
Pyriform in shape
Has membrane, nucleus, and various organelle
Pseudocyst: inside macrophages
Cyst: in brain tissues. 50 – 200 µ. 50 to several thousands of bradyzoites,
Oocyst: Formed in small intestine of cat. 10 – 14 µ
Life cycle T. gondii tachyzoites multiply within host cells by endodyogeny: 2 daughter cells r formed within a mother cell.
As the distended host cells fill up w parasites, they rupture, releasing parasites that enter new cells. Dissemination in
macrophages, lymphocytes, granulocytes & free in plasma.
The infected host cell may swell up, develop a membrane, and become a cyst.
Tachyzoites consume oxygen, evolve CO2

[Can grow in any mammalian or avian organs or tissues, developing in the brain, eye, and skeletal muscles.]

1. In Specific host
• Mice and rats containing the infective cysts are eaten by cat
• The cyst wall is digested, releasing the organism
• Bradyzoites penetrate the epithelial cells in small intestine.
• Intracellular multiplications occur  developments of micro- and macrogametes
• Fertilization  development of oocyst
• Infected intestinal epithelial cells RUPTURE, discharge oocysts into the intestinal lumen
• Oocyst contains undifferentiated material, develop into 2 sporocyst within several days
• Each sporocyst contains 4 sporozoites [Disporocystic Tetrasporozoic]

2. In accidental non-specific host

Ingested oocyst or cyst  enteric infection  regional L. Nodes  thoracic duct  lungs  arterial circulation  all
over body

Ingested oocyst or cyst  enteric infection  portal circulation  Liver  systemic circulation  lungs  arterial
circulation  all over body
Epidemiology Cosmopolitan
Multiplication According to
-Virulence
-State of immunity

1. Acute infection
a. Tachyzoites divide repeatedly by endodyogeny
b. Host cells may swell up
c. Develop a membrane and become a cyst (pseudocyst)
2. Chronic infection
a. Bradyzoites – multiply slowly by endodyogony within true cysts w tough wall
b. Cysts formed – in brain, liver, heart & muscles – persist for months or years
c. Released bradyzoites stimulate persistence of immunity
d. When immunity is lowered,
i. Parasite multiply as trachyzoites
ii. Localised or generalised relapse
e. When immunity returns to normal,
i. Cysts are formed, hidden from immune system
Mode of infection 1. Cat infected by ingestion of:
a. Cysts (from raw meat & infected rodents)
b. Pseudocysts
c. Oocyst
2. Non-specific hosts infected by ingestion of:
a. Oocyst (only source for herbivores, Man)
b. Cysts in raw or improperly cooked beef, pork or mutton meal (carnivores & omnivores)
3. Transplacental from mother to foetus (in mothers that are not immune to the organism i.e get infected for
the first time during pregnancy - dangerous)
 4. Blood transfusion (within white cells, platelets, but packed red cells transfusion is safe)
5. Organ transplantation
Clinical picture: .Asymptomatic to mild flu-like
.Congenital Toxoplamosis
-1-5/1000 pregnancies
-severed and fatal depending on age of fetus
-primary infection during
The 1st trimester abortion
The 2nd trimester still birth
The 3rd trimester congenital infection
Typical syndrome of :
intra-ceberal calcification
Chorioretinitis
Hydrocephalus
.Acquired or reactivated infection
• Acute form in children & adults that resembles typhus & is usually fatal
• Infectious mononucleosis
• In immunocompromised AIDS patients; meningio-encephalitis
• In immunosuppressed patients; pneumonitis, lymphadenopathy, myocarditis, encephalopathy
.Chronic form in adults presenting as:
• Chorioretinitis
• Lymphadenopathy, usually single, post-cervical
Diagnosis 1. Direct methods:
Tissues or fluids suspected of containing parasites
-biopsied lymph node or muscle
-CSF
Blood
Are used for detection of parasites by:
• Staining by Giemsa or immunoflorescence
• PCR for detection of parasite DNA in AIDS patients whose antibody testing is useless
• Tissue culture

2. Indirect methods: most important

• Depends on demonstration of immunity
• Serologic dx requires demonstration of Ab titre
• A very high Ab lvl is not sufficient evidence, it is the rising titre of IgM (acute infection) and
IgG in reactivated form (chronic infect)
• Indirect IF test & ELISA rising titre, repeat test after 2 or 4 weeks
• In Asia, even vegetarians hv a high Ab titre
• Congenital infection – demonstration of IgM (not IgG)
Treatment Pyrimethamin (Daraprim)
Spiramycin (Rovamycin) for pregnant females
Prevention Mainly through cooking of all meats. –barbecue, be careful
Careful attention to cat feces (oocyst remain infective for 18 months)

For pregnant women:

• Avoid tasting raw meat
• Wash hands with soap & water after handling meat
• Cook all meat thoroughly, including hamburgers & frozen meats
• Get rid of cats or keep them in house where there are no rodents,
o Feed cats dry or cooked-canned cat food
o Empty little box daily
o Disinfect little box w boiling water & wash hands afterwards
• Better delegate this job to other member of the family