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Lint: pulmonary-pneumocystis-jirovecii-infection-2

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"Presentation in HIV is typically non-specific and insidious, the most common symptoms being dyspnoea and/or non-productive cough. In nonHIV-infected immuno-compromised patients, the disease is more fulminant with severe hypoxaemia and high mortality, which may be linked to the more marked recruitment of inflammatory cells 19."

Line 11:140 · Use a hyphen-minus ('-') instead of an en-dash ('–').
Emphasis
warning

"Pneumocystis jirovecii pneumonia (PCP/PJP), formerly known as Pneumocystis carinii pneumonia, is a potentially life-threatening opportunistic fungal infection primarily affecting immunocompromised individuals. PJP incidence in HIV patients has declined since the introduction of antiretrovirals, but its incidence is rising in non-HIV immunocompromised patients, including those with solid organ transplantation, stem cell transplantation, malignancies, autoimmune conditions and cirrhosis-associated immune dysfunction 19."

Line 1:12 · Italics should be used only in exceptional circumstances: '<em>Pneumocystis jirovecii</em> pneumonia (PCP/PJP)</strong>, formerly known as <strong><em>Pneumocystis carinii</em>'

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:43 · Italics should be used only in exceptional circumstances: '<em>Pneumocystis carinii</em> pneumonia, but the causative organism was reclassified as <em>Pneumocystis jirovecii.</em> <em>Pneumocystis carinii</em> now only refers to a species found in rats, while <em>Pneumocystis jirovecii</em> refers to the human isolate <sup>14</sup>. However, there continues to be widespread use of the acronym PCP; a <em>post hoc</em> justification for its use is that it stands for <strong><em>P</em></strong><em>neumo</em><strong><em>c</em></strong><em>ystis</em> <strong>p</strong>neumonia <sup>14,15</sup>. The acronym "PJP" for <em>Pneumocystis jirovecii</em>'

"Pneumocystis jirovecii is an atypical yeast-like fungus of the genus Pneumocystis 10 that was previously thought to be a protozoan."

Line 13:4 · Italics should be used only in exceptional circumstances: '<em>Pneumocystis jirovecii </em>is an atypical yeast-like fungus of the genus <em>Pneumocystis </em>'

"Histology of the infected lung demonstrates intra-alveolar eosinophilic masses with a foamy appearance, due to small cysts within which the Pneumocystis jirovecii organism is found 9."

Line 14:144 · Italics should be used only in exceptional circumstances: '<em>Pneumocystis jirovecii</em>'

"Culturing Pneumocystis jirovecii can be very difficult. Diagnostic confirmation requires identification of organisms in sputum or bronchoalveolar lavage fluid. Monoclonal antibodies for detecting Pneumocystis jirovecii are available and have a sensitivity greater than 90% for detecting Pneumocystis jirovecii in induced sputum from HIV-infected patients 10."

Line 15:14 · Italics should be used only in exceptional circumstances: '<em>Pneumocystis jirovecii </em>can be very difficult. Diagnostic confirmation requires identification of organisms in sputum or bronchoalveolar lavage fluid. Monoclonal antibodies for detecting <em>Pneumocystis jirovecii </em>are available and have a sensitivity greater than 90% for detecting <em>Pneumocystis jirovecii </em>'

"Features which are highly suggestive of pneumocystis pneumonia in patients with CD4 counts below 200/mm3 include 5:"

Line 20:44 · Italics should be used only in exceptional circumstances: '<em>pneumocystis</em>'

"High-resolution computed tomography is more sensitive and specific and may be used to exclude Pneumocystis pneumonia in patients with clinical suspicion but normal or inconclusive chest radiographs 3."

Line 29:105 · Italics should be used only in exceptional circumstances: '<em>Pneumocystis</em>'

"Gallium-67 lung scintigraphy is highly sensitive for Pneumocystis pneumonia, and a normal gallium scan renders the diagnosis of Pneumocystis pneumonia very unlikely. The gallium scan in patients with Pneumocystis pneumonia demonstrates diffuse pulmonary uptake, which may be heterogeneous or homogeneous."

Line 57:64 · Italics should be used only in exceptional circumstances: '<em>Pneumocystis</em> pneumonia, and a normal gallium scan renders the diagnosis of <em>Pneumocystis</em> pneumonia very unlikely. The gallium scan in patients with <em>Pneumocystis</em>'
Acronyms
warning

"Pneumocystis jirovecii pneumonia (PCP/PJP), formerly known as Pneumocystis carinii pneumonia, is a potentially life-threatening opportunistic fungal infection primarily affecting immunocompromised individuals. PJP incidence in HIV patients has declined since the introduction of antiretrovirals, but its incidence is rising in non-HIV immunocompromised patients, including those with solid organ transplantation, stem cell transplantation, malignancies, autoimmune conditions and cirrhosis-associated immune dysfunction 19."

Line 1:55 · 'PCP' has no definition. Spell it out if it's unfamiliar to the audience.

"Pneumocystis jirovecii pneumonia (PCP/PJP), formerly known as Pneumocystis carinii pneumonia, is a potentially life-threatening opportunistic fungal infection primarily affecting immunocompromised individuals. PJP incidence in HIV patients has declined since the introduction of antiretrovirals, but its incidence is rising in non-HIV immunocompromised patients, including those with solid organ transplantation, stem cell transplantation, malignancies, autoimmune conditions and cirrhosis-associated immune dysfunction 19."

Line 1:59 · 'PJP' has no definition. Spell it out if it's unfamiliar to the audience.

"Pneumocystis jirovecii pneumonia (PCP/PJP), formerly known as Pneumocystis carinii pneumonia, is a potentially life-threatening opportunistic fungal infection primarily affecting immunocompromised individuals. PJP incidence in HIV patients has declined since the introduction of antiretrovirals, but its incidence is rising in non-HIV immunocompromised patients, including those with solid organ transplantation, stem cell transplantation, malignancies, autoimmune conditions and cirrhosis-associated immune dysfunction 19."

Line 1:266 · 'PJP' has no definition. Spell it out if it's unfamiliar to the audience.

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:18 · 'PCP' has no definition. Spell it out if it's unfamiliar to the audience.

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:380 · 'PCP' has no definition. Spell it out if it's unfamiliar to the audience.

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:594 · 'PJP' has no definition. Spell it out if it's unfamiliar to the audience.

"It remains one of the most common causes of life-threatening pulmonary infection in people living with HIV, typically occurring when CD4 counts fall below 200 cells/mm³. With the widespread adoption of antiretroviral therapy and PJP prophylaxis in resource-rich settings, the epidemiology has shifted considerably. PJP now affects both sexes across a broad age range, and the historical framing of risk around specific HIV transmission groups reflects early epidemic data rather than current demographics."

Line 6:233 · 'PJP' has no definition. Spell it out if it's unfamiliar to the audience.

"It remains one of the most common causes of life-threatening pulmonary infection in people living with HIV, typically occurring when CD4 counts fall below 200 cells/mm³. With the widespread adoption of antiretroviral therapy and PJP prophylaxis in resource-rich settings, the epidemiology has shifted considerably. PJP now affects both sexes across a broad age range, and the historical framing of risk around specific HIV transmission groups reflects early epidemic data rather than current demographics."

Line 6:319 · 'PJP' has no definition. Spell it out if it's unfamiliar to the audience.

"Non-HIV patients now constitute a substantial and growing proportion of PJP cases. The most commonly affected groups include those with haematological malignancies, solid organ cancers receiving chemotherapy, solid organ or haematopoietic stem cell transplant recipients, and patients on prolonged corticosteroid or other immunosuppressive therapy for autoimmune conditions. Decompensated liver cirrhosis is an increasingly recognised independent risk factor, mediated through cirrhosis-associated immune dysfunction. Diabetes mellitus and chronic debilitating illness may act as contributing factors, particularly in the presence of lymphopenia or concurrent immunosuppression, though these are not yet incorporated into formal prophylaxis guidelines 20."

Line 7:76 · 'PJP' has no definition. Spell it out if it's unfamiliar to the audience.

"Most patients with acute infection are treated with trimethoprim-sulfamethoxazole (co-trimoxazole or TMP-SMZ) 17, combined with corticosteroids in patients with moderate to severe infections 8. The same agent may be used as prophylaxis. Several alternative agents may also be employed, both for acute treatment and prophylaxis. They include atovaquone, pentamidine, dapsone, and clindamycin-primaquine, among others 17. Systemic prophylaxis protects the patient from haematogenous and lymphatic spread."

Line 60:105 · 'TMP-SMZ' has no definition. Spell it out if it's unfamiliar to the audience.
Strong
warning

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:453 · Generally, don't use bold in text: '<strong><em>P</em></strong>'

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:494 · Generally, don't use bold in text: '<strong><em>c</em></strong>'

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:536 · Generally, don't use bold in text: '<strong>p</strong>'
List Caps
warning

"Kaposi sarcoma"

Line 95:11 · In general, we don't start a list item with a capital letter. Exceptions are proper nouns.
Semicolons
suggestion

"Classically, "PCP" was the acronym for Pneumocystis carinii pneumonia, but the causative organism was reclassified as Pneumocystis jirovecii. Pneumocystis carinii now only refers to a species found in rats, while Pneumocystis jirovecii refers to the human isolate 14. However, there continues to be widespread use of the acronym PCP; a post hoc justification for its use is that it stands for Pneumocystis pneumonia 14,15. The acronym "PJP" for Pneumocystis jirovecii pneumonia is also in use."

Line 3:383 · Use semicolons judiciously.

"Despite this, the specificity of the gallium scan is low; hence, it is most useful in patients in whom bronchoalveolar lavage may be less diagnostic (e.g. in suspected relapse)."

Line 58:60 · Use semicolons judiciously.
Inline EG
suggestion

"Despite this, the specificity of the gallium scan is low; hence, it is most useful in patients in whom bronchoalveolar lavage may be less diagnostic (e.g. in suspected relapse)."

Line 58:153 · Consider replacing a bracketed e.g. with an inline e.g. after a comma.