Abstract
Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients. We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017. The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial. Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.
Highlights
Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality
The PJ organism, previously known as Pneumocystis carinii, was thought to be a primary infection occurring in young children
It is possible that PJ infection can occur due to airborne transmission from the respiratory tract of other mammals and humans [7,9]
Summary
Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. Results: The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Pneumocystis jirovecii (PJ) pneumonia (PJP) is an opportunistic fungal infection that is associated with a high mortality rate in immunocompromised patients, including those with acquired immunodeficiency syndrome (AIDS) and those without AIDS (nonAIDS). The non-AIDS group includes patients with innate or acquired immunodepression such as those receiving long-term or high-dose corticosteroids or immune suppression treatment (monoclonal antibody therapy) for autoimmune diseases, those with solidorgan or hematologic malignancies receiving hematopoietic stem cell transplantation, and those with bone marrow or solid-organ transplantations [1,2]. In the case of PJP, clinical studies have shown that the clinical course of non-AIDS-PJP is potentially fulminant, and that the prognosis can be poor if the diagnosis of PJP is delayed, thereby resulting in poor outcomes [1,2]. The aim of this review was to raise the awareness of clinicians and intensivists so that they can make an early diagnosis of
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