Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia
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Abstract
In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a wellknownopportunistic infection and its management has been established. However, PCP is an emerging threat toimmunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeuticsfor malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite differentbetween patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult todiagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomographyfindings are different between PCP patients with HIV infection and those without. These differences in clinical andradiological features are due to severe or dysregulated inflammatory responses that are evoked by a relatively smallnumber of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of polymerasechain reaction and serum β-D-glucan assay for rapid and non-invasive diagnosis of PCP has been revealed. Althoughcorticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, theoptimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization isprevalent and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread ofPneumocystis by airborne transmission. These findings suggest the need for chemoprophylaxis in immunocompromisedpatients as well as infection control measures, although the indications remain controversial. Because a variety of novelimmunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis andtreatment of PCP are needed.
- keywords
- Pneumocystis jirovecii Pneumonia, Immunocompromised Host, Loop-Mediated Isothermal Amplification, Chemoprophylaxis, Infection Control
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