Abstract
Objective: The information about the epidemiology of Pneumocystis pneumonia (PcP) in Europe is scarce, and in Spain there are only data nationwide on patients with HIV infection. This study has been carried out with the aim of knowing in our country the current epidemiological spectrum and the risk factors of PcP.Methods: Observational, descriptive transversal study that included all patients admitted in Spain with diagnosis upon discharge of PcP registered in the National Health System's Hospital Discharge Records Database of Spain, between 2008 and 2012.Results: Four thousand five hundred and fifty four cases of PcP were reported, 1,204 (26.4%) in HIV-negative patients. During the study period, mean annual incidence (cases per million) was 19.4, remaining globally stable, increasing from 4.4 to 6.3 in HIV-negative patients and decreasing from 15.5 to 13.4 among HIV-infected patients. Risk factors were identified in 85.5% of HIV-negative cases, the most frequent being hematological neoplams (29%), chronic lung diseases (15.9%), and non-hematological cancers (14.9%). Mean mortality and hospitalization cost were high (25.5% and 12,000 euros, respectively).Conclusions: The results of this first nationwide study in Spain allow a change in the misconception that, after the AIDS epidemic, PcP is an infrequent disease, showing that today it is an emerging problem in patients without HIV infection. These findings underlines the need for increased efforts toward a better characterization of risk groups to improve prophylactic strategies and reduce the burden of disease.
Highlights
Pneumocytis jirovecii continues to be one of the major opportunistic pathogens that affect individuals with acquired immune deficiency syndrome (AIDS) and patients with immunosuppression due to other causes, in which it causes severe pneumonia with high morbi-mortality [1,2,3]
After the introduction of chemoprophylaxis with cotrimoxazole in HIV-infected patients with a CD4+ lymphocyte count lower than 200 cells/mm3 from 1989 and, above all, after the generalization of highly active antiretroviral therapy (HAART) in the mid-’90s, an important decrease in the incidence of Pneumocystis pneumonia (PcP) was observed in developed countries [3], which in Europe fell from 4.9 cases per 100 persons-year before 1995 to 0.3 cases per 100 persons-year after 1998 [4]
Observational, descriptive transversal study that included patients admitted in Spain with diagnosis upon discharge of PcP registered as code 136.3 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), listed in any position in the Hospitalization Minimum Data Set (CMBD), that is the National database of hospital discharge records in Spain, between 2008 and 2012
Summary
Pneumocytis jirovecii continues to be one of the major opportunistic pathogens that affect individuals with acquired immune deficiency syndrome (AIDS) and patients with immunosuppression due to other causes, in which it causes severe pneumonia with high morbi-mortality [1,2,3]. PcP continues to be a non-infrequent disease in patients with HIV infection, both in developed countries and in some areas of the third world in which HIV is endemic, where access to chemoprophylaxis and antiretroviral drugs is limited [1, 5]. An increasing number of PcP cases are currently being described in immunosuppressed patients without HIV infection [1, 2], due to the increased use of immunosuppressive drugs and chemotherapy in people with cancer, bone marrow, or solid organ transplants and autoimmune diseases in developed countries [2, 6,7,8]
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