Exploring the Differences in Pneumocystis Pneumonia Infection Between HIV and Non-HIV Patients

Abstract

Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections worldwide that affects the lung. Pneumocystis leads to pneumonia, caused by Pneumocystis jirovecii, formerly known as Pneumocystis carinii. In recent decades, PCP has been a major health problem for human immunodeficiency virus (HIV) patients and is responsible for most of mortality and morbidity. However, the increasing number of immunosuppressive-related diseases has led to outbreaks in other patient populations, raising the concern for PCP as it becomes a major concern among those patients. These changes led to marked changes in the prevalence and mortality rates of PCP. Huge variations in those parameters among HIV and non-HIV patients have been seen also. Historically, the diagnosis was made by staining and direct visualization of the organism within the bronchoalveolar lavage (BAL) fluid. The diagnosis is now made by microscopic examination and a real-time polymerase chain reaction (PCR) of BAL. Serum (1,3)-β-D-glucan, which is a component of the Pneumocystis jirovecii cell wall that distinguishes it from other fungi, has become an important diagnostic tool. Early diagnosis and treatment play a vital role in the patient's survival and in the infection outcome; hence, empirical PCP therapy should be started immediately when the infection is suspected without waiting for the results of the diagnostic test. Steroids play an important role in the treatment of HIV patients, especially patients who present with hypoxia and respiratory failure. Prophylaxis is very effective and should be given to all patients at high risk of PCP. Antiretroviral therapy (ART) should be started as soon as possible in newly diagnosed HIV-infected patients with PCP, and the immune status of immunocompromised patients with PCP should be improved by temporarily withholding immunosuppressive drugs or reducing their doses.

Protocol for the systematic review of the Pneumocystis jirovecii-associated pneumonia in non-HIV immunocompromised patients

“…patients with non-HIV immunosuppression, including those undergoing corticosteroid treatment, chemotherapy, organ transplants, or managing autoimmune diseases [4][5][6][7]. Apparently, from an epidemiologic viewpoint, the increase in prevalence among patients with non-HIV immunosuppression may be explained possibly as a result of improved access to diagnostics and treatment [8].…”

“…The clinical presentation of PJP may differ between patients with and without HIV infection [ 8 ], which may influence early detection and initiation of appropriate treatment [ 9 ]. Studies have shown that PJP in non-HIV patients experiences a more progressive clinical course, a poor prognosis, and a higher mortality rate (ranging from 30% to 60%) than in HIV patients [ 4 , 10 ].…”

Deep mutational scanning ofPneumocystis jiroveciidihydrofolate reductase reveals allosteric mechanism of resistance to an antifolate

“…In this group, the disease caused by P. jirovecii has a mortality rate close to 60% despite the use of prophylaxis. This increase raises major concerns about the future of Pneumocystis pneumonia in vulnerable populations [29–31]. Furthermore, P. jirovecii has been detected in healthy, non-immunocompromised groups, and in up to 50% of the general population, implying a higher prevalence than previously estimated [26,32–35].…”

Retrospective comparative analysis of clinical, laboratory, and imaging features of Pneumocystis jirovecii pneumonia among HIV-infected individuals and patients with cancer

“…Pneumocystis jiroveci pneumonia is the most common opportunistic infection in HIV patients, and it is also an important but sporadic opportunistic lung infection in immunocompromised HIV seronegative population (Hakamifard et al,2022).In previous studies,risk factors for the high incidence of Pneumocystis jiroveci pneumonia included severe malnutrition,primary immunode ciency,hematological malignancies,and solid organ or bone marrow transplantation (Nasr et al,2022).Recently, patients with cancer, especially those receiving high-dose corticosteroid therapy or chemotherapy, have been identi ed as a group of concern for a recent increased risk of Pneumocystis jiroveci pneumonia .But the clinical data differentiation of PJP-HIV and PJP-cancer for diagnostic features is still overlooked.Therefore, herein we retrospectively compare the clinical, laboratory, and imaging features of PJP-HIV and PJP-cancer in order to provide evidence for early detection, diagnosis, and treatment. burden and more severe clinical manifestations, such as cough and sputum (62.5% vs 63%), chest tightness (37.5% vs 55.6%), and asthma (18.8% vs 40.7%).…”