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Pneumocystis jirovecii Pneumonia in Neurologic Disorders: Is Prophylaxis Necessary?
Tiffany Pike-Lee1, Sana Syed1, Mary Alissa Willis1
1Department of Neurology, Neurological Institute, Cleveland Clinic, OH. Dr. Willis is now with Department of Neurology, University of Mississippi Medical Center, Jackson.
Insights
The incidence of Pneumocystis jirovecii pneumonia (PJP) is very low in patients with non-neoplastic neurologic disorders. Routine PJP prophylaxis is likely unnecessary for these patients, except possibly in neuro-oncology cases.
Area of Science:
- Infectious Diseases
- Neurology
- Pulmonology
Background:
- The incidence of Pneumocystis jirovecii pneumonia (PJP) in patients with neurologic conditions is not well-established.
- The need for PJP prophylaxis in immunocompromised patients with neurologic disorders remains uncertain.
Purpose of the Study:
- To determine the incidence of PJP in patients with primary neurologic disorders.
- To evaluate the necessity of PJP prophylaxis in this patient population.
Main Methods:
- Retrospective analysis of 142 non-HIV PJP patients at a tertiary referral center (2007-2016).
- Analysis focused on patients with primary neurologic diagnoses.
Main Results:
- Twenty patients had primary neurologic diagnoses; 122 had non-neurologic conditions.
- PJP incidence was low in non-neoplastic neurologic disorders (e.g., 0.3% for myasthenia gravis).
- Malignancy or organ failure was present in 90% of neurologic PJP patients, suggesting overall health status is a key factor.
Conclusions:
- The incidence of PJP in non-neoplastic neurologic disorders is exceedingly low.
- Routine PJP prophylaxis is questionable for neurologic patients, except possibly in neuro-oncology.
- Overall health status, particularly malignancy or organ failure, appears to predispose patients to PJP.
Background:
The incidence of Pneumocystis jirovecii pneumonia (PJP) in patients with underlying neurologic conditions is not well established, and the necessity of PJP prophylaxis for immunocompromised patients with neurologic disorders is uncertain.
Methods:
Single-center retrospective analysis of non-HIV PJP patients at a tertiary referral center from 2007 to 2016 to determine the incidence of PJP in patients with primary neurologic disorders.
Results:
The study included 142 patients with PJP without HIV. Twenty patients had primary neurologic diagnoses, and 122 had non-neurologic conditions. Associated neurologic diagnoses included brain malignancies (N = 14), myasthenia gravis (MG) (N = 2), myopathy (N = 2), neuromyelitis optica (NMO) (N = 1), and CNS vasculitis (N = 1). Estimated incidences of PJP were 0.7% for patients with NMO and 0.3% for patients with MG for the 10-year study period, whereas 4.6% of patients with NMO and 3.8% of patients with MG were placed on PJP prophylaxis. A survey of 24 neurologists who prescribe immunotherapy or chemotherapy confirmed an infrequent occurrence of PJP in their practice. Malignancy or parenchymal organ failure was present in 90% of neurologic patients with PJP, and coexisting infections occurred in 45%.
Conclusions:
The overall incidence of PJP in patients with non-neoplastic neurologic disorders is exceedingly low, raising doubt about the value of routine PJP prophylaxis in neurologic patients outside neuro-oncology. PJP infection occurs frequently in patients with malignancy or parenchymal organ failure, indicating that overall health status may serve as a predisposing factor for PJP.
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