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Pneumocystis pneumonia

Histopathology showing Pneumocystis cysts in the lung of a patient with AIDS

Pneumocystis jirovecii in the lung of an HIV/AIDS patient.

Pneumocystis pneumonia (PCP) is a serious infection caused by the fungus Pneumocystis jirovecii.

Most people who get PCP have a medical condition that weakens their immune system, like HIV/AIDS, or take medicines that lower the body’s ability to fight germs and sickness. In the United States, people with HIV/AIDS are less likely to get PCP today than before the availability of antiretroviral therapy (ART). However, PCP is still a substantial public health problem.1-3 Much of the information we have about PCP and its treatment comes from caring for patients with HIV/AIDS.

Scientists have changed both the classification and the name of this organism since it first appeared in patients with HIV in the 1980s. Pneumocystis jirovecii used to be classified as a protozoan but is now considered a fungus.4 Pneumocystis jirovecii used to be called Pneumocystis carinii. When scientists renamed P. carinii to P. jirovecii, some people considered using the abbreviation “PJP,” but to avoid confusion, Pneumocystis jirovecii pneumonia is still abbreviated “PCP.”5

References

  1. Harris JR, Balajee SA, Park BJ. Pneumocystis jirovecii pneumonia: current knowledge and outstanding public health issues. Curr Fung Infect Rep 2010;4:229-37.
  2. Kaplan JE, Hanson D, Dworkin MS, et al. Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis 2000;30 Suppl 1:S5-14.
  3. Morris A, Lundgren JD, Masur H, et al. Current epidemiology of Pneumocystis pneumonia. Emerging infectious diseases 2004;10:1713-20.
  4. Edman JC, Kovacs JA, Masur H, Santi DV, Elwood HJ, Sogin ML. Ribosomal RNA sequence shows Pneumocystis carinii to be a member of the fungi. Nature 1988;334:519-22.
  5. Stringer JR, Beard CB, Miller RF, Wakefield AE. A new name (Pneumocystis jiroveci) for Pneumocystis from humans. Emerging infectious diseases 2002;8:891-6.
  6. Kovacs JA, Hiemenz JW, Macher AM, et al. Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Annals of internal medicine 1984;100:663-71.
  7. Roux A, Canet E, Valade S, et al. Pneumocystis jirovecii pneumonia in patients with or without AIDS, France. Emerging infectious diseases 2014;20:1490-7.
  8. Medrano FJ, Montes-Cano M, Conde M, et al. Pneumocystis jirovecii in general population. Emerging infectious diseases 2005;11:245-50.
  9. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. 2017, at https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/0.)
  10. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. 2017, at https://aidsinfo.nih.gov/guidelines/html/5/pediatric-oi-prevention-and-treatment-guidelines/0.)
  11. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biology of blood and marrow transplantation 2009;15:1143-238.
  12. Stern A, Green H, Paul M, Vidal L, Leibovici L. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. The Cochrane database of systematic reviews 2014:CD005590.
  13. Fishman JA. Prevention of infection caused by Pneumocystis carinii in transplant recipients. Clin Infect Dis 2001;33:1397-405.
  14. Gianella S, Haeberli L, Joos B, et al. Molecular evidence of interhuman transmission in an outbreak of Pneumocystis jirovecii pneumonia among renal transplant recipients. Transplant infectious disease 2010;12:1-10.
  15. Mori S, Cho I, Sugimoto M. A cluster of Pneumocystis jirovecii infection among outpatients with rheumatoid arthritis. J Rheumatol 2010;37:1547-8.
  16. Schmoldt S, Schuhegger R, Wendler T, et al. Molecular evidence of nosocomial Pneumocystis jirovecii transmission among 16 patients after kidney transplantation. Journal of clinical microbiology 2008;46:966-71.
  17. Pifer LL, Hughes WT, Stagno S, Woods D. Pneumocystis carinii infection: evidence for high prevalence in normal and immunosuppressed children. Pediatrics 1978;61:35-41.
  18. Wakefield AE, Lindley AR, Ambrose HE, Denis CM, Miller RF. Limited asymptomatic carriage of Pneumocystis jiroveci in human immunodeficiency virus-infected patients. The Journal of infectious diseases 2003;187:901-8.
  19. Karageorgopoulos DE, Qu JM, Korbila IP, Zhu YG, Vasileiou VA, Falagas ME. Accuracy of beta-D-glucan for the diagnosis of Pneumocystis jirovecii pneumonia: a meta-analysis. Clinical microbiology and infection 2013;19:39-49.
  20. CDC. Pneumocystis pneumonia–Los Angeles. MMWR Morbidity and mortality weekly report 1981;30:250-2.
  21. Hay JW, Osmond DH, Jacobson MA. Projecting the medical costs of AIDS and ARC in the United States. Journal of acquired immune deficiency syndromes 1988;1:466-85.
  22. Buchacz K, Baker RK, Palella FJ, Jr., et al. AIDS-defining opportunistic illnesses in US patients, 1994-2007: a cohort study. Aids 2010;24:1549-59.
  23. Kelley CF, Checkley W, Mannino DM, Franco-Paredes C, Del Rio C, Holguin F. Trends in hospitalizations for AIDS-associated Pneumocystis jirovecii Pneumonia in the United States (1986 to 2005). Chest 2009;136:190-7.
  24. Buchacz K, Lau B, Jing Y, et al. Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000-2010. The Journal of infectious diseases 2016;214:862-72.
  25. de Armas Rodriguez Y, Wissmann G, Muller AL, et al. Pneumocystis jirovecii pneumonia in developing countries. Parasite 2011;18:219-28.
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