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Pneumocystis jirovecii colonization and infection among non HIV-infected patients
F Fily1, S Lachkar, L Thiberville
1Clinique pneumologique, hôpital Charles-Nicolle, CHU de Rouen, Rouen, France. fily.fabien@wanadoo.fr
Objective And Method:
The epidemiology of pneumocystosis has changed in the last decade with a decreased incidence in HIV infected patients, and the emerging concept of Pneumocystis colonization. The study objective was to describe Pneumocystis infection as well as colonization among non-HIV infected patients in the Rouen teaching hospital and cancer institute. A retrospective study was made of all patients with a positive respiratory sample for Pneumocystis jirovecii between January 1, 2000 and June 6, 2007.
Results:
Fifty-four cases were reported (46 cases of pneumocystosis and eight of asymptomatic carriage) and an increasing yearly incidence over the study period was observed. Underlying diseases for pneumocystosis were haematological malignancies (n=25; 54%), organ transplantation (n=8; 17.4%), inflammatory disorders (n=6; 13%), and solid cancer (n=5; 10.8%). Sixty-five per cent of patients were under long-term steroid therapy. The overall mortality rate was 21.4%. The CD4 count for 26 patients, ranged from 18 to 1449/mm(3) (median: 107). Eight cases of asymptomatic carriage were reported with an underlying immunodepression (n=6) and pulmonary disease (n=2).
Discussion:
The increasing incidence of pneumocystosis in immunosuppressed patients without AIDS is due to more frequent favorable conditions and progress of diagnostic tools. The clinical presentations are severe. Prophylaxis is badly codified because there is no threshold value for CD4 count. Colonization could present a warning value.
Insights
Pneumocystis pneumonia (PCP) is increasing in non-HIV patients, often linked to immunosuppression and steroid use. Asymptomatic colonization may signal risk, highlighting the need for better prophylaxis guidelines.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Epidemiology
Background:
- Pneumocystis pneumonia (PCP) epidemiology has shifted, with declining rates in HIV patients and emerging understanding of Pneumocystis colonization.
- Non-HIV immunosuppressed populations are increasingly recognized as susceptible to PCP.
Purpose of the Study:
- To describe the incidence and characteristics of Pneumocystis jirovecii infection and colonization in non-HIV patients.
- To analyze underlying conditions, treatments, and outcomes in this patient group.
Main Methods:
- Retrospective study of respiratory samples positive for Pneumocystis jirovecii.
- Data collected from January 2000 to June 2007 at Rouen teaching hospital and cancer institute.
- Analysis of patient demographics, underlying diseases, CD4 counts, and mortality.
Main Results:
- 54 cases identified (46 PCP, 8 asymptomatic carriage) with increasing yearly incidence.
- Hematological malignancies (54%), organ transplantation (17.4%), and long-term steroid therapy (65%) were common underlying factors.
- Overall mortality was 21.4%; asymptomatic carriage occurred in immunosuppressed individuals.
Conclusions:
- Increasing PCP incidence in non-AIDS immunosuppressed patients is linked to favorable conditions and improved diagnostics.
- Severe clinical presentations and lack of clear prophylaxis guidelines (e.g., CD4 thresholds) pose challenges.
- Pneumocystis colonization may serve as a valuable warning sign for infection risk.
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