Epidemiological and clinical characteristics of immunocompromised patients infected with Pneumocystis jirovecii in a twelve-year retrospective study from Norway

• Published in: BMC infectious diseases 2021-07, Vol.21 (1), p.1-659, Article 659
• Main Authors: Granseth, Stine, Rogne, Tormod, Hannula, Raisa, Ãsvold, Bjarn Olav, Afset, Jan Egil, Damås, Jan Kristian
• Format: Article
• Language: English
• Subjects: Chemotherapy; Comorbidity; Corticoids; Corticosteroids; Cough; Dyspnea; Epidemiology; Estimates; Fever; Health aspects; Hematology; HIV; Hospitals; Human immunodeficiency virus; Hypoxia; Immunocompromised; Immunocompromised host; Immunocompromised hosts; Immunosuppression; Immunosuppressive agents; Infectious diseases; Laboratories; Lavage; Medical records; Opportunist infection; Patients; PCP; Pneumocystis carinii pneumonia; Pneumocystis jirovecii; Pneumonia; Polymerase chain reaction; Population; Population studies; Prophylaxis; Respiration; Risk analysis; Risk factors; Statistics; Transplants & implants
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06144-1

Pneumocystis pneumonia (PCP) severely menaces modern chemotherapy and immunosuppression. Detailed description of the epidemiology of Pneumocystis jirovecii today is needed to identify candidates for PCP-prophylaxis. We performed a 12-year retrospective study of patients with P. jirovecii detected by polymerase chain reaction in Central Norway. In total, 297 patients were included. Comprehensive biological, clinical and epidemiological data were abstracted from patients' medical records. Regional incidence rates and testing trends were also assessed. From 2007 to 2017 we found a 3.3-fold increase in testing for P. jirovecii accompanied by a 1.8-fold increase in positive results. Simultaneously, regional incidence rates doubled from 5.0 cases per 100,000 person years to 10.8. A majority of the study population had predisposing conditions other than human immunodeficiency virus (HIV). Hematological (36.0%) and solid cancers (25.3%) dominated. Preceding corticosteroids were a common denominator for 72.1%. Most patients (74.4%) presented with at least two cardinal symptoms; cough, dyspnea or fever. Main clinical findings were hypoxia, cytopenias and radiological features consistent with PCP. A total of 88 (29.6%) patients required intensive care and 121 (40.7%) suffered at least one complication. In-hospital mortality was 21.5%. Three patients (1.0%) had received prophylaxis. P. jirovecii is re-emerging; likely due to increasing immunosuppressants use. This opportunistic pathogen threatens the life of heterogenous non-HIV immunosuppressed populations currently at growth. Corticosteroids seem to be a major risk factor. A strategy to increase prophylaxis is called for.