Pneumocystispneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients

Abstract

Introduction: Pneumocystis pneumonia (PcP) has classically been described as a serious complication in patients infected with the human immunodeficiency virus (HIV). However, the emerging number of conditions associated with immunosuppression has led to its appearance in other patient populations, such as those receiving chronic corticosteroid therapy, those with hematological or solid malignancies, transplant recipients and those who receive immunomodulatory or biological therapy. Areas covered: This article reviews the most recent publications on PcP in the HIVinfected and HIV-uninfected population, focusing on epidemiology, diagnostic, therapy and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles including randomized clinical trials, meta-analyses, observational studies and clinical reviews. Eligible studies were selected in two stages: sequential examination of title and abstract, followed by full text. Expert opinion: Widespread use of antiretroviral and prophylactic therapy in HIVinfected patients has decreased the incidence of PcP in this population. However, the growing incidence of Pneumocystis infection in the HIV-uninfected population suggests the need for new global epidemiological studies in order to identify the true scale of the disease in this population. These data would allow us to improve diagnosis, therapeutic strategies, and clinical management. It is very important that both patients and physicians realize that HIV-uninfected patients are at risk of PcP and that rapid diagnosis and early initiation of treatment are associated with better prognosis. Currently, in-hospital mortality rates are very high: 15% for HIV-infected patients and 50% in some HIV-uninfected patients. Therefore, adequate preventive measures should be implemented to avoid the high mortality rates seen in recent decades.

Etiology of Severe Community-Acquired Pneumonia in Adults Based on Metagenomic Next-Generation Sequencing: A Prospective Multicenter Study

“…One reason for the lower detection rate with microscopic examination was that Wright-Giemsa staining was not performed routinely. The prevalence rates of Pneumocystis pneumonia have been reported ranging from 0 to 11% in non-HIV patients [ 35 ], while the incidence of severe pneumonia caused by P. jirovecii remained undetermined. In this study, P .…”

Pneumocystis pneumonia in patients with primary nephrotic syndrome: analysis of 18 cases

“…Previous studies have found a higher mortality of 2 to 28% in patients with rheumatoid arthritis [30], 13 to 43% in patient with kidney transplant [31], and 30 to 60% in patients with hematological malignancies [23]. According to previous studies, possible prognostic factors in HIV-negative patients were old age, coinfections, respiratory failure, pre-existing lung disease and a higher LDH level [32][33][34]. The reason that no patients died in our study may be due their relatively younger age (average 48.5 years) and the disease itself.…”

Single-Cell TCR Sequencing Reveals the Dynamics of T Cell Repertoire Profiling During Pneumocystis Infection

“…The mortality of HIV-negative PCP patients is estimated to range from 20 to 80%, which is higher than in HIV patients (5-15%) (Rilinger et al, 2019;Shoji et al, 2020). The incidence of PCP in HIV-negative patients has continued to increase in recent years (Cilloniz et al, 2019;Lee et al, 2019), highlighting the need to better understand the immune mechanism against Pneumocystis to identify new therapeutic targets.…”