Pneumocystosis: a network survey in the Paris area 2003–2008

• Published in: European journal of clinical microbiology & infectious diseases 2011-05, Vol.30 (5), p.673-675
• Main Authors: Magne, D., Angoulvant, A., Botterel, F., Bouges-Michel, C., Bougnoux, M.-E., Bouree, P., Chochillon, C., Cornet, M., Dannaoui, E., Fekkar, A., Galeazzi, G., Yera, H., Sarfati, C., Roux, P.
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Antifungal Agents - pharmacology; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; CD4 Lymphocyte Count; Comorbidity; Compliance; Corticoids; Cytotoxicity; Dihydropteroate Synthase - genetics; Disease prevention; Drug Resistance, Fungal; Female; Genetic markers; Genotype; Genotypes; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Hospitals; Human immunodeficiency virus; Human mycoses; Humans; Immunocompromised Host; Infections; Infectious diseases; Internal Medicine; Lymphocytes; Male; Medical Microbiology; Medical sciences; Middle Aged; Mortality; Mutation; Mycoses; Mycoses of the respiratory system; Neoplasms - drug therapy; Neoplasms - epidemiology; Paris - epidemiology; Pneumocystis carinii - classification; Pneumocystis carinii - drug effects; Pneumocystis carinii - genetics; Pneumocystis carinii - isolation & purification; Pneumonia, Pneumocystis - epidemiology; Pneumonia, Pneumocystis - microbiology; Prophylaxis; Serology; Steroids; Sulfanilamides - pharmacology; Transplantation
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-010-1139-0

The aims of this network group were to collect epidemiological data of PcP cases in 14 hospitals in the Paris area and to determine the Di-Hydro Pteroate Synthase (DHPS) genotypes, genetic markers for possible sulfamide resistance. From January 1, 2003 to December 31, 2008, 993 (mean 166/year) PcP cases have been reported. Sixty-five percent of patients were HIV-positive. The median count of CD4 lymphocytes was 32/mm 3 (30 in HIV-positive patients, 152 in HIV-negative patients). In HIV-positive patients, PcP revealed the HIV infection in 39%. Among 304 PcP occurring in HIV known infected patients, no prophylaxis was prescribed for 64%; cotrimoxazole prophylaxis had been prescribed to 47 patients but only one of them had the right compliance. In HIV-negative patients (264), corticosteroids were prescribed in 59% and cytotoxic chemotherapies in 34%; 78% did not receive prophylaxis. One hundred sixty nine tumoral pathologies and 116 transplantations were notified. The mortality rate was 16% at day 14 (13% in HIV-positive patients, 26% in HIV-negative patients). Mutations in DHPS genes were detected in 18.5% of samples; 12.5% of patients were infected with several strains. The total annual number of cases has been stable for five years but the proportion of HIV-negative patients increased from 25% to 43%.