Pneumocystis jirovecii pneumonia in systemic autoimmune rheumatic disease: A case–control study

Tadros, Susan; Teichtahl, Andrew; Ciciriello, Sabina; Wicks, Ian P.

doi:10.1016/j.semarthrit.2016.09.009

Cited by 31 publications

(13 citation statements)

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“…Twenty-four studies in HIV-infected and uninfected patients with PCP were identified and were divided, based on geographic location. Seven studies were from USA, two from South America, 11 from Northern Europe, three from Southern Europe, and one from Australia, (Table 2) [6, 19–41]. These studies were a mixture of prospective and retrospective clinical or laboratory (including autopsy) studies and were national, multi-center or single center in their design.…”

Section: Resultsmentioning

confidence: 99%

“…Among the adult studies 19 included only HIV-infected adults, two included HIV-infected and uninfected adults, and one included HIV-uninfected adults with underlying rheumatologic conditions. In the two studies of infants, subjects were HIV-uninfected [19–41].…”

Section: Resultsmentioning

confidence: 99%

“…Subsequently, the relationship between seasonality and temperature and hospitalization with PCP has described inconsistent findings with some, but not all studies describing any association. In both HIV-infected and uninfected patients the risk of PCP has been observed to be higher in summer (London, UK) [28, 35], (Geneva, Switzerland [29] (Munich, Germany) [36] and (San Francisco, USA) [6] autumn (Melbourne, Australia) [41], and winter (Seville, Spain) [40]. As previously suggested [6], these differing results might be as a result of differences in patient populations, climatological factors, geography, Pneumocystis genotypes, or to differences in study design [6].…”

Section: Discussionmentioning

confidence: 99%

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The Relationship between Pneumocystis Infection in Animal and Human Hosts, and Climatological and Environmental Air Pollution Factors: A Systematic Review

2018

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Background: Over the past decade, there has been rising interest in the interaction of Pneumocystis with the environment. This interest has arisen in part from the demonstration that environmental factors have important effects on the viability and transmission of microbes, including Pneumocystis. Environmental factors include climatological factors such as temperature, humidity, and precipitation, and air pollution factors including carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matter. Methods: We undertook a systematic review in order to identify environmental factors associated with Pneumocystis infection or PCP, and their effects on human and animal hosts. Results: The systematic review found evidence of associations between Pneumocystis infection in animal and human hosts, and climatological and air pollution factors. Data from human studies infers that rather than a seasonal association, presentation with PCP appears to be highest when the average temperature is between 10 and 20°C. There was evidence of an association with hospitalization with PCP and ambient air pollution factors, as well as evidence of an effect of air pollution on both systemic and bronchoscopic lavage fluid humoral responses to Pneumocystis. Interpretation of human studies was confounded by possible genetically-determined predisposition to, or protection from infection. Conclusions: This systematic review provides evidence of associations between Pneumocystis infection in both animal and human hosts, and climatological and environmental air pollution factors. This information may lead to an improved understanding of the conditions involved in transmission of Pneumocystis in both animal and human hosts. Such knowledge is critical to efforts aimed at prevention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Relationship between Pneumocystis Infection in Animal and Human Hosts, and Climatological and Environmental Air Pollution Factors: A Systematic Review

2018

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“…Age, functional status, disease activity, comorbidities, previous infections and usage of glucocorticoids and immunosuppressive agents contribute to the risk of infections in RA patients 3 . Also, lymphopenia is a risk factor for increased infection and Pneumocystis jirovecii pneumonia among patients with systemic autoimmune rheumatic diseases 4,5 . Reactivation of cytomegalovirus (CMV) is sometimes observed during immunosuppressive management of systemic autoimmune diseases, 6,7 which indicates a compromised immune system.…”

Section: Introductionmentioning

confidence: 99%

“…rheumatic diseases. 4,5 Reactivation of cytomegalovirus (CMV) is sometimes observed during immunosuppressive management of systemic autoimmune diseases, 6,7 which indicates a compromised immune system. CMV reactivation is evaluated by CMV antigenemia (Ag) assay, and a previous report showed that a maximum CMV Ag (CMV Ag MAX) of more than 5 per 10 5 white blood cells (WBC) was a risk factor for death in patients with autoimmune diseases receiving immunosuppressive therapies.…”

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confidence: 99%

Elevation of cytomegalovirus antigenemia predicts serious infection and death in patients receiving immunosuppressive therapies for autoimmune diseases

et al. 2020

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Survival rates of patients with autoimmune diseases have steadily improved. In addition to steroids, several kinds of immunosuppressive reagents have been developed, and the therapeutic protocols are well-designed. Therefore, the disease symptoms of the majority of autoimmune diseases can be controlled, and death due to autoimmune diseases themselves has dramatically waned. However, it remains an unsolved problem how to avoid the occurrence of serious infections, especially opportunistic infections. In cases of systemic lupus erythematosus, the major cause of death during the acute phase is serious infection, not active disease. 1 Moreover, several biologics have been applied to therapeutic strategies for autoimmune diseases, and risks for serious infections are increasing, such as tumor necrosis factor (TNF)-α inhibitors for rheumatoid arthritis (RA). 2 Therefore, it is important to learn how to predict and prevent serious infections in order to achieve better clinical outcomes. Age, functional status, disease activity, comorbidities, previous infections and usage of glucocorticoids and immunosuppressive agents contribute to the risk of infections in RA patients. 3 Also, lymphopenia is a risk factor for increased infection and Pneumocystis jirovecii pneumonia among patients with systemic autoimmune

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Pneumocystis Jirovecii Pneumonia in Systemic Lupus Erythematosus: A Nationwide Cohort Study in Taiwan

Wang

Lai

Huang

et al. 2022

Arthritis Care & Research

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Objective To evaluate Pneumocystis jirovecii pneumonia (PJP) infection risk in patients with systemic lupus erythematosus (SLE) in Taiwan. Methods We identified 24,367 patients with SLE from the National Health Insurance research database between 1997 and 2012 and compared the PJP incidence rates (IRs) with those in 243,670 age‐ and sex‐matched non‐SLE controls. PJP risk in the patients was evaluated using a Cox multivariate proportional hazards model. Results The SLE patients exhibited a significantly higher PJP risk than the controls, with an IR of 2.63 per 10,000 person‐years and IR ratio of 27.65 (95% confidence interval 17.2–45.3; P < 0.001). Male sex (hazard ratio [HR] 2.42, P < 0.01), end‐stage renal disease (ESRD; HR 1.74, P = 0.01), recent use of mycofenolate mofetil (MMF; HR 4.43, P < 0.001), intravenous steroid pulse therapy (HR 108.73, P < 0.001), and average oral dosage of >7.5 mg/day prednisolone or equivalent treatment (HR 4.83, P < 0.001) were associated with PJP in SLE, whereas hydroxychloroquine use reduced its risk (HR 0.51, P = 0.01). Of note, cyclophosphamide was not associated with PJP infection in the multivariate Cox proportional hazard model. Conclusion Patients with SLE have a considerably high PJP risk. Cyclophosphamide does not increase PJP risk. Male sex, ESRD, MMF use, intravenous steroid pulse therapy, and oral prednisolone or equivalent treatment (>7.5 mg/day) are risk factors for PJP, whereas hydroxychloroquine use reduces PJP risk.

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Pneumocystis jirovecii pneumonia in systemic autoimmune rheumatic disease: A case–control study

Cited by 31 publications

References 30 publications

The Relationship between Pneumocystis Infection in Animal and Human Hosts, and Climatological and Environmental Air Pollution Factors: A Systematic Review

The Relationship between Pneumocystis Infection in Animal and Human Hosts, and Climatological and Environmental Air Pollution Factors: A Systematic Review

Elevation of cytomegalovirus antigenemia predicts serious infection and death in patients receiving immunosuppressive therapies for autoimmune diseases

Pneumocystis Jirovecii Pneumonia in Systemic Lupus Erythematosus: A Nationwide Cohort Study in Taiwan

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