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Incidence of Pneumocystis jiroveci Pneumonia among Groups at Risk in HIV-negative Patients

      Abstract

      Background

      Pneumocystis jiroveci pneumonia in human immunodeficiency virus (HIV)-negative immunocompromised patients is associated with high mortality rates. Although trimethoprim-sulfamethoxazole provides a very effective prophylaxis, pneumocystosis still occurs and may even be emerging due to suboptimal characterization of patients most at risk, hence precluding targeted prophylaxis.

      Methods

      We retrospectively analyzed all cases of documented pneumocystosis in HIV-negative patients admitted in our institution, a referral center in the area, from January 1990 to June 2010, and extracted data on their underlying condition(s). To estimate incidence rates within each condition, we estimated the number of patients followed-up in our area for each condition by measuring the number of patients admitted with the corresponding international classification diagnostic code, through the national hospital discharge database (Program of Medicalization of the Information System [PMSI]).

      Results

      From 1990 to 2010, 293 cases of pneumocystosis were documented, of which 154 (52.6%) tested negative for HIV. The main underlying conditions were hematological malignancies (32.5%), solid tumors (18.2%), inflammatory diseases (14.9%), solid organ transplant (12.3%), and vasculitis (9.7%). Estimated incidence rates could be ranked in 3 categories: 1) high risk (incidence rates >45 cases per 100,000 patient-year): polyarteritis nodosa, granulomatosis with polyangiitis, polymyositis/dermatopolymyositis, acute leukemia, chronic lymphocytic leukemia, and non-Hodgkin lymphoma; 2) intermediate risk (25-45 cases per 100,000 patient-year): Waldenström macroglobulinemia, multiple myeloma, and central nervous system cancer; and 3) low risk (<25 cases per 100,000 patient-year): other solid tumors, inflammatory diseases, and Hodgkin lymphoma.

      Conclusions

      These estimates may be used as a guide to better target pneumocystosis prophylaxis in the groups most at risk.

      Keywords

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      Linked Article

      • All Patients with Leukemia Are Not Equally at Risk of Contracting Pneumocystis jirovecii Pneumonia
        The American Journal of MedicineVol. 128Issue 1
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          We read with interest the article of Fillatre et al1 about Pneumocystis jirovecii pneumonia in patients not infected with human immunodeficiency virus (HIV).1 Among those at risk, they define a group called “leukemia.” The same amalgam was made in a previous study in hematological patients.2 It is suggested that among these patients with acute respiratory failure, the diagnostic and therapeutic approaches are based on the attitude, called “DIRECT.”3 It is to analyze the clinical picture from: Delay since malignancy onset or hematopoietic stem cells transplantation (HSCT), since symptom onset and since implementation of antibiotics/prophylaxis; pattern of Immune deficiency; Radiographic appearance; Experience and knowledge of the literature; Clinical picture (including ongoing chemoprophylaxis and effective antibiotic therapy); and findings by high-resolution computed Tomography.
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