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Orozco-Ugarriza ME, Olivo-Martínez Y, Rodger-Cervantes YE. Protocol for the systematic review of the Pneumocystis jirovecii-associated pneumonia in non-HIV immunocompromised patients. PLoS One 2024; 19:e0302055. [PMID: 38722952 PMCID: PMC11081338 DOI: 10.1371/journal.pone.0302055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/25/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Pneumocystis jirovecii pneumonia (PJP) is a well-known and frequent opportunistic infection in HIV patients. However, there has been an increase in the number of reports of PJP in other immunosuppressed patients with autoimmune inflammatory disorders or because of chemotherapy and high doses of steroids, especially when used in combination as part of immunosuppressive therapy. OBJECTIVE Despite the increasing importance of PJP in non-HIV patients, there is a lack of comprehensive and updated information on the epidemiology, pathogenesis, diagnosis, microbiology, treatments, and prophylaxis of this infection in this population. Therefore, the objective of this systematic review is to synthesize information on these aspects, from a perspective of evidence-based medicine. METHODS The protocol is prepared following the preferred reporting items for systematic reviews and meta-analyses (PRISMA-P) guidelines. We will perform a systematic review of literature published between January 2010 and July 2023, using the databases PubMed, Google Scholar, ScienceDirect, and Web of Science. In addition, manual searches will be carried out through related articles, and references to included articles. The main findings and clinical outcomes were extracted from all the eligible studies with a standardized instrument. Two authors will independently screen titles and abstracts, review full texts, and collect data. Disagreements will be resolved by discussion, and a third reviewer will decide if there is no consensus. We will synthesize the results using a narrative or a meta-analytic approach, depending on the heterogeneity of the studies. EXPECTED RESULTS It is expected that this systematic review will provide a comprehensive and up-to-date overview of the state-of-the-art of PJP in non-HIV patients. Furthermore, the study will highlight possible gaps in knowledge that should be addressed through new research. CONCLUSIONS Here, we present the protocol for a systematic review which will consider all existing evidence from peer-reviewed publication sources relevant to the primary and secondary outcomes related to diagnosing and managing PJP in non-HIV patients.
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Affiliation(s)
- Mauricio Ernesto Orozco-Ugarriza
- Grupo de Investigación en Microbiología y Ambiente (GIMA), Universidad de San Buenaventura, Cartagena, Colombia
- Grupo de Investigación Traslacional en Biomedicina y Biotecnología (GITB&B), Corporación para el Desarrollo de la Investigación en Biomedicina & Biotecnología, Cartagena, Colombia
| | - Yenifer Olivo-Martínez
- Grupo de Investigación en Microbiología y Ambiente (GIMA), Universidad de San Buenaventura, Cartagena, Colombia
- Biochemistry and Diseases Research Group, Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia
| | - Yuranis E. Rodger-Cervantes
- Graduated from the Bacteriology and Clinical Laboratory Program, Faculty of Health Sciences, Universidad de San Buenaventura Cartagena, Cartagena, Colombia
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Ahmadpour E, Valilou S, Ghanizadegan MA, Seyfi R, Hosseini SA, Hatam-Nahavandi K, Hosseini H, Behravan M, Barac A, Morovati H. Global prevalence, mortality, and main characteristics of HIV-associated pneumocystosis: A systematic review and meta-analysis. PLoS One 2024; 19:e0297619. [PMID: 38526997 PMCID: PMC10962827 DOI: 10.1371/journal.pone.0297619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 03/27/2024] Open
Abstract
The epidemiology of Human Immunodeficiency Virus (HIV)-associated pneumocystosis (HAP) is poorly described on a worldwide scale. We searched related databases between January 2000 and December 2022 for studies reporting HAP. Meta-analysis was performed using StatsDirect (version 2.7.9) and STATA (version 17) according to the random-effects model for DerSimonian and Laird method and metan and metaprop commands, respectively. Twenty-nine studies with 38554 HIV-positive, 79893 HIV-negative, and 4044 HAP populations were included. The pooled prevalence of HAP was 35.4% (95% CI 23.8 to 47.9). In contrast, the pooled prevalence of PCP among HIV-negative patients was 10.16% (95% CI 2 to 25.3). HIV-positive patients are almost 12 times more susceptible to PCP than the HIV-negative population (OR: 11.710; 95% CI: 5.420 to 25.297). The mortality among HAP patients was 52% higher than non-PCP patients (OR 1.522; 95% CI 0.959 to 2.416). HIV-positive men had a 7% higher chance rate for PCP than women (OR 1.073; 95% CI 0.674 to 1.706). Prophylactic (OR: 6.191; 95% CI: 0.945 to 40.545) and antiretroviral therapy (OR 3.356; 95% CI 0.785 to 14.349) were used in HAP patients six and three times more than HIV-positive PCP-negatives, respectively. The control and management strategies should revise and updated by health policy-makers on a worldwide scale. Finally, for better management and understanding of the epidemiology and characteristics of this coinfection, designing further studies is recommended.
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Affiliation(s)
- Ehsan Ahmadpour
- Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sevda Valilou
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rouhollah Seyfi
- Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Abdollah Hosseini
- Department of Parasitology and Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hanieh Hosseini
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Behravan
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia
| | - Hamid Morovati
- Department of Medical Mycology and Parasitology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Rouis H, Moussa C, Houcine Y, Zendah I, Kwas H, Ghedira H, Maâlej S. Pneumocystis jirovecii pneumonia in a healthy immunocompetent patient: A case report and literature review. SAGE Open Med Case Rep 2023; 12:2050313X231220802. [PMID: 38162420 PMCID: PMC10757429 DOI: 10.1177/2050313x231220802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Pneumocystis jirovecii pneumonia, typically an opportunistic infection, is commonly associated with risk factors such as low CD4+ lymphocyte count, underlying malignancies, organ transplantation, or immunosuppressive medications. However, occurrences in healthy individuals without known risk factors are exceptionally rare and sparsely documented. In our retrospective analysis of a 42-year-old male without past medical history at Abderrahmane Mami Hospital, Tunisia, Pneumocystis jirovecii pneumonia was diagnosed. The patient presented with fever, productive cough, hemoptysis, and a decline in general health. Clinical examination revealed fever and hypoxemia, and imaging studies demonstrated bilateral necrotic alveolar opacities. Despite empirical antibiotics, nonresponse necessitated bronchoscopy, confirming Pneumocystis jirovecii. Treatment with oral Sulfamethoxazole-Trimethoprim yielded excellent outcomes. This case highlights the potential occurrence of Pneumocystis jirovecii pneumonia in immunocompetent individuals, underscoring the importance of direct microbiological methods in assessing suggestive clinical and radiological features.
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Affiliation(s)
- Houda Rouis
- Pneumology Department 3, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Chirine Moussa
- Pneumology Department 3, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Yoldez Houcine
- Pathology Department, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Ines Zendah
- Pneumology Department 3, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Hamida Kwas
- Pulmonary Department, Regional Hospital of Gabes Mohammed Ben Sassi, Gabes, Tunisia
| | - Habib Ghedira
- Pneumology Department 3, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Sonia Maâlej
- Pneumology Department 3, Abderrahmane Mami Hospital, Ariana, Tunisia
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Bian W, Xie Y, Shang Y, Zhao L, Yang Z, Ma X, He Y, Yu W, Xi W, Yang D, Wang F, Chen Y, Gong P, Gao Z. Relationship between clinical features and droplet digital PCR copy number in non-HIV patients with pneumocystis pneumonia. BMC Infect Dis 2023; 23:833. [PMID: 38012564 PMCID: PMC10683233 DOI: 10.1186/s12879-023-08580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/04/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Droplet digital PCR (ddPCR) is a novel assay to detect pneumocystis jjrovecii (Pj) which has been defined to be more sensitive than qPCR in recent studies. We aimed to explore whether clinical features of pneumocystis pneumonia (PCP) were associated with ddPCR copy numbers of Pj. METHODS A total of 48 PCP patients were retrospectively included. Pj detection was implemented by ddPCR assay within 4 h. Bronchoalveolar fluid (BALF) samples were collected from 48 patients with molecular diagnosis as PCP via metagenomic next generation sequencing (mNGS) or quantitative PCR detection. Univariate and multivariate logistic regression were performed to screen out possible indicators for the severity of PCP. The patients were divided into two groups according to ddPCR copy numbers, and their clinical features were further analyzed. RESULTS Pj loading was a pro rata increase with serum (1,3)-beta-D glucan, D-dimmer, neutrophil percentage, procalcitonin and BALF polymorphonuclear leucocyte percentage, while negative correlation with albumin, PaO2/FiO2, BALF cell count, and BALF lymphocyte percentage. D-dimmer and ddPCR copy number of Pj were independent indicators for moderate/severe PCP patients with PaO2/FiO2 lower than 300. We made a ROC analysis of ddPCR copy number of Pj for PaO2/FiO2 index and grouped the patients according to the cut-off value (2.75). The high copy numbers group was characterized by higher level of inflammatory markers. Compared to low copy number group, there was lower level of the total cell count while higher level of polymorphonuclear leucocyte percentage in BALF in the high copy numbers group. Different from patients with high copy numbers, those with high copy numbers had a tendency to develop more severe complications and required advanced respiratory support. CONCLUSION The scenarios of patients infected with high ddPCR copy numbers of Pj showed more adverse clinical conditions. Pj loading could reflect the severity of PCP to some extent.
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Affiliation(s)
- Wenjie Bian
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Yu Xie
- Department of Respiratory Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Shang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Lili Zhao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Zhengwu Yang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Xinqian Ma
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Yukun He
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Wenyi Yu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Wen Xi
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Donghong Yang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Fang Wang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Yanwen Chen
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China
| | - Pihua Gong
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China.
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, China.
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Zhang J, Sun X, Xu J, Gu X, Chen Q, Gao J, Xu X, Zhang T. Outcomes and factors contributing to poor prognosis of Pneumocystis jirovecii pneumonia in HIV-negative patients: a cross-sectional retrospective study in a Chinese single center. Eur J Clin Microbiol Infect Dis 2023; 42:109-12. [PMID: 36319918 DOI: 10.1007/s10096-022-04518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 10/24/2022] [Indexed: 01/06/2023]
Abstract
Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection mainly occurring in immunocompromised patients. Almost half of the 30 HIV-negative patients enrolled in this study from 2016-2020 in a Chinese single-center contracted 17 hematological malignancies, and 25 received long-term systemic corticosteroids. Only 4 patients received prophylaxis. The overall mortality was 30%. Patients with older age (> 43 years), dyspnea, and LDH > 404U/L had significantly higher risk of developing into a severe form. LDH > 424 U/L, PaO2 < 60 mmHg, monocyte < 0.2 × 10^9/L, and lymphocyte < 0.3 × 10^9/L were factors contributing to a poor survival outcome.
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Sun Y, Shao C, Huang H, Chen R, Xu K, Li M, Zhang X, Xu Z. Prognostic Analysis of Pneumocystis Jirovecii Pneumonia in Interstitial Lung Disease Patients: A Retrospective Clinical Study. Diagnostics (Basel) 2022; 12. [PMID: 36552932 DOI: 10.3390/diagnostics12122925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Background: The clinical characteristics and the prognostic factors of HIV-negative Pneumocystis jirovecii pneumonia (PJP) patients (non-HIV-PJP) with interstitial lung disease (ILD) remain unclear. Our objectives were to describe the clinical characteristics and to explore the prognostic factors of non-HIV-ILD-PJP patients. (2) Methods: The enrolled patients in this retrospective study were stratified based on the presence or absence of ILD and fibrotic ILD (FILD). The log-rank test and Cox regression models were used to analyze the prognostic factors. (3) Results: Among 378 non-HIV-PJP patients, there were 133 patients with ILD-PJP, and 70 patients were classified as having FILD-PJP. The all-cause mortality rate for the ILD-PJP group is higher than that of the ILD-PJP group (57.9% vs. 38.4%, p < 0.001). However, the all-cause mortality is similar between the FILD-PJP group and non-FILD-PJP group. Preexisting ILD (HR: 2.156, p = 0.003) and honeycomb appearance on the chest HRCT (HR = 16.3, p < 0.001) are independent survival risk factors for ILD-PJP. Non-invasive ventilation is an independent survival risk factor for ILD-PJP patients (HR = 928.56, p < 0.01) and FILD-PJP patients (HR = 33.86, p < 0.001). (4) Conclusions: Pre-existing ILD and honeycomb appearance on the chest HRCT are independent survival risk factors for PJP patients. Non-invasive ventilation is associated with poor survival for both ILD-PJP and FILD-PJP patients.
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