Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 10, Number 10—October 2004
Perspective

Current Epidemiology of Pneumocystis Pneumonia

Alison Morris*†Comments to Author , Jens D. Lundgren‡, Henry Masur§, Peter D. Walzer¶, Debra L. Hanson#, Toni Frederick#, Laurence Huang**, Charles B. Beard††, and Jonathan E. Kaplan#
Author affiliations: *University of Southern California, Los Angeles, California, USA; †University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; ‡University of Copenhagen, Hvidovre, Denmark; §National Institutes of Health, Bethesda, Maryland, USA; ¶University of Cincinnati, Cincinnati, Ohio, USA; #Centers for Disease Control and Prevention, Atlanta, Georgia, USA; **University of California San Francisco, San Francisco, California, USA; ††Centers for Disease Control and Prevention, Fort Collins, Colorado, USA

Main Article

Table 2

Summary of selected studies of Pneumocystis pneumonia in African childrena

Study (ref) Site Study period No. patients Population/age Diagnostic sample/method % with 
PCP (n)
Ansari, 2003 (37) Botswana 1997–1998 35 Died while inpatient/ 
1–13 y Autopsy lung tissue/Grocott 29 (10)
Chintu, 2002 (38) Zambia 1997–2000 180 Died from respiratory disease/1 mo–16 y Autopsy lung tissue/ Methenamine silver 29 (52)
Graham, 2000 (39) Malawi 1996 93 Hospitalized for pneumonia/2 mo–5 y NPA/IF 17 (16)
Ikeogu, 1997 (40) Zimbabwe 1992–1993 122 Died on arrival to hospital/<5 y Autopsy lung tissue/ Methenamine silver 16 (19)
Lucas, 2000 (41) Côte d’Ivoire 1991–1992 78 HIV-positive undergoing autopsy, inpatient or outpatient/1 mo–12 y Autopsy lung tissue/unknown 14 (11)
Madhi, 2002 (42) South Africa 2000–2001 185 (231 episodes) Hospitalized with severe pneumonia/1–38 mo IS, NPA/IF 44 (101)
Ruffini, 2002 (43) South Africa 1999 105 Hospitalized with severe pneumonia/2–24 mo IS, NPA/IF 49 (51)
Zar, 2001 (44) South Africa 1998 151 Hospitalized with pneumonia/3–16 mo BAL, IS, NPA/ Methenamine silver, IF 10 (15)

aBAL, bronchoalveolar lavage; IF, immunofluorescence; IS, induced sputum; NPA, nasopharyngeal aspirate.

Main Article

References
  1. Kaplan  JE, Hanson  D, Dworkin  MS, Frederick  T, Bertolli  J, Lindegren  ML, 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):S514. DOIPubMedGoogle Scholar
  2. Masur  H, Michelis  MA, Greene  JB, Onorato  I, Stouwe  RA, Holzman  RS, An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. N Engl J Med. 1981;305:14318. DOIPubMedGoogle Scholar
  3. Phair  J, Munoz  A, Detels  R, Kaslow  R, Rinaldo  C, Saah  A. The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. N Engl J Med. 1990;322:1615. DOIPubMedGoogle Scholar
  4. Hay  JW, Osmond  DH, Jacobson  MA. Projecting the medical costs of AIDS and ARC in the United States. J Acquir Immune Defic Syndr. 1988;1:46685.PubMedGoogle Scholar
  5. Fischl  MA, Dickinson  GM, La Voie  L. Safety and efficacy of sulfamethoxazole and trimethoprim chemoprophylaxis for Pneumocystis carinii pneumonia in AIDS. JAMA. 1988;259:11859. DOIPubMedGoogle Scholar
  6. Kaslow  RA, Ostrow  DG, Detels  R, Phair  JP, Polk  BF, Rinaldo  CR Jr. The multicenter AIDS cohort study: rationale, organization, and selected characteristics of the participants. Am J Epidemiol. 1987;126:3108.PubMedGoogle Scholar
  7. Detels  R, Tarwater  P, Phair  JP, Margolick  J, Riddler  SA, Munoz  A. Effectiveness of potent antiretroviral therapies on the incidence of opportunistic infections before and after AIDS diagnosis. AIDS. 2001;15:34755. DOIPubMedGoogle Scholar
  8. Mocroft  A, Katlama  C, Johnson  AM, Pradier  C, Antunes  F, Mulcahy  F, AIDS across Europe, 1994-98: the EuroSIDA study. Lancet. 2000;356:2916. DOIPubMedGoogle Scholar
  9. Weverling  GJ, Mocroft  A, Ledergerber  B, Kirk  O, Gonzales-Lahoz  J, d’Arminio Monforte  A, Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection. EuroSIDA Study Group. Lancet. 1999;353:12938. DOIPubMedGoogle Scholar
  10. Stansell  JD, Osmond  DH, Charlebois  E, LaVange  L, Wallace  JM, Alexander  BV, Predictors of Pneumocystis carinii pneumonia in HIV-infected persons. Pulmonary Complications of HIV Infection Study Group. Am J Respir Crit Care Med. 1997;155:606.PubMedGoogle Scholar
  11. Kaplan  JE, Masur  H, Holmes  KK. Guidelines for preventing opportunistic infections among HIV-infected persons—2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51:152.PubMedGoogle Scholar
  12. Kaplan  JE, Hanson  DL, Navin  TR, Jones  JL. Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus-infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis. J Infect Dis. 1998;178:112632. DOIPubMedGoogle Scholar
  13. Morgello  S, Mahboob  R, Yakoushina  T, Khan  S, Hague  K. Autopsy findings in a human immunodeficiency virus-infected population over 2 decades: influences of gender, ethnicity, risk factors, and time. Arch Pathol Lab Med. 2002;126:18290.PubMedGoogle Scholar
  14. Huang  L, Crothers  K, Morris  A, Groner  G, Fox  M, Turner  JR, Pneumocystis colonization in HIV-infected patients. J Eukaryot Microbiol. 2003;50(Suppl):6167. DOIPubMedGoogle Scholar
  15. Nevez  G, Raccurt  C, Jounieaux  V, Dei-Cas  E, Mazars  E. Pneumocystosis versus pulmonary Pneumocystis carinii colonization in HIV-negative and HIV-positive patients. AIDS. 1999;13:5356. DOIPubMedGoogle Scholar
  16. Dankner  WM, Lindsey  JC, Levin  MJ. Correlates of opportunistic infections in children infected with the human immunodeficiency virus managed before highly active antiretroviral therapy. Pediatr Infect Dis J. 2001;20:408. DOIPubMedGoogle Scholar
  17. Kattan  M, Platzker  A, Mellins  RB, Schluchter  MD, Chen  XC, Peavy  H, Respiratory diseases in the first year of life in children born to HIV-1-infected women. Pediatr Pulmonol. 2001;31:26776. DOIPubMedGoogle Scholar
  18. Kovacs  A, Frederick  T, Church  J, Eller  A, Oxtoby  M, Mascola  L. CD4 T-lymphocyte counts and Pneumocystis carinii pneumonia in pediatric HIV infection. JAMA. 1991;265:1698703. DOIPubMedGoogle Scholar
  19. Wakefield  AE, Stewart  TJ, Moxon  ER, Marsh  K, Hopkin  JM. Infection with Pneumocystis carinii is prevalent in healthy Gambian children. Trans R Soc Trop Med Hyg. 1990;84:8002. DOIPubMedGoogle Scholar
  20. Vargas  SL, Hughes  WT, Santolaya  ME, Ulloa  AV, Ponce  CA, Cabrera  CE, Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis. 2001;32:85561. DOIPubMedGoogle Scholar
  21. Williams  AJ, Duong  T, McNally  LM, Tookey  PA, Masters  J, Miller  R, Pneumocystis carinii pneumonia and cytomegalovirus infection in children with vertically acquired HIV infection. AIDS. 2001;15:3359. DOIPubMedGoogle Scholar
  22. Vargas  SL, Ponce  CA, Hughes  WT, Wakefield  AE, Weitz  JC, Donoso  S, Association of primary Pneumocystis carinii infection and sudden infant death syndrome. Clin Infect Dis. 1999;29:148993. DOIPubMedGoogle Scholar
  23. Fisk  DT, Meshnick  S, Kazanjian  PH. Pneumocystis carinii pneumonia in patients in the developing world who have acquired immunodeficiency syndrome. Clin Infect Dis. 2003;36:708. DOIPubMedGoogle Scholar
  24. Wannamethee  SG, Sirivichayakul  S, Phillips  AN, Ubolyam  S, Ruxrungtham  K, Hanvanich  M, Clinical and immunological features of human immunodeficiency virus infection in patients from Bangkok, Thailand. Int J Epidemiol. 1998;27:28995. DOIPubMedGoogle Scholar
  25. Lumbiganon  P, Kosalaraksa  P, Loapaiboon  M. Survival of children with AIDS: experience in a university hospital in northeast Thailand. J Med Assoc Thai. 2000;83:6526.PubMedGoogle Scholar
  26. Michalany  J, Mattos  AL, Michalany  NS, Filie  AC, Montezzo  LC. Acquired immune deficiency syndrome (AIDS) in Brazil. Necropsy findings. Ann Pathol. 1987;7:1524.PubMedGoogle Scholar
  27. Weinberg  A, Duarte  MI. Respiratory complications in Brazilian patients infected with human immunodeficiency virus. Rev Inst Med Trop Sao Paulo. 1993;35:12939. DOIPubMedGoogle Scholar
  28. Pitchenik  AE, Fischl  MA, Dickinson  GM, Becker  DM, Fournier  AM, O’Connell  MT, Opportunistic infections and Kaposi’s sarcoma among Haitians: evidence of a new acquired immunodeficiency state. Ann Intern Med. 1983;98:27784.PubMedGoogle Scholar
  29. Mohar  A, Romo  J, Salido  F, Jessurun  J, Ponce de Leon  S, Reyes  E, The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of autopsied patients in Mexico. AIDS. 1992;6:46773. DOIPubMedGoogle Scholar
  30. Abouya  YL, Beaumel  A, Lucas  S, Dago-Akribi  A, Coulibaly  G, N’Dhatz  M, Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome. Am Rev Respir Dis. 1992;145:61720.PubMedGoogle Scholar
  31. Ansari  NA, Kombe  AH, Kenyon  TA, Hone  NM, Tappero  JW, Nyirenda  ST, Pathology and causes of death in a group of 128 predominantly HIV-positive patients in Botswana, 1997–1998. Int J Tuberc Lung Dis. 2002;6:5563.PubMedGoogle Scholar
  32. Aderaye  G, Bruchfeld  J, Olsson  M, Lindquist  L. Occurrence of Pneumocystis carinii in HIV-positive patients with suspected pulmonary tuberculosis in Ethiopia. AIDS. 2003;17:43540. DOIPubMedGoogle Scholar
  33. Batungwanayo  J, Taelman  H, Lucas  S, Bogaerts  J, Alard  D, Kagame  A, Pulmonary disease associated with the human immunodeficiency virus in Kigali, Rwanda. A fiberoptic bronchoscopic study of 111 cases of undetermined etiology. Am J Respir Crit Care Med. 1994;149:15916.PubMedGoogle Scholar
  34. Kamanfu  G, Mlika-Cabanne  N, Girard  PM, Nimubona  S, Mpfizi  B, Cishako  A, Pulmonary complications of human immunodeficiency virus infection in Bujumbura, Burundi. Am Rev Respir Dis. 1993;147:65863.PubMedGoogle Scholar
  35. Malin  AS, Gwanzura  LK, Klein  S, Robertson  VJ, Musvaire  P, Mason  PR. Pneumocystis carinii pneumonia in Zimbabwe. Lancet. 1995;346:125861. DOIPubMedGoogle Scholar
  36. Worodria  W, Okot-Nwang  M, Yoo  SD, Aisu  T. Causes of lower respiratory infection in HIV-infected Ugandan adults who are sputum AFB smear-negative. Int J Tuberc Lung Dis. 2003;7:11723.PubMedGoogle Scholar
  37. Ansari  NA, Kombe  AH, Kenyon  TA, Mazhani  L, Binkin  N, Tappero  JW, Pathology and causes of death in a series of human immunodeficiency virus-positive and -negative pediatric referral hospital admissions in Botswana. Pediatr Infect Dis J. 2003;22:437. DOIPubMedGoogle Scholar
  38. Chintu  C, Mudenda  V, Lucas  S, Nunn  A, Lishimpi  K, Maswahu  D, Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet. 2002;360:985. DOIPubMedGoogle Scholar
  39. Graham  SM, Mtitimila  EI, Kamanga  HS, Walsh  AL, Hart  CA, Molyneux  ME. Clinical presentation and outcome of Pneumocystis carinii pneumonia in Malawian children. Lancet. 2000;355:36973. DOIPubMedGoogle Scholar
  40. Ikeogu  MO, Wolf  B, Mathe  S. Pulmonary manifestations in HIV seropositivity and malnutrition in Zimbabwe. Arch Dis Child. 1997;76:1248. DOIPubMedGoogle Scholar
  41. Lucas  SB, Peacock  CS, Hounnou  A, Brattegaard  K, Koffi  K, Honde  M, Disease in children infected with HIV in Abidjan, Cote d’Ivoire. BMJ. 1996;312:3358.PubMedGoogle Scholar
  42. Madhi  SA, Cutland  C, Ismail  K, O’Reilly  C, Mancha  A, Klugman  KP. Ineffectiveness of trimethoprim-sulfamethoxazole prophylaxis and the importance of bacterial and viral coinfections in African children with Pneumocystis carinii pneumonia. Clin Infect Dis. 2002;35:11206. DOIPubMedGoogle Scholar
  43. Ruffini  DD, Madhi  SA. The high burden of Pneumocystis carinii pneumonia in African HIV-1-infected children hospitalized for severe pneumonia. AIDS. 2002;16:10512. DOIPubMedGoogle Scholar
  44. Zar  HJ, Hanslo  D, Tannenbaum  E, Klein  M, Argent  A, Eley  B, Aetiology and outcome of pneumonia in human immunodeficiency virus-infected children hospitalized in South Africa. Acta Paediatr. 2001;90:11925. DOIPubMedGoogle Scholar
  45. Mocroft  A, Phillips  AN, Friis-Moller  N, Colebunders  R, Johnson  AM, Hirschel  B, Response to antiretroviral therapy among patients exposed to three classes of antiretrovirals: results from the EuroSIDA study. Antivir Ther. 2002;7:2130.PubMedGoogle Scholar

Main Article

Page created: March 30, 2011
Page updated: March 30, 2011
Page reviewed: March 30, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external