Comprehensive National Inpatient Sample data reveals low but rising Pneumocystis jiroveci pneumonia risk in inflammatory bowel disease patients

Abstract

Background There are only limited data to guide the management of infectious risk for Pneumocystis jiroveci pneumonia (PCP) in patients with inflammatory bowel disease (IBD). We evaluated the frequency of admissions for PCP among patients with IBD, as well as the temporal trend in PCP admission rates and the contribution of non-IBD risk factors to the development of infection. Methods The National Inpatient Sample from 2016-2017 was queried for all admissions involving both PCP and either Crohn’s disease or ulcerative colitis. Inpatient outcomes associated with PCP and additive risk factors for development of PCP within the IBD patient population were assessed using multivariate regression. Linear regression was performed on data from 2002-2017 to measure infectious trends over time. Results There were an estimated 225 admissions involving PCP among patients with IBD from 2016-2017 nationwide, representing 0.035% of total admissions. IBD patients with PCP faced a 4.67-fold higher adjusted odds of inpatient mortality (95% confidence interval 1.72-12.66), while 49% of patients with IBD who developed PCP had an unrelated risk factor. The most common factors were HIV and congenital immunodeficiency, both of which were associated with PCP in adjusted regression. The infectious incidence of PCP increased by 141% from 2002 to 2017 (P=0.003). Conclusions National admissions data indicate that significant PCP is rare in IBD patients. Routine PCP prophylaxis is probably not necessary, although further study of high-risk subgroups of patients is required. The rising incidence of PCP indicates a need for continued surveillance.

Crohn’s disease in human immunodeficiency virus-infected patient: A case report

“…New data shows that IBD patients with an additional risk factor, of which HIV is the most common one, are more likely to develop pneumocystic pneumonia. However, there are currently no clear recommendations on how to prevent it in the presence of IBD and a background of HIV[ 3 ]. The authors of the report of a similar clinical case of a patient who presented with CD without HIV but was infected with P. jirovecii , mention that pneumocystic pneumonia prophylaxis is still questionable for patients with IBD, while HIV-positive people can benefit from it if their CD4 + counts are < 200 cells/μL[ 10 ].…”

“…Both IBD and HIV infection can coexist in the same person, although this coexistence is rarely observed; therefore, the relationship between one and the other and the impact of this relationship on the immune system are not fully understood yet[ 1 , 2 ]. However, there are speculations that the HIV-modified CD4 + lymphocyte count plays its role in altering the course of IBD alongside increasing the likelihood of opportunistic infections occurring[ 2 , 3 ].…”

Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection

“…PCP has been reported as a complication of a great variety of autoimmune and inflammatory diseases (AIIDs), including at least 19 individual diseases, as listed in Table S1 [ 4 , 40 , 70 , 97 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 ]. Among them, the most frequently reported diseases associated with PCP are granulomatosis with polyangiitis (GPA, formerly known as Wegener’s granulomatosis), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD, including Crohn’s disease and ulcerative colitis) [ 32 , 123 , 143 ].…”