Pneumocystis jirovecii Pneumonia and Human Immunodefi-ciency Virus Co-Infection in Western Iran
Background: The human immunodeficiency virus (HIV) is one of the greatest health challenges facing worldwide. The virus suppresses the immune system of the patient. The purpose of this study was to describe the epidemiology of Pneumocystis jirovecii colonization, rarely found in normal people, in patients with stage 4 HIV infection in Kermanshah, Iran, from Mar 1995 to Feb 2016.
Methods: In this retrospective study, we surveyed medical records of stage 4 HIV-positive patients with Pneumocystis admitted to Behavioral Counseling Center of Kermanshah. Several parameters were analyzed including demographic characteristics, body mass index (BMI), treatment regimen, diagnostic methods, presenting signs and symptoms, presence of co-pathogens (bacteria, viruses, or fungi), and nadir of CD4 T-cell count before and after treatment.
Results: During the study period, 114 HIV-positive patients were analyzed, of whom 93 were male and 21 were female, respectively. Of 114 cases, 26 (22.8%) patients had Pneumocystis. All 26 colonized patients had CD4 cell counts below 200 cells/mm3 (range 9–186). The median CD4 count increased from 91 cells/mm3 pre- trimethoprim/sulfamethoxazole (TMP/SMX) to an estimated 263 cells/mm3 after starting (TMP/SMX). BMI was normal in the majority of the patients (85%) and coughs, sputum, and chest pain (19; 73%) followed by dyspnea, weakness, and lethargy (7; 27%) were the most common presentations of fungal pneumonia.
Conclusion: HIV/AIDS-infected patients are an environmental reservoir of P. jirovecii infection that might transmit the infection from one person to another via the airborne route. In addition, rapid identification of such individuals may reduce the morbidity and mortality rate of this disease.
2. Khademi N, Reshadat S, Zangeneh A et al (2017). A comparative study of the spatial distribution of HIV prevalence in the metropolis of Kermanshah, Iran, in 1996− 2014 using geographical information systems. HIV Med, 18(3):220-4.
3. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2016. http://www.who.int/hiv/pub/arv/arv-2016/en/
4. Limper AH, Adenis A, Le T et al (2017). Fungal infections in HIV/AIDS. Lancet Infect Dis, 17(11): e334-e343.
5. Aliouat-Denis C-M, Chabé M, Demanche C et al (2008). Pneumocystis species, co-evolution and pathogenic power. Infect Genet Evol, 8(5):708-26.
6. Hof H (2012). Pneumocystis jirovecii: A peculiar fungus posing particular problems for therapy and prophylaxis. Mycoses, 55(s1):1-7.
7. Van der Meer G, Brug SL (1942). Infection à Pneumocystis chez l’homme et chez les animaux. Ann Soc Belge Med Trop, 22: 301.
8. Post C, Dutz W, Nasarian I (1964). Endemic Pneumocystis carinii pneumonia in south Iran. Arch Dis Child, 39(203):35-40.
9. Kohout E, Post C, Azadeh B et al (1972). Immunoglobulin levels in infantile pneumocystosis. J Clin Pathol, 25(2):135-140.
10. Janbakhsh A, Sayad B, Mikaili A (2003). The first report of Pneumocystis carini pneumonia in a patient with HIV infection in Kermanshah. J Kermanshah Univ Med Sci, 7(2):60-65.
11. Nazari N, Bozorgomid A, Janbakhsh A et al (2018). Toxoplasma gondii and human immunodeficiency virus co-infection in western Iran: A cross sectional study. Asian Pac J Trop Med, 11(1): 58-62.
12. Aboualigalehdari E, Mahmoudabadi AZ, Fatahinia M et al (2015). The prevalence of Pneumocystis jirovecii among patients with different chronic pulmonary disorders in Ahvaz, Iran. Iran J Microbiol, 7(6):333-7.
13. Kaur R, Mehra B, Dhakad MS et al (2017). Fungal Opportunistic Pneumonias in HIV/AIDS Patients: An Indian Tertiary Care Experience. J Clin Diagn Res,11(2): DC14-DC19.
14. Pereira RM, Müller AL, Zimerman RA et al (2014). High prevalence of Pneumocystis jirovecii colonization among HIV-positive patients in southern Brazil. Med Mycol, 52(8):804-9.
15. Homayouni MM, Behniafar H, Mehbod ASA et al (2017). Prevalence of Pneumocystis jirovecii among immunocompromised patients in hospitals of Tehran city, Iran. J Parasit Dis, 41(3):850-53.
16. Wang D, Hu Y, Li T et al (2017). Diagnosis of Pneumocystis jirovecii pneumonia with serum cell-free DNA in non-HIV-infected immunocompromised patients. Oncotarget, 8(42):71946-53.
17. Khodavaisy S, Mortaz E, Mohammadi F et al (2015). Pneumocystis jirovecii colonization in Chronic Obstructive Pulmonary Disease (COPD). Curr Med Mycol, 1(1):42-8.
18. Zubairi ABS, Shahzad H, Zafar A (2016). Clinical outcomes of Pneumocystis pneumonia from a tertiary care centre in Pakistan. J Pak Med Assoc, 66(11):1367-71.
19. Miller RF, Huang L, Walzer PD (2013). Pneumocystis pneumonia associated with human immunodeficiency virus. Clin Chest Med, 34(2):229-41.
20. Javier B, Susana L, Santiago G et al (2012). Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans. Asian Pac J Trop Biomed, 2(1):80-2.
21. Llibre JM, Revollo B, Vanegas S et al (2013). Pneumocystis jirovecii pneumonia in HIV-1-infected patients in the late-HAART era in developed countries. Scand J Infect Dis, 45(8):635-44.
22. Castro JG, Morrison-Bryant M (2010). Management of Pneumocystis jirovecii pneumonia in HIV infected patients: current options, challenges and future directions. HIV AIDS (Auckl), 2:123-34.
23. Ponce CA, Chabé M, George C et al (2017). High Prevalence of Pneumocystis jirovecii Dihydropteroate Synthase Gene Mutations in Patients with a First Episode of Pneumocystis Pneumonia in Santiago, Chile, and Clinical Response to Trimethoprim-Sulfamethoxazole Therapy. Antimicrob Agents Chemother, 61(2): e01290-16.
24. Jones KD, Berkley JA (2014). Severe acute malnutrition and infection. Paediatr Int Child Health, 34(sup1):1-29.
25. Attalla El Halabieh N, Petrillo E, Laviano A et al (2016). A Case of Pneumocystis jirovecii Pneumonia in a Severely Malnourished, HIV-Negative Patient: A Role for Malnutrition in Opportunistic Infections?JPEN J Parenter Enteral Nutr. 40(5):722-24.
26. Asai N, Motojima S, Ohkuni Y et al (2012). Non-HIV Pneumocystis pneumonia: do conventional community-acquired pneumonia guidelines under estimate its severity? Multidiscip Respir Med, 7(1):2.
27. Lee SH, Huh KH, Joo DJ et al (2017). Risk factors for Pneumocystis jirovecii pneumonia (PJP) in kidney transplantation recipients. Sci Rep, 7(1):1571.