Detection of Pneumocystis jirovecii in Hospitalized Children Less Than 3 Years of Age

Abstract

Few data are available in the literature regarding Pneumocystis jirovecii infection in children under 3 years old. This retrospective cohort study aimed to describe medically relevant information among them. All children under 3 years old treated in the same medical units from April 2014 to August 2020 and in whom a P. jirovecii evaluation was undertaken were enrolled in the study. A positive case was defined as a child presenting at least one positive PCR for P. jirovecii in a respiratory sample. Medically relevant information such as demographical characteristics, clinical presentation, microbiological co-infections, and treatments were collected. The objectives were to describe the characteristics of these children with P. jirovecii colonization/infection to determine the key underlying diseases and risk factors, and to identify viral respiratory pathogens associated. The PCR was positive for P. jirovecii in 32 children. Cardiopulmonary pathologies (21.9%) were the most common underlying disease in them, followed by severe combined immunodeficiency (SCID) (18.8%), hyaline membrane disease (15.6%), asthma (9.4%) and acute leukaemia (6.3%). All SCID children were diagnosed with pneumocystis pneumonia. Co-infection with Pj/Rhinovirus (34.4%) was not significant. Overall mortality was 18.8%. Paediatric pneumocystis is not restricted to patients with HIV or SCID and should be considered in pneumonia in children under 3 years old.

Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection

“…A recent single-center study of hospitalized children (<3 years old) in France found that 11% (32/279) of them were infected with P. jirovecii , with the highest positivity rate found in children with cardiopulmonary pathologies (22%), followed by SCID (19%), hyaline membrane disease (16%), asthma (9%), and acute leukaemia (6%) [ 222 ]. Of the infected children, 40% were considered colonization cases while 56% had confirmed PCP, mainly associated with SCID and other congenital diseases.…”

A unique case of pneumocystis pneumonia in infancy

“…To date, our patient's extensive immunologic testing has been negative, suggesting presence of a primary PJP infection without any underlying immunodeficiency. Though previous studies have identified presence of PJP by polymerase chain reaction testing in children hospitalized with respiratory tract infections, this is thought to represent past exposure or colonization alone 2 . In such cases of exposure in non‐immunosuppressed children, if symptoms are even present, they are generally self‐limited and resolve without treatment 3 …”