Near-Universal Prevalence of Pneumocystis and Associated Increase in Mucus in the Lungs of Infants With Sudden Unexpected Death
Author
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Vargas Munita, Sergio
Author
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Ponce, Carolina A.
es_CL
Author
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Gallo, Miriam
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Author
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Pérez, Francisco
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Author
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Astorga, J. Felipe
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Author
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Bustamante, Rebeca
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Author
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Chabé, Magali
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Author
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Durand Joly, Isabelle
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Author
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Iturra, Pablo
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Author
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Miller, Robert F.
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Author
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Aliouat, El Moukthar
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Author
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Dei Cas, Eduardo
es_CL
Admission date
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2014-02-14T17:11:56Z
Available date
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2014-02-14T17:11:56Z
Publication date
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2013
Cita de ítem
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Clinical Infectious Diseases 2013;56(2):171–9
en_US
Identifier
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DOI: 10.1093/cid/cis870
Identifier
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https://repositorio.uchile.cl/handle/2250/129279
General note
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Artículo de publicación ISI
en_US
Abstract
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Background. Pneumocystis without obvious accompanying pathology is occasionally reported in autopsied
infant lungs. Its prevalence and significance are unknown. Interestingly, this mild infection induces a strong activation
of mucus secretion–related genes in young immunocompetent rodents that has not been explored in
infants. Excess mucus is induced by multiple airway offenders through nonspecific pathways and would explain a
cofactor role of Pneumocystis in respiratory disease. We undertook characterization of the prevalence of Pneumocystis
and associated mucus in infant lungs.
Methods. Samples from 128 infants (mean age, 101 days) who died suddenly and unexpectedly in Santiago
during 1999–2004 were examined for Pneumocystis using nested polymerase chain reaction (nPCR) amplification
of the P. jirovecii mtLSU ribosomal RNA gene and immunofluorescence microscopy (IF). Pneumocystis-negative
infants 28 days and older and their age-closest positives were studied for MUC5AC expression and Pneumocystis
burden by Western blot and quantitative PCR, respectively.
Results. Pneumocystis DNA was detected by nPCR in 105 of the 128 infants (82.0%) and Pneumocystis organisms
were visualized by IF in 99 (94.3%) of the DNA-positive infants. The infection was commonest at 3–4
months with 40 of 41 (97.6%) infants of that age testing positive. MUC5AC was significantly increased in
Pneumocystis-positive tissue specimens (P = .013). Death was unexplained in 113 (88.3%) infants; Pneumocystis
was detected in 95 (84.0%) of them vs 10 of 15 (66.7%) with explained death (P = .28).
Conclusions. A highly focal Pneumocystis infection associated to increased mucus expression is almost universally
present in the lungs of infants dying unexpectedly in the community regardless of autopsy diagnosis.