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J Antimicrob Chemother. 2016 Sep;71(9):2379-85. doi: 10.1093/jac/dkw155. Epub 2016 May 12.

Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients.

Author information

1
Department of Haematology, Henri Mondor Teaching Hospital, Assistance Publique-hôpitaux de Paris, and Université Paris-Est-Créteil, Créteil, France catherine.cordonnier@aphp.fr.
2
Department of Haematology, Oncoematologia Pediatrica, Policlinico G. B. Rossi, Verona, Italy.
3
Department of Haematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany.
4
Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany.
5
Department of Haematology Radboud University Medical Center, Nijmegen, The Netherlands.
6
Parasitology-Mycology Laboratory, Groupe Hospitalier Lariboisière Saint-Louis Fernand Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Diderot, Sorbonne Paris Cité, and Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
7
Institute of Microbiology, Lausanne University Hospital and University, Lausanne, Switzerland.
8
Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium and National Reference Center for Mycosis, Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
9
Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
10
Department of Infectious Diseases, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
11
Medical Parasitology Unit, Group of Opportunistic Protozoa/HIV and Other Protozoa, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
12
Department of Haematology, Acute Leukaemia and Stem Cell Transplantation Unit, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.

Abstract

Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from that associated with HIV infection, with the disease being acute and more often severe, having a lower fungal burden and being more frequently linked to treatment with corticosteroids. Most cases occur in patients not receiving adequate prophylaxis. The development of new therapies, including targeted treatments and monoclonal antibodies in various haematological diseases, justifies constant vigilance in order to identify new at-risk populations and give prophylaxis accordingly. The fifth and sixth European Conferences on Infections in Leukaemia (ECIL-5 and ECIL-6) aimed to review risk factors for PCP in haematology patients and to establish evidence-based recommendations for PCP diagnosis, prophylaxis and treatment. This article focuses on the magnitude of the problem, the main differences in clinical presentation between haematology patients and other immunocompromised populations, especially HIV-infected patients, and the main risk factors.

PMID:
27550990
DOI:
10.1093/jac/dkw155
[Indexed for MEDLINE]

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