Pneumocystis and pneumocystosis in Europe at the end of the 20th century.

Pneumocystis carinii was described as a new microorganism in the lungs of rats living in Paris by Delanoe and Delanoe in 1912 [1]. In the early 1950s, the first cases of human pneumocystosis were described in orphans and in infants living in eastern Europe [2, 3]. Then Pneumocystis carinii pneumonia (PCP) was reported as an opportunistic disease in patients treated with immunosuppressive therapy [4] for malignancy, hemopathies or cancer. The significant increase in PCP incidence at the beginning of the 1980s has been related to the emergence of the AIDS epidemic [5]. In the last 10 years, important improvements have occurred in the field of diagnosis and therapy strategies, simultaneously, due to the interest of an increasing number of research teams. From the diagnostic point of view, more sensitive techniques such as immunofluorescence with monoclonal antibodies [6] and PCR [7–10] have been proposed with less invasive samples such as bronchoalveolar lavage, induced sputum [11] and more recently oral washes [12–14]. Since the beginning of the 1990s, primary prophylaxis has been proposed for HIV-infected patients with a CD4 count below 200/mm3[15]. Trimethoprim-sulfamethoxazole (TMT-SMX) is the most efficient molecule, but others can be proposed such as aerosolized pentamidine [16]. The evolution of antiretroviral therapies, mainly new antiretroviral associations for HIV infection, will change the wide spread of PCP, but many questions are …