Pneumocystis jirovecii pneumonia epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pneumocystis jirovecii pneumonia exists worldwide, in humans and animals. Serologic evidence indicates that most healthy children have been exposed by age 3 to 4. Pneumocystis pneumonia (PCP) occurs in immunosuppressed individuals and in premature, malnourished infants.
Epidemiology and Demographics
Pneumocystis pneumonia has been described in all continents except Antarctica.[1] It was originally described as a rare cause of pneumonia in neonates. It is believed to be an environmental organism, and human-to-human transmission is thought not to occur (although in one outbreak of 12 cases among transplant patients in Leiden it was postulated, but not proven, that human-to-human spread may have occurred).[2] Greater than 75% of children are seropositive by the age of 4, which suggest a high background exposure to the organism.
The disease PCP is relatively rare in people with normal immune systems, but common among people with weakened immune systems, such as premature or severely malnourished children, the elderly, and especially persons living with HIV/AIDS, in whom it is most commonly observed.[3] PCP can also develop in patients who are taking immunosuppressive medications. It can occur in patients who have undergone solid organ transplantation or bone marrow transplantation and after surgery.[4] Infections with Pneumocystis pneumonia are also common in infants with hyper IgM syndrome, an X-linked or autosomal recessive trait.
The causative organism of PCP is distributed worldwide[1] and Pneumocystis pneumonia has been described in all continents except Antarctica.[1] Greater than 75% of children are seropositive by the age of 4, which suggest a high background exposure to the organism. A post-mortem study conducted in Chile of 96 persons who died of unrelated causes (suicide, traffic accidents, and so forth) found that 65 (68%) of them had pneumocystis in their lungs, which suggests that asymptomatic pneumocystis infection is extremely common.[5]
Pneumocystis jirovecii was originally described as a rare cause of pneumonia in neonates. It is commonly believed to be a commensal organism (dependent upon its human host for survival). The possibility of person-to-person transmission has recently gained credence, with supporting evidence coming from many different genotyping studies of Pneumocystis jirovecii isolates from human lung tissue.[6][7] For example, in one outbreak of 12 cases among transplant patients in Leiden, it was suggested as likely, but not proven, that human-to-human spread may have occurred.[8]
PCP and AIDS
Since the start of the AIDS epidemic, PCP has been closely associated with AIDS. Because it only occurs in an immunocompromised host, it may be the first clue to a new AIDS diagnosis if the patient has no other reason to be immunocompromised (e.g. taking immunosuppressive drugs for organ transplant). An unusual rise in the number of PCP cases in North America, noticed when physicians began requesting large quantities of the rarely used antibiotic pentamidine, was the first clue to the existence of AIDS in the early 1980s.[9][10]
Prior to the development of more effective treatments, PCP was a common and rapid cause of death in persons living with AIDS. Much of the incidence of PCP has been reduced by instituting a standard practice of using oral co-trimoxazole to prevent the disease in people with CD4 counts less than 200/mm³. In populations that do not have access to preventive treatment, PCP continues to be a major cause of death in AIDS.
References
- ↑ 1.0 1.1 1.2 Morris A, Lundgren JD, Masur H; et al. (2004). "Current epidemiology of Pneumocystis pneumonia". Emerging Infect. Dis. 10 (10): 1713–20. PMID 15504255. Unknown parameter
|month=ignored (help) - ↑ de Boer M, Bruijnesteijn van Coppenraet L, Gaasbeek A; et al. (2007). "An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype
among renal transplant recipients: interhuman transmission or a common environmental source?". Clin Infect Dis. 44 (9): 1143&ndash, 49. PMID 17407029. line feed character in
|title=at position 79 (help) - ↑ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0838585299.
- ↑ Puzio J, Kucewicz E, Sioła M; et al. (2009). "[Atypical and opportunistic pulmonary infections after cardiac surgery.]". Anestezjologia Intensywna Terapia (in Polish). 41 (1): 41–5. PMID 19517677.
- ↑ Ponce CA, Gallo M, Bustamante R, Vargas SL (2010). "Pneumocystis colonization is highly prevalent in the autopsied lungs of the general population". Clin Infect Dis. 50 (3): 347–353. doi:10.1086/649868. PMID 20047487.
- ↑ Schmoldt S, Schuhegger R, Wendler T; et al. (2008). "Molecular evidence of nosocomial Pneumocystis jirovecii transmission among 16 patients after kidney transplantation". J. Clin. Microbiol. 46 (3): 966–71. doi:10.1128/JCM.02016-07. PMC 2268360. PMID 18216217. Unknown parameter
|month=ignored (help) - ↑ Morris A, Beard CB, Huang L (2002). "Update on the epidemiology and transmission of Pneumocystis carinii". Microbes Infect. 4 (1): 95–103. doi:10.1016/S1286-4579(01)01514-3. PMID 11825780. Unknown parameter
|month=ignored (help) - ↑ de Boer M, Bruijnesteijn van Coppenraet L, Gaasbeek A; et al. (2007). "An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotypeamong renal transplant recipients: interhuman transmission or a common environmental source?". Clin Infect Dis. 44 (9): 1143–9. doi:10.1086/513198. PMID 17407029.
- ↑ Fannin S, Gottlieb MS, Weisman JD; et al. (1982). "A Cluster of Kaposi's Sarcoma and Pneumocystis carinii pneumonia among homosexual male residents of Los Angeles and Range Counties, California". MMWR Weekly. 31 (32): 305–7.
- ↑ Masur H, Michelis MA, Greene JB; et al. (10 December 1981). "An outbreak of community-acquired Pneumocystis carinii pneumonia". N Engl J Med. 305 (24): 1431–8. doi:10.1056/NEJM198112103052402. PMID 6975437.