The changing trends and profile of pneumocystosis mortality in the United States, 1999‐2014

Abstract

Pneumocystosis (PCP) mortality in the U.S. has received less attention in recent years. This study describes recent trends in mortality and the estimated burden of PCP in the U.S., using the national multiple cause of death data during 1999-2014. PCP mortality rates were calculated for age, sex, race and year. Demographic differences were presented for decedents with and without a human immunodeficiency virus (HIV) co-diagnosis. Matched odds ratios (MOR) were generated to describe associations between non-HIV conditions and PCP mortality. In total, 11 512 PCP deaths occurred during 1999-2014. Annual age-adjusted PCP mortality decreased over this time period, from 0.479 to 0.154 per 100 000 population (1999 vs 2014 respectively). Over two-thirds of decedents were male and Blacks had the highest mortality as compared to Whites. HIV co-diagnosis accounted for 48% of all PCP deaths in 2014 vs 71% in 1999. Comorbid conditions such as connective tissue disorders (MOR=12.29; 95% confidence interval=[10.26, 14.71]) were associated with a PCP diagnosis. Productivity losses amounted to >$12 billion during the study period. Although widespread use of antiretroviral therapy and PCP prophylaxis for HIV infection likely contributed to the overall decline in PCP deaths during 1999-2014, a continual need exists to prevent and treat this fungal disease in immune-compromised populations that are not infected with HIV.

High initial (1, 3) Beta-d-Glucan concentration may be a predictor of satisfactory response of c aspofungin combined with TMP/SMZ for HIV-negative patients with moderate to severe Pneumocystis jirovecii pneumonia

“…Therefore, it may be inferred that the combination therapy with caspofungin can compensate for the defects of TMP/SMZ in patients with delayed PJP treatment. 3Increasing evidence of mutations in the genes that encode dihydropteroate synthase may lead to drug resistance of sulfa agents, and several studies have demonstrated that it was associated with treatment failure (Wickramasekaran et al, 2017;Nahimana et al, 2003). With the attention paid to the prevention of PJP, long-term oral administration of TMP/SMZ may increase the risk of drug resistance.…”

“…The first-line therapy of PJP is TMP/SMZ (trimethoprim/ sulfamethoxazole), which has remained unchanged for many years (White et al, 2017;Wickramasekaran et al, 2017;Roembke et al, 2014). However, about 25% of patients cannot complete the full course of the TMP/SMZ regimen because of treatment failure or various side effects such as marrow suppression, renal damage, gastrointestinal upset and so on (Benfield et al, 2008).…”

New advances in understanding the host immune response to Pneumocystis

“…This has important implications when designing diagnostic tools and new treatment strategies for infected patients. While PCP is recognised as an AIDS-defining illness, the increased incidence in non-HIV patients is alarming and warrants the need for improved diagnostic and treatment strategies for affected patients [2, 3]. …”

Use of (1→3)‐β‐d‐glucan for diagnosis and management of invasive mycoses in HIV‐infected patients

“…Invasive fungal infections (IFIs) are a leading cause of morbidity in immunocompromised people, including those living with HIV (PLHIV) . Pathogenic fungi are responsible for a variety of syndromes in PLHIV, such infections can develop into life‐threatening conditions .…”