ラ: Pneumocystis jirovecii, Pneumocystis jiroveci?
日: ニューモシスチス・イロベチ
旧: Pneumocystis carinii

first aid step1 2006 p.147

生物学特徴

感染症

ニューモシスチス肺炎

びまん性の間質性肺炎を引き起こす
感染経路は空気感染

参考

真菌の写真 - Fungal Images

http://www.asm.org/Division/c/fungi.htm

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/23 05:39:55」(JST)

wiki en

[Wiki en表示]

Pneumocystis jirovecii is a yeast-like fungus of the genus Pneumocystis. The causative organism of Pneumocystis pneumonia, it is an important human pathogen, particularly among immunocompromised hosts. Prior to its discovery as a human-specific pathogen, P. jirovecii was known as P. carinii.

Life-cycle[edit]

The complete life-cycles of any of the species of Pneumocystis are not known, but presumably all resemble the others in the genus. The terminology follows zoological terms, rather than mycological terms, reflecting the initial misdetermination as a protozoan parasite. It is an extracellular parasite. All stages are found in lungs and because they cannot be cultured ex-vivo, direct observation of living Pneumocystis is difficult. The trophozoite stage is thought to be equivalent to the so-called vegetative state of other species (such as Schizosaccharomyces pombe) which, like Pneumocystis belong to the Taphrinomycotina branch of the fungal kingdom.^[1] The Trophozoite stage is single-celled and appears amoeboid (multilobed) and closely associated with host cells. Globular cysts eventually form that have a thicker wall. Within these ascus-like cysts, eight spores form which are released through rupture of the cyst wall. The cysts often collapse forming crescent-shaped bodies visible in stained tissue. It is not known for certain if meiosis takes place within the cysts, or what the genetic status is of the various cell types.^[2]

Medical relevance[edit]

For more details on this topic, see Pneumocystis pneumonia.

Pneumocystis pneumonia is an important disease of immunocompromised humans, particularly patients with HIV, but also patients with an immune system that is severely suppressed for other reasons; for example, following a bone marrow transplant. In humans with a normal immune system, it is an extremely common silent infection.^[3]

Nomenclature[edit]

At first, the name Pneumocystis carinii was applied to the organisms found in both rats and humans, as it was not yet known that the parasite was host-specific. In 1976 the name Pneumocystis jiroveci was proposed for the first time, to distinguish the organism found in humans from variants of Pneumocystis in other animals. The organism was named thus in honor of Otto Jirovec, who described Pneumocystis pneumonia in humans in 1952. After DNA analysis showed significant differences in the human variant, the proposal was made again in 1999 and has come into common use.^[4]

The name was spelled according to the International Code of Zoological Nomenclature, since the organism was believed to be a protozoan. After it became clear that it was a fungus, the name was changed to Pneumocystis jirovecii,^[5] according to the International Code of Botanical Nomenclature (ICBN), which requires such names be spelled with double i (ii).^[6] Both spellings are commonly used, but according to the ICBN P. jirovecii has priority.^[7] A change in the ICBN in 2005 now recognizes the validity of the 1976 publication, making the 1999 proposal redundant, and cites Pneumocystis and P. jirovecii as examples of the change in ICBN Article 45, Ex 8. The name P. jirovecii is typified (both lectotypified and epitypified) by samples from human autopsies dating from the 1960s. ^[8]

The term PCP, which was widely used by practitioners and patients, has been retained for convenience, with the rationale that it now stands for the more general Pneumocystis pneumonia rather than Pneumocystis carinii pneumonia.

The name P. carinii is incorrect for the human variant, but still describes the species found in rats and that name is typified by an isolate from rats.^[8]

Pneumocystis genome[edit]

Pneumocystis species cannot be grown in culture. Therefore, there is a limitation to the availability of the human disease causing agent, P. jirovecii. Hence, investigation of the whole genome of a Pneumocystis is largely based upon true P. carinii available from experimental rats which can be maintained with infections. Genetic material of other species, such as P. jirovecii can be compared to the genome of P. carinii.^[9]

The genome of P. jirovecii has been sequenced from a bronchoalveolar lavage sample.^[10] The genome is small, low in G+C content and lacks most amino acid biosynthesis enzymes.

History[edit]

The earliest report of this genus appears to have been that of Carlos Chagas in 1909^[11] who discovered it in experimental animals but confused it with part of the life-cycle of Trypanosoma cruzi (causal agent of Chagas disease) and later called both organisms 'Schizotrypanum cruzi' a form of trypanosome infecting humans.^[12] The rediscovery of Pneumocystis cysts was reported by Antonio Carini in 1910 also in Brazil.^[13] The genus was again discovered in 1912 by Delanoë and Delanoë this time at the Pasteur Institute in Paris, France who found it in rats and who proposed the genus and species name Pneumocystis carinii after Carini.^[14]

Pneumocystis was redescribed as a human pathogen in 1942 by two Dutch investigators, van der Meer and Brug who found it in three new cases: a 3-month-old infant with congenital heart disease and in 2 of 104 autopsy cases - a 4-month-old infant and a 21-year-old adult.^[15] There being only one described species in the genus, they considered the human parasite to be P. carinii. Nine years later (1951) Dr. Josef Vanek at Charles University in Prague in Prague, Czechoslovakia showed in a study of lung sections from sixteen children that the organism labelled "P. carinii" was the causative agent of pneumonia in these children.^[16] The following year (1952) Jírovec reported "P. carinii" as the cause of interstitial pneumonia in neonates.^[17]^[18]^[19] Following the realization that Pneumocystis from humans could not infect experimental animals such as rats, and that the rat form of Pneumocystis differed physiologically and had different antigenic properties, Frenkel^[20] was the first to recognize the human pathogen as a distinct species. He named it Pneumocystis jirovecii (see nomenclature above). There has been controversy over the relabeling of P. carinii in humans as P. jirovecii,^[8]^[21] which is why both names still appear in publications. However, only the name P. jirovecii is used exclusively for the human pathogen, whereas the name P. carinii has had a broader application to many species.^[22] Frenkel and those before him believed that all Pneumocystis were protozoans, but soon afterwards evidence began accumulating that Pneumocystis was a fungal genus. Recent studies show it to be an unusual, in some ways a primitive genus of Ascomycota, related to a group of yeasts.^[1] Every tested primate, including humans, appears to have its own type of Pneumocystis that is incapable of cross-infecting other host species and has co-evolved with each mammal species.^[23] Currently only 5 species have been formally named: P. jirovecii from humans, P. carinii as originally named from rats, P. murina from mice,^[24] P. wakefieldiae^[25]^[26] also from rats, and P. oryctolagi from rabbits.^[27]

Historical and even recent reports of P. carinii from humans are based upon older classifications (still used by many, or those still debating the recognition of distinct species in the genus Pneumocystis) which does not mean that the true P. carinii from rats actually infects humans. In an intermediate classification system, the various taxa in different mammals have been called formae speciales or forms. For example the human "form" was called Pneumocystis carinii f. [or f. sp.] hominis, while the original rat infecting form was called Pneumocystis carinii f. [or f. sp.] carinii. This terminology is still used by some researchers. The species of Pneumocystis originally seen by Chagas have not yet been named as distinct species.^[8] Many other undescribed species presumably exist and those that have been detected in many mammals are only known from molecular sample detection from lung tissue or fluids, rather than by direct physical observation.^[28]^[29] Currently, they are cryptic taxa.

References[edit]

^ ^a ^b James TY et al. (2006). "Reconstructing the early evolution of Fungi using a six-gene phylogeny". Nature 443 (7113): 818–822. doi:10.1038/nature05110. PMID 17051209.
^ "see DPDx life-cycle diagram". Dpd.cdc.gov. Retrieved 2013-03-26.
^ Ponce CA, Gallo M, Bustamante R, Vargas SL (2010). "Pneumocystis colonization is highly prevalent in the autopsied lungs of the general population". Clin Infect Dis 50 (3): 347–353. doi:10.1086/649868. PMID 20047487.
^ Stringer JR, Beard CB, Miller RF, Wakefield AE (2002). "A New Name for Pneumocystis from Humans and New Perspectives on the Host-Pathogen Relationship". Emerg Infect Dis 8 (9): 891–6. PMC 2732539. PMID 12194762.
^ Stringer JR, Beard CB, Miller RF Spelling Pneumocystis jirovecii Emerg Infect Dis. March 2009; doi:10.3201/eid1503.081060
^ "ICBN Recommendation 60C.1". "If the personal name ends with a consonant (except -er), substantival epithets are formed by adding -i- (stem augmentation) plus the genitive inflection appropriate to the sex and number of the person(s) honoured (e.g. lecardii for Lecard."
^ "ICBN Art. 45.4". "If a taxon originally assigned to a group not covered by this Code is treated as belonging to a group of plants other than algae or fungi, the authorship and date of any of its names are determined by the first publication that satisfies the requirements for valid publication under this Code."
^ ^a ^b ^c ^d Redhead SA, Cushion MT, Frenkel JK, Stringer JR (2006). "Pneumocystis and Trypanosoma cruzi: nomenclature and typifications". J Eukaryot Microbiol 53 (1): 2–11. doi:10.1111/j.1550-7408.2005.00072.x. PMID 16441572.
^ "Pneumocystis Genome Project". Pgp.cchmc.org. Retrieved 2013-03-26.
^ Cissé OH, Pagni M, Hauser PM (2012) De novo assembly of the Pneumocystis jirovecii genome from a single bronchoalveolar lavage fluid specimen from a patient. MBio 4(1). pii: e00428-12. doi: 10.1128/mBio.00428-12
^ Chagas C (1909). "Neue Trypanosomen". Vorläufige Mitteilung. Arch. Schiff. Tropenhyg. 13: 120–122.
^ Chagas C (1909). "Nova tripanozomiase humana: Estudos sobre a morfolojia e o ciclo evolutivo do Schizotrypanum cruzi n. gen., n. sp., ajente etiolojico de nova entidade morbida do homem". Mem Inst Oswaldo Cruz 1 (2): 159–218. doi:10.1590/S0074-02761909000200008.
^ Carini A. (1910). "Formas des eschizogonia do Trypanosoma lewisi". Soc Med Cir São Paulo 38 (8): –.
^ Delanoë P, Delanoë M. (1912). "Sur les rapports des kystes de Carini du poumon des rats avec le Trypanosoma lewisi". Comptes rendus de l'Academie des sciences 155: 658–61.
^ van der Meer MG, Brug SL. (1942). "Infection à Pneumocystis chez l'homme et chez les animaux". Amer Soc Belge Méd Trop 22: 301–9.
^ Vanek J. (1951). "Atypicka (interstitiálni) pneumonie detí vyvolaná Pneumocystis carinii (Atypical interstitial pneumonia of infants produced by Pneumocystis carinii)". Casop lék cesk 90: 1121–4.
^ Jírovec O. (1952). "Pneumocystis carinii puvodce t. zv intertitialnich plasmocelularnich pneumonii kojencw (Pneumocystis carinii, the cause of interstitial plasmacellular pneumonia in neonates)". P Csl. Hyg epid mikrob 1: 141.
^ Vanek J, Jírovec O, Lukes J. (1953). "Interstitial plasma cell pneumonia in infants". Ann Paediatrici 180: 1–21.
^ Gajdusek DC (1957). "Pneumocystis carinii; etiologic agent of interstitial plasma cell pneumonia of premature and young infants". Pediatrics 19: 543–65.
^ Frenkel JK (1976). "Pneumocystis jiroveci n. sp. from man: morphology, physiology, and immunology in relation to pathology". Natl Cancer Inst Monogr 43: 13–27. PMID 828240.
^ Gigliotti F (2005). "Pneumocystis carinii: has the name really been changed?". Clin Infect Dis 41 (12): 1752–5. doi:10.1086/498150. PMID 16288399.
^ Hawksworth DL (2007). "Responsibility in naming pathogens: the case of Pneumocystis jirovecii, the causal agent of pneumocystis pneumonia". Lancet Infect. Dis. 7 (1): 3–5. doi:10.1016/S1473-3099(06)70663-6. PMID 17182335.
^ Hugot J, Demanche C, Barriel V, Dei-Cas E, Guillot J (2003). "Phylogenetic systematics and evolution of primate-derived Pneumocystis based on mitochondrial or nuclear DNA sequence comparison". Syst Biol 52 (6): 735–744. doi:10.1080/10635150390250893. PMID 14668114.
^ Keely S, Fischer J, Cushion M, Stringer J (2004). "Phylogenetic identification of Pneumocystis murina sp. nov., a new species in laboratory mice". Microbiology 150 (Pt 5): 1153–65. doi:10.1099/mic.0.26921-0. PMID 15133075.
^ Cushion MT, Keely SP, Stringer JR (2004). "Molecular and phenotypic description of Pneumocystis wakefieldiae sp. nov., a new species in rats". Mycologia 96 (3): 429–438. doi:10.2307/3762163. JSTOR 3762163. PMID 21148866.
^ Cushion MT, Keely SP, Stringer JR (2005). "Validation of the name Pneumocystis wakefieldiae". Mycologia 97: 268–268. doi:10.3852/mycologia.97.1.268.
^ Dei-Cas E et al. (2006). "Pneumocystis oryctolagi sp. nov., an uncultured fungus causing pneumonia in rabbits at weaning: review of current knowledge, and description of a new taxon on genotypic, phylogenetic and phenotypic bases". FEMS Micriobiol. Rev. 30 (6): 853–871. doi:10.1111/j.1574-6976.2006.00037.x. PMID 17064284.
^ Aliouat-Denis, C-M. et al. (2008). "Pneumocystis species, co-evolution and pathogenic power". Infection, Genetics & Evolution 8 (5): 708–726. doi:10.1016/j.meegid.2008.05.001. PMID 18565802.
^ Demanche C et al. (2001). "Phylogeny of Pneumocystis carinii from 18 Primate Species Confirms Host Specificity and Suggests Coevolution". J. Clinical Microbiol. 39 (6): 2126–2133. doi:10.1128/JCM.39.6.2126-2133.2001. PMC 88100. PMID 11376046.

UpToDate Contents

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1. HIV感染患者におけるニューモシスチスによる肺感染症の臨床症状および診断 clinical presentation and diagnosis of pneumocystis pulmonary infection in hiv infected patients
2. 非HIV感染患者におけるニューモシスチス肺炎の治療および予防 treatment and prevention of pneumocystis pneumonia in non hiv infected patients
3. HIV感染患者におけるニューモシスチス感染の治療 treatment of pneumocystis infection in hiv infected patients
4. 非HIV感染患者におけるニューモシスチス肺炎の疫学、臨床症状、および診断 epidemiology clinical manifestations and diagnosis of pneumocystis pneumonia in non hiv infected patients
5. HIV感染患者におけるニューモシスチス感染の予防 prophylaxis against pneumocystis infection in hiv infected patients

English Journal

A limited number of ITS haplotypes defines the diversity of Pneumocystis jirovecii strains in Sweden.

Beser J, Botero-Kleiven S, Lebbad M, Hagblom P, Fernandez V.SourceSwedish Institute for Infectious Disease Control, SE-171 82 Solna, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases.2011 Jul;11(5):948-54. Epub 2011 Mar 16.
The infectious fungus Pneumocystis jirovecii remains an important cause of pneumonia (PCP) in the immunocompromised host. To study the biodiversity of P. jirovecii in Sweden the internal transcribed spacers (ITS) of the rDNA locus were amplified, cloned and sequenced from a set of diagnostic respira
PMID 21419238

Pneumocystis jirovecii pneumonia as first manifestation of late relapse angioimmunoblastic T-cell lymphoma.

Garcia-Noblejas A, Velasco A, Garcia-Leon N, Cananta-Ortiz J, Steegmann JL.SourceDepartment of Hematology, Hospital La Princesa, Madrid, Spain.
Leukemia research.2011 May 12. [Epub ahead of print]
Angioimmunoblastic T-cell lymphoma (AITL) is a distinct peripheral T-cell lymphoma (PTCL) with peculiar and frequent clinical features of immune deregulation. Another hallmark of this disease is the secondary immunodeficiency. In this paper, we report a case of Pneumocistis jirovecii infection as th
PMID 21570116

Japanese Journal

Pneumocystis jirovecii Pneumonia and Alveolar Hemorrhage in a Pregnant Woman with Human T Cell Lymphotropic Virus Type-1 Infection

Tamaki Yuichiro,Higa Futoshi,Tasato Daisuke,Nakamura Hideta,Uechi Kayoko,Tamayose Maki,Haranaga Shusaku,Yara Satomi,Tateyama Masao,Fujita Jiro
Internal Medicine 50(4), 351-354, 2011
… Pneumocystis jirovecii pneumonia (PCP) is a rare disease but may occur in pregnant immune-suppressed women. …
NAID 130000413122

Clinical and Radiological Features of Acute-Onset Diffuse Interstitial Lung Diseases in Patients with Rheumatoid Arthritis Receiving Treatment with Biological Agents: Importance of Pneumocystis Pneumonia in Japan Revealed by a Multicenter Study

Kameda Hideto,Tokuda Hitoshi,Sakai Fumikazu,Johkoh Takeshi,Mori Shunsuke,Yoshida Yuji,Takayanagi Noboru,Taki Hirofumi,Hasegawa Yoshinori,Hatta Kazuhiro,Yamanaka Hisashi,Dohi Makoto,Hashimoto Shu,Yamada Hidehiro,Kawai Shinichi,Takeuchi Tsutomu,Tateda Kazuhiro,Goto Hajime
Internal Medicine 50(4), 305-313, 2011
… Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). … jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. …
NAID 130000413114

Related Pictures

★リンクテーブル★

国試過去問	「100B067」
リンク元	「真菌」「肺炎」「メセナミン銀染色」
拡張検索	「Pneumocystis jirovecii感染症」「Pneumocystis jirovecii infection」
関連記事	「Pneumocystis」

「100B067」

Pneumocystis
	P. jirovecii cysts in tissue
Scientific classification
Kingdom:	Fungi
Phylum:	Ascomycota
Class:	Pneumocystidomycetes
Order:	Pneumocystidales
Family:	Pneumocystidaceae
Genus:	Pneumocystis
Species:	P. jirovecii
Binomial name
	Pneumocystis jirovecii; J.K.Frenkel

　　[★]

慢性肉芽腫症で感染の原因となりやすいのはどれか。

a. Listeria monocytogenes
b. Mycobacterium tuberculosis
c. Pneumocystis jirovecii Pneumocystis carinii
d. Staphylococcus aureus
e. Streptococcus pneumoniae

[正答]

※国試ナビ4※　［100B066］←［国試_100］→［100B068］

「真菌」

　　[★]

英: fungus, (pl.)fungi
同: かび、菌類 Mycota
関: 微生物学、真菌症、抗真菌薬

細菌、真菌、藻類、原虫

いずれも単細胞生物
細菌は核を持たないが、それ以外は核を持つ
細胞壁の多糖：細菌はペプチドグリカンなど。真菌はβグルカン、キチン。藻類はセルロース。原虫は細胞壁を持たない
栄養獲得様式：藻類は光合成独立栄養生性。

大きさ

数μm。観察に油浸レンズは不要

細胞膜

リン脂質＋グリセリド＋ステロール(6%。主にエルゴステロール)
機能：細胞内への物質輸送、細胞内物質の排出、細胞内浸透圧調節
細胞壁の合成酵素(β-1,3-グルカン合成酵素,キチン合成酵素)・分解酵素(キチナーゼ、β-グルカナーゼ)が存在

細胞壁

線維状多糖＋糖タンパク質
真菌に特有の成分(β-グルカン、マンナン、ガラクトマンナン)から構成される

線維状多糖

細胞壁の骨格となる
キチンとβ-グルカンからなる。
特殊な多糖にキトサンがある

キチン

N-アセチルグルコサミンのホモ重合体
β(1→4)結合
リゾチームで分解される
糸状菌では細胞壁成分にキチンが多い

β-グルカン

グルコースのホモ重合体
β(1→3)結合、β(1→6)結合
酵母では細胞壁成分にβ-1,3-グルカンが多い

キトサン

グルコサミンのホモ重合体
接合菌はキチンの代わりにキトサンを多く含む一方、β-グルカンをほとんど含まない。

糖タンパク質

線維状多糖の間を埋めている糖タンパク質
アスペルギルス属：ガラクトマンナン
カンジダ属　　　：マンナン。α(1→6)結合からなる主鎖。α(1→2)結合とα(1→3)結合からなるD-マンノースのホモ重合体

形態による分類

糸状菌 filamentous fungi 菌糸状真菌 mycelial fungi
酵母 yeast 酵母状真菌 yeastlike fungi
二形性真菌 dimorphic fungi

Coccidioides immitis

Histoplasma capsulatum

Sporothrix schenckii

Candida albicans

培養と感染組織における形態

カンジダ属 Candida albicans　：　培養(球形)　組織内(仮性菌糸)
アスペルギルス属 Aspergillus fumigatus　：　培地(胞子産生)　組織内(菌糸. 胞子は末梢に出てこない)
クリプトコッカス属 Cryptococcus neoformans　：　培地(球形)　組織内(球形)

菌糸の構造

無隔菌糸

接合菌などの下等真菌にのみ見られる

有隔菌糸
高等真菌(子嚢菌、担子菌、不完全菌)

菌糸の機能

栄養菌糸 vegetative hypha 基質菌糸 substrate hypha
生殖菌糸 reproductive hypha

胞子を形成

分生子柄：形成される胞子が分生子である場合の生殖菌糸の特別な呼称

生殖方式による分類

有性生殖と無性生殖

完全菌 perfect fungi

有性生殖と無性生殖を行う

有性生殖により形成された胞子：有性胞子 sexual spore
無性生殖により形成された胞子：無性胞子 asexual spore

不完全菌 imperfect fungi

無性生殖のみ行う

有性胞子形成

無性胞子形成

培養

サブロー･グルコース寒天培地 Sabouraud glucose agar

グルコース1-4%, ペプトン1%

種類

真菌の染色法(SMB.358)

細胞壁の多糖を染色：コットンブルー(cotton blue)、グラム染色(全ての真菌はグラム陽性)
真菌細胞壁多糖を特異的に染色：PAS染色、Grocottメテナミン銀染色、ファンギフローラY

参考

真菌の写真 - Fungal Images

http://www.asm.org/Division/c/fungi.htm

病原体としての真菌

分類群

菌名

病名

出芽分裂

菌体

菌糸

胞子

発芽管

寄生性

感染経路

病原体の特徴

病型

検査

治療

Candida albicans

形成

常在菌→各所

日和見感染症

担子菌

Filobasidiella neoformans

クリプトコッカス症

出芽

厚い莢膜

通性細胞内寄生体

鳩の乾燥糞→空気感染→肺(通性細胞内寄生体)

日和見感染菌

肺クリプトコッカス症、
中枢神経クリプトコッカス症、
皮膚クリプトコッカス症、
全身性クリプトコッカス症

墨汁染色

( アムホテリシンB or フルコナゾール )
　 ± フルシトシン

不完全菌

Trichosporon asahii

トリコスポロン症

仮性菌糸

分節分生子

子嚢菌

Aspergillus fumigatus/
'Aspergillus flavus

アスペルギルス症

糸状菌
不完全菌

有隔菌糸

土壌や朽ちた植物、空気中の浮遊胞子

Mucor/'Rhizopus/
Absidia/Rhizomucor

ムコール症

無隔菌糸

血管に親和性

土壌や朽ちた植物、空気中の浮遊胞子
　→　浮遊胞子の吸入

鼻眼脳型ムコール症
侵襲性肺ムコール症
全身播種型ムコール症

β-D-グルカン陰性。
喀痰、血培陰性

アムホテリシンB

子嚢菌

Pneumocystis jirovecii
('Pneumocystis carini)

ニューモシスチス・カリニ感染症

子嚢菌

Histoplasma capsulatum

ヒストプラスマ症

二形性真菌
　37℃酵母型発育
　25℃菌糸形成

空気感染。肺に一次病変を作り様々な臓器に播種

AIDS患者に好発

不完全菌

Coccidioides immitis

コクシジオイデス症

二形性真菌

内生胞子

不完全菌

Sporothrix schenckii

スポロトリクス症

二形性真菌

「肺炎」

　　[★]

英: pneumonia pneumonitis
関

疫学

日本の肺炎の受療率は人口10万対3、死亡率は人口10万対7。死因順位は第4位である。
受療率・罹患率共に高齢になるに従い急激に増加し、85歳以上の男性では死因第2位、90歳以上の男性では死因第1位となる(ガイドライン1)。
死亡者の95%以上が高齢者である。

年代と病原体

乳児	RSウイルス	インフルエンザウイルス	肺炎球菌	インフルエンザ菌
小児	RSウイルス	インフルエンザウイルス	肺炎球菌	クラミジア・ニューモニエ	マイコプラズマ・ニューモニエ
青年期	肺炎球菌	インフルエンザ菌	マイコプラズマ・ニューモニエ
成人	肺炎球菌	インフルエンザ菌
高齢者	肺炎球菌	インフルエンザ菌	レジオネラ・ニューモニエ	インフルエンザウイルス

日本における肺炎の年齢階級別受療率と死亡率(人口10 万対，2002 年)

ガイドライン1 2004 年「国民衛生の動向」改変

	年齢階級	総数	15～	25～	35～	45～	55～	65～	75～	85～	90～
	年齢階級	総数	19	29	39	49	59	69	79	89
受療率	外来	6	3	4	3	3	6	7	14	21	21
受療率	入院	19	2	3	2	3	7	21	86	309	489
死亡率	男性	76.4	0.5	0.5	1.5	4.6	15.2	69.2	339	2087	4317
	女性	62.7	0.3	0.5	0.9	1.9	5.6	22.4	144	934	2291
	総数	69.4	0.4	0.5	1.2	3.2	10.3	44.6	249	1291	2787

分類

発症の場

市中肺炎：上気道のウイルス感染後に多い。

起炎菌：肺炎球菌(最多)、インフルエンザ菌、マイコプラズマ、クラミジア・ニューモニエ

院内肺炎：入院後48時間以降に発症

起炎菌：グラム陰性桿菌(緑膿菌、クレブシエラ、大腸菌)、メシチリン耐性黄色ブドウ球菌、真菌、Pneumocystis jirovecii、サイトメガロウイルス

原因

細菌性肺炎　⇔ 非定型肺炎：細菌が検出できない肺炎の総称
真菌性肺炎
ウイルス性肺炎

病理

肺胞性肺炎

大葉性肺炎

気管支肺炎

上気道から連続的に下気道へ、あるいは、直接下気道に及んでいる。炎症は上皮に包まれた管腔内

間質性肺炎

間質性肺炎は、肺の実質や間質に炎症が存在

肺炎の比較

肺炎球菌性肺炎：発熱、咳嗽、喀痰。大葉性肺炎となることが多く、区域性に濃い浸潤影を示す。
マイコプラズマ肺炎：発熱、強い咳嗽
ニューモシスチス肺炎：発熱、乾性咳嗽、呼吸困難。びまん性スリガラス影
肺アスペルギルス症：肺アスペルスギローマ、侵襲性肺アスペルギルス症、慢性壊死性肺アスペルギルス症

ガイドライン

1. 成人市中肺炎診療ガイドライン

「メセナミン銀染色」

　　[★]

英: methenamine-silver stain
関: 染色法、銀染色

Pneumocystis jirovecii(Pneumocystis carinii;PCP)の証明に用いられる

メセナミン銀溶液 methenamine-silver solution

「Pneumocystis jirovecii感染症」

　　[★]

英: Pneumocystis jirovecii infection

「Pneumocystis jirovecii infection」

　　[★] ニューモシスチス肺炎

「Pneumocystis」

　　[★] ニューモシスチス属

[James_2006-1] James TY et al. (2006). "Reconstructing the early evolution of Fungi using a six-gene phylogeny". Nature 443 (7113): 818–822. doi:10.1038/nature05110. PMID 17051209.

[2] "see DPDx life-cycle diagram". Dpd.cdc.gov. Retrieved 2013-03-26.

[3] Ponce CA, Gallo M, Bustamante R, Vargas SL (2010). "Pneumocystis colonization is highly prevalent in the autopsied lungs of the general population". Clin Infect Dis 50 (3): 347–353. doi:10.1086/649868. PMID 20047487.

[Stringer_2002-4] Stringer JR, Beard CB, Miller RF, Wakefield AE (2002). "A New Name for Pneumocystis from Humans and New Perspectives on the Host-Pathogen Relationship". Emerg Infect Dis 8 (9): 891–6. PMC 2732539. PMID 12194762.

[5] Stringer JR, Beard CB, Miller RF Spelling Pneumocystis jirovecii Emerg Infect Dis. March 2009; doi:10.3201/eid1503.081060

[6] "ICBN Recommendation 60C.1". "If the personal name ends with a consonant (except -er), substantival epithets are formed by adding -i- (stem augmentation) plus the genitive inflection appropriate to the sex and number of the person(s) honoured (e.g. lecardii for Lecard."

[7] "ICBN Art. 45.4". "If a taxon originally assigned to a group not covered by this Code is treated as belonging to a group of plants other than algae or fungi, the authorship and date of any of its names are determined by the first publication that satisfies the requirements for valid publication under this Code."

[Redhead_2006-8] Redhead SA, Cushion MT, Frenkel JK, Stringer JR (2006). "Pneumocystis and Trypanosoma cruzi: nomenclature and typifications". J Eukaryot Microbiol 53 (1): 2–11. doi:10.1111/j.1550-7408.2005.00072.x. PMID 16441572.

[9] "Pneumocystis Genome Project". Pgp.cchmc.org. Retrieved 2013-03-26.

[10] Cissé OH, Pagni M, Hauser PM (2012) De novo assembly of the Pneumocystis jirovecii genome from a single bronchoalveolar lavage fluid specimen from a patient. MBio 4(1). pii: e00428-12. doi: 10.1128/mBio.00428-12

[Chagas_1909-11] Chagas C (1909). "Neue Trypanosomen". Vorläufige Mitteilung. Arch. Schiff. Tropenhyg. 13: 120–122.

[Chagas_1909b-12] Chagas C (1909). "Nova tripanozomiase humana: Estudos sobre a morfolojia e o ciclo evolutivo do Schizotrypanum cruzi n. gen., n. sp., ajente etiolojico de nova entidade morbida do homem". Mem Inst Oswaldo Cruz 1 (2): 159–218. doi:10.1590/S0074-02761909000200008.

[Carini_1910-13] Carini A. (1910). "Formas des eschizogonia do Trypanosoma lewisi". Soc Med Cir São Paulo 38 (8): –.

[14] Delanoë P, Delanoë M. (1912). "Sur les rapports des kystes de Carini du poumon des rats avec le Trypanosoma lewisi". Comptes rendus de l'Academie des sciences 155: 658–61.

[Meer_1942-15] van der Meer MG, Brug SL. (1942). "Infection à Pneumocystis chez l'homme et chez les animaux". Amer Soc Belge Méd Trop 22: 301–9.

[Vanek_1951-16] Vanek J. (1951). "Atypicka (interstitiálni) pneumonie detí vyvolaná Pneumocystis carinii (Atypical interstitial pneumonia of infants produced by Pneumocystis carinii)". Casop lék cesk 90: 1121–4.

[17] Jírovec O. (1952). "Pneumocystis carinii puvodce t. zv intertitialnich plasmocelularnich pneumonii kojencw (Pneumocystis carinii, the cause of interstitial plasmacellular pneumonia in neonates)". P Csl. Hyg epid mikrob 1: 141.

[Vanek_1953-18] Vanek J, Jírovec O, Lukes J. (1953). "Interstitial plasma cell pneumonia in infants". Ann Paediatrici 180: 1–21.

[Gajdusek_1957-19] Gajdusek DC (1957). "Pneumocystis carinii; etiologic agent of interstitial plasma cell pneumonia of premature and young infants". Pediatrics 19: 543–65.

[Frenkel_1976-20] Frenkel JK (1976). "Pneumocystis jiroveci n. sp. from man: morphology, physiology, and immunology in relation to pathology". Natl Cancer Inst Monogr 43: 13–27. PMID 828240.

[Gigliotti_2005-21] Gigliotti F (2005). "Pneumocystis carinii: has the name really been changed?". Clin Infect Dis 41 (12): 1752–5. doi:10.1086/498150. PMID 16288399.

[Hawksworth_2007-22] Hawksworth DL (2007). "Responsibility in naming pathogens: the case of Pneumocystis jirovecii, the causal agent of pneumocystis pneumonia". Lancet Infect. Dis. 7 (1): 3–5. doi:10.1016/S1473-3099(06)70663-6. PMID 17182335.

[Hugot_2003-23] Hugot J, Demanche C, Barriel V, Dei-Cas E, Guillot J (2003). "Phylogenetic systematics and evolution of primate-derived Pneumocystis based on mitochondrial or nuclear DNA sequence comparison". Syst Biol 52 (6): 735–744. doi:10.1080/10635150390250893. PMID 14668114.

[Keely_2004-24] Keely S, Fischer J, Cushion M, Stringer J (2004). "Phylogenetic identification of Pneumocystis murina sp. nov., a new species in laboratory mice". Microbiology 150 (Pt 5): 1153–65. doi:10.1099/mic.0.26921-0. PMID 15133075.

[Cushion_2004b-25] Cushion MT, Keely SP, Stringer JR (2004). "Molecular and phenotypic description of Pneumocystis wakefieldiae sp. nov., a new species in rats". Mycologia 96 (3): 429–438. doi:10.2307/3762163. JSTOR 3762163. PMID 21148866.

[Cushion_2005-26] Cushion MT, Keely SP, Stringer JR (2005). "Validation of the name Pneumocystis wakefieldiae". Mycologia 97: 268–268. doi:10.3852/mycologia.97.1.268.

[Dei-Cas_2006-27] Dei-Cas E et al. (2006). "Pneumocystis oryctolagi sp. nov., an uncultured fungus causing pneumonia in rabbits at weaning: review of current knowledge, and description of a new taxon on genotypic, phylogenetic and phenotypic bases". FEMS Micriobiol. Rev. 30 (6): 853–871. doi:10.1111/j.1574-6976.2006.00037.x. PMID 17064284.

[Aliouat-Denis_2008-28] Aliouat-Denis, C-M. et al. (2008). "Pneumocystis species, co-evolution and pathogenic power". Infection, Genetics & Evolution 8 (5): 708–726. doi:10.1016/j.meegid.2008.05.001. PMID 18565802.

[Demanche_2001-29] Demanche C et al. (2001). "Phylogeny of Pneumocystis carinii from 18 Primate Species Confirms Host Specificity and Suggests Coevolution". J. Clinical Microbiol. 39 (6): 2126–2133. doi:10.1128/JCM.39.6.2126-2133.2001. PMC 88100. PMID 11376046.

Pneumocystis

P. jirovecii cysts in tissue
Scientific classification
Kingdom:	Fungi
Phylum:	Ascomycota
Class:	Pneumocystidomycetes
Order:	Pneumocystidales
Family:	Pneumocystidaceae
Genus:	Pneumocystis
Species:	P. jirovecii
Binomial name
*Pneumocystis jirovecii* J.K.Frenkel

匿名

検索

案内

Pneumocystis jirovecii

生物学特徴

感染症

参考

Wikipedia preview

wiki en

Contents

Life-cycle[edit]

Medical relevance[edit]

Nomenclature[edit]

Pneumocystis genome[edit]

History[edit]

References[edit]

UpToDate Contents

English Journal

Japanese Journal

Related Links

Related Pictures

★リンクテーブル★

「100B067」

「真菌」

細菌、真菌、藻類、原虫

大きさ

細胞膜

細胞壁

線維状多糖

キチン

β-グルカン

キトサン

糖タンパク質

形態による分類

培養と感染組織における形態

菌糸の構造

菌糸の機能

生殖方式による分類

有性生殖と無性生殖

有性胞子形成

無性胞子形成

培養

種類

真菌の染色法(SMB.358)

参考

病原体としての真菌

「肺炎」

疫学

日本における肺炎の年齢階級別受療率と死亡率(人口10 万対，2002 年)

分類

発症の場

原因

病理

肺炎の比較

ガイドライン

「メセナミン銀染色」

メセナミン銀溶液 methenamine-silver solution

「Pneumocystis jirovecii感染症」

「Pneumocystis jirovecii infection」

「Pneumocystis」