Pneumocystis jiroveciiPneumonia in Patients with or without AIDS, France

Roux, Antoine; Canet, Emmanuel; Valade, Sandrine; Gangneux-Robert, Florence; Hamane, Samia; Lafabrie, Ariane; Maubon, Danièle; Debourgogne, Anne; Gal, Solène Le; Dalle, Frédéric; Leterrier, Marion; Toubas, D.; Pomarès, Christelle; Bellanger, Anne Pauline; Bonhomme, Julie; Berry, Antoine; Durand-Joly, Isabelle; Magne, Denis; Pons, Denis; Hennequin, Christophe; Maury, Éric; Roux, Patricia; Azoulay, Élie

doi:10.3201/eid2009.131668

Cited by 264 publications

(265 citation statements)

References 27 publications

(41 reference statements)

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“…Studies in the early 2000s reported an incidence of PCP among HIV-infected individuals below 1 case per 100 person-years [2-8]. Given the trend towards earlier diagnosis of HIV infection and immediate ART independent of CD4+ T cell count, the incidence of PCP in HIV patients has likely decreased further during recent years [9-12]. …”

Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia

et al. 2018

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The substantial decline in the Pneumocystis jirovecii pneumonia (PCP) incidence in HIV-infected patients after the introduction of antiretroviral therapy (ART) in resource-rich settings and the growing number of non-HIV-infected immunocompromised patients at risk leads to considerable epidemiologic changes with clinical, diagnostic, and treatment consequences for physicians. HIV-infected patients usually develop a subacute course of disease, while non-HIV-infected immunocompromised patients are characterized by a rapid disease progression with higher risk of respiratory failure and higher mortality. The main symptoms usually include exertional dyspnea, dry cough, and subfebrile temperature or fever. Lactate dehydrogenase may be elevated. Typical findings on computed tomography scans of the chest are bilateral ground-glass opacities with or without cystic lesions, which are usually associated with the presence of AIDS. Empiric treatment should be initiated as soon as PCP is suspected. Bronchoalveolar lavage has a higher diagnostic yield compared to induced sputum. Immunofluorescence is superior to conventional staining. A combination of different diagnostic tests such as microscopy, polymerase chain reaction, and (1,3)-β-D-glucan is recommended. Trimethoprim/sulfamethoxazole for 21 days is the treatment of choice in adults and children. Alternative treatment regimens include dapsone with trimethoprim, clindamycin with primaquine, atovaquone, or pentamidine. Patients with moderate to severe disease should receive adjunctive corticosteroids. In newly diagnosed HIV-infected patients with PCP, ART should be initiated as soon as possible. In non-HIV-infected immunocompromised patients, improvement of the immune status should be discussed (e.g., temporary reduction of immunosuppressive agents). PCP prophylaxis is effective and depends on the immune status of the patient and the underlying immunocompromising disease.

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Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia

et al. 2018

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“…PCP often occurs in HIV-infected patients, but frequency of PCP in other immunocompromised populations, such as patients with kidney transplantation, is increasing (1-3). Common clinical manifestations and outcomes of PCP between HIVpositive and HIV-negative patients are well known; in non-HIVinfected patients symptomatology is more acute, mortality is generally higher, and fungal burden is lower (2,4). In any case, biological diagnosis of PCP is required, and the microscopic identification of P. jirovecii (cysts and trophic forms) by staining bronchoalveolar lavage (BAL) samples continues to be the most widely used method.…”

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confidence: 99%

Performances of Four Real-Time PCR Assays for Diagnosis of Pneumocystis jirovecii Pneumonia

et al. 2016

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Pneumonia due to Pneumocystis jirovecii (PCP) is a frequent infection among HIVThe performances of these PCR assays were also evaluated according to the classification of the probability of PCP (proven, probable, possible, or no final diagnosis of PCP) based on clinical and radiological signs as well as on the direct examination of bronchoalveolar lavage samples. In the proven PCP category, Pneumocystis jirovecii DNA was detected with all four assays. In the probable PCP category, the in-house PCR, AmpliSens, and the MycAssay PCR were positive for all samples, while the Bio-Evolution PCR failed to detect Pneumocystis jirovecii DNA in two samples. In the possible PCP category, the percentage of positive samples according to PCR varied from 54.5% to 86.4%. Detection of colonized patients is discussed. Finally, among the four evaluated PCR assays, one was not suitable for colonization detection but showed good performance in the proven and probable PCP groups. For the three other assays, performances were excellent and allowed detection of a very low fungal burden.

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“…The clin-ical presentation of PCP in HIV-negative patients is more severe than in HIV-positive patients, leading to estimated mortality rates of 40% and 15%, respectively (20)(21)(22). This is probably due to differences in the pathophysiology of the disease, and particularly in the host immune response.…”

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confidence: 99%

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

et al. 2015

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Quantitative PCR (qPCR) is now a key diagnostic tool forPneumocystispneumonia. However, cutoffs to distinguish between infected and colonized patients according to their HIV status have not yet been determined. According to clinical, radiological, and biological data, we retrospectively classified bronchoalveolar lavage (BAL) samples subjected to qPCR over a 3-year period into four categories, i.e., definite PCP, probable PCP,Pneumocystiscolonization, and no infection. Fungal burden was then analyzed according to the HIV status of the patients. Among 1,212 episodes of pneumonia screened in immunocompromised patients, 52 and 27 HIV-positive patients were diagnosed with a definite and probable PCP, whereas 4 and 22 HIV-negative patients had definite and probable PCP, respectively. Among patients with definite or a probable PCP, HIV-negative patients had a significantly lower burden than HIV-positive patients (P< 10−4). In both groups, the median fungal burden was significantly higher in patients with definite PCP than in colonized patients. A single cutoff at 1.5 × 104copies/ml allowed to differentiate colonized and infected HIV-positive patients with 100% sensitivity and specificity. In HIV-negative patients, cutoff values of 2.87 × 104and 3.39 × 103copies/ml resulted in 100% specificity and sensitivity, respectively. Using cutoffs determined for the whole population would have led us to set aside the diagnosis of PCP in 9 HIV-negative patients with definite or probable PCP. qPCR appeared to be the most sensitive test to detectPneumocystisin BAL samples. However, because of lower inocula in HIV-negative patients, different cutoffs must be used according to the HIV status to differentiate between colonized and infected patients.

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Pneumocystis jiroveciiPneumonia in Patients with or without AIDS, France

Abstract: Immunosuppressed patients without AIDS had longer time to treatment and a higher rate of death than did patients with AIDS.

Cited by 264 publications

References 27 publications

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with <b><i>Pneumocystis jirovecii</i></b> Pneumonia

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with <b><i>Pneumocystis jirovecii</i></b> Pneumonia

Performances of Four Real-Time PCR Assays for Diagnosis of Pneumocystis jirovecii Pneumonia

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

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