Colonization by Pneumocystis jirovecii in patients with chronic obstructive pulmonary disease: association with
Alejandra Cañas-Arboleda1, Catalina Hernández-Flórez2, Javier Garzón3
1Hospital Universitario San Ignacio, Departamento de Medicina Interna, Unidad de Neumología, Bogotá, Colombia; Pontificia Universidad Javeriana, Escuela de Medicina, Bogotá, Colombia.
Abstract:
Exposure to Pneumocystis jirovecii (P. jirovecii) can lead to a wide variety of presenting features ranging from colonization in immunocompetent patients with lung disease, to invasive infections in immunocompromised hosts. Colonization by this fungus in patients with chronic obstructive pulmonary disease (COPD) could be associated with higher rates of exacerbations and impaired lung function in these patients. Our objective was to determine whether colonization by P. jirovecii in patients with COPD is associated with increased exacerbations and deterioration of lung function. This was a prospective cohort study on patients with COPD. All participants meeting selection criteria underwent clinical and microbiological assessments and were then classified as colonized vs. non-colonized patients. Chi-squared tests were performed and multivariate logistic models were fitted in order to obtain risk ratios (RR) with 95% confidence intervals (CI). We documented a frequency of colonization by P. jirovecii of 32.3%. Most patients were categorized as having GOLD B and D COPD. The history of significant exacerbations in the last year, health status impairment (COPD Assesment Tool ≥10), airflow limitation (percent of post-bronchodilator FEV1), and BODEx score (≥5) were similar between groups. After a 52-week follow-up period, the rate of adjusted significant exacerbations did not differ between groups. However, a decrease in FEVI was found in both groups.
Insights
Pneumocystis jirovecii colonization in chronic obstructive pulmonary disease (COPD) patients did not increase exacerbations over 52 weeks. Lung function declined similarly in both colonized and non-colonized COPD groups.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Microbiology
Background:
- Pneumocystis jirovecii (P. jirovecii) exposure can cause lung disease, ranging from colonization to invasive infections.
- Colonization by P. jirovecii in chronic obstructive pulmonary disease (COPD) patients may correlate with increased exacerbations and reduced lung function.
Purpose of the Study:
- To investigate the association between P. jirovecii colonization and exacerbations or lung function decline in COPD patients.
Main Methods:
- Prospective cohort study involving clinical and microbiological assessments of COPD patients.
- Patients were categorized as P. jirovecii colonized or non-colonized.
- Statistical analyses included Chi-squared tests and multivariate logistic models to determine risk ratios.
Main Results:
- P. jirovecii colonization frequency was 32.3% among COPD patients, predominantly GOLD B and D.
- Baseline characteristics, including exacerbation history, health status, airflow limitation, and BODEx score, were similar between colonized and non-colonized groups.
- No significant difference in adjusted exacerbation rates was observed after 52 weeks; however, both groups showed a decrease in FEV1.
Conclusions:
- P. jirovecii colonization in COPD patients is not associated with an increased rate of significant exacerbations over a one-year period.
- Lung function (FEV1) declined in both colonized and non-colonized COPD patients, suggesting other factors contribute to disease progression.
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