Pneumocystis jirovecii pneumonia: a proposed novel model of corticosteroid benefit

Amal A Gharamti, William Mundo, Daniel B Chastain, Carlos Franco-Paredes, Andrés F Henao-Martínez, Leland Shapiro, Amal A Gharamti, William Mundo, Daniel B Chastain, Carlos Franco-Paredes, Andrés F Henao-Martínez, Leland Shapiro

No abstract available

Keywords: AIDS; ARDS; HIV; Pneumocystis jirovecii; corticosteroids.

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Proposed mechanism of adjuvant steroid benefit during Pneumocystis jirovecii pneumonia (PJP) treatment. A (red). During immunosuppression, monocytes and lymphocytes are reduced in number or function. B (red). Pneumocystis jirovecii colonizes and replicates within alveoli due to weakened host defenses. C (red) Antimicrobial medication (trimethoprim-sulfamethoxazole, TMP/SMX) lyses P. jirovecii, liberating internal components, which interact with and inactivate surfactant. This antimicrobial lytic activity substantially augments ongoing lytic activity caused by a residual immune attack on PJP organisms. D (red) Inactivated surfactant results in alveolar collapse. E (red) Alveolar collapse is associated with compromised wall integrity, and fluid enters alveoli. C (Green) Adjuvant (adjunct) corticosteroid therapy suppresses immune attack on P. jirovecii, lowering net pathogen lysis. This reduces total surfactant inactivation. D (Green) Partial maintenance of surfactant function reduces alveolar collapse and amount of fluid intrusion into alveoli. Thus, the infection clears over time.

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