Evasive strategies of the organism

P. carinii maintains an extracellular existence within the lung alveoli and adheres tightly to a specific lining cell, the type I pneumocyte. With immunosuppression, the organism proliferates slowly and initiates a series of changes in the alveolar microenvironment which culminate in damage to the type I cell. The mechanisms which permit P. carinii to evade the host defenses are poorly understood. Impaired cellular immunity is generally considered to be the main host factor that predisposes to infection, but impaired humoral immunity also plays a role. Even with successful treatment of P. carinii, the host remains susceptible to recurrent episodes of pneumocystosis as long as the immunosuppressive conditions persist.

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