Features and global impact of invasive fungal infections caused by Pneumocystis jirovecii: A systematic review to inform the World Health Organization fungal priority pathogens list

Author:

McMullan Brendan12,Kim Hannah Yejin345,Alastruey-Izquierdo Ana6,Tacconelli Evelina7,Dao Aiken58,Oladele Rita9,Tanti Daniel210,Govender Nelesh P11121314,Shin Jong-Hee15,Heim Jutta16,Ford Nathan Paul1718,Huttner Benedikt19,Galas Marcelo20,Nahrgang Saskia Andrea21,Gigante Valeria22,Sati Hatim22,Alffenaar Jan Willem345,Morrissey C Orla2324,Beardsley Justin58

Affiliation:

1. Faculty of Medicine and Health, UNSW , Sydney, New South Wales , Australia

2. Department of Immunology and Infectious Diseases, Sydney Children’s Hospital , Sydney, New South Wales , Australia

3. Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney , Camperdown, New South Wales , Australia

4. Department of Pharmacy, Westmead Hospital, Western Sydney LHD , North Parramatta, New South Wales , Australia

5. Sydney Infectious Diseases Institute, The University of Sydney , Camperdown, New South Wales , Australia

6. Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III , Majadahonda, Madrid , Spain

7. Department of Diagnostics and Public Health, Verona University , Verona , Italy

8. Westmead Hospital, Western Sydney LHD , North Parramatta, New South Wales , Australia

9. Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos , Lagos , Nigeria

10. Discipline of Paediatrics, Faculty of Medicine and Health, University of NSW , Sydney , Australia

11. Division of the National Health Laboratory Service, National Institute for Communicable Diseases , Johannesburg , South Africa

12. Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa

13. Institute of Infection and Immunity, St George’s University of London , London , UK

14. MRC Centre for Medical Mycology, University of Exeter , Exeter , UK

15. Department of Laboratory Medicine, Chonnam National University School of Medicine , Gwangju , South Korea

16. Scientific Advisory Committee, Helmholtz Centre for Infection Research , Germany

17. Department of HIV, Viral Hepatitis and STIs, World Health Organization , Geneva , Switzerland

18. Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa

19. Essentials Medicines List Team, WHO , Geneva , Switzerland

20. Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization , Washingdom, District of Columbia , USA

21. Antimicrobial Resistance Programme, World Health Organization European Office , Copenhagen , Denmark

22. AMR Division, WHO , Geneva , Switzerland

23. Department of Infectious Diseases, Alfred Health , Melbourne, Victoria , Australia

24. Department of Infectious Diseases, Monash University , Clayton, Victoria , Australia

Abstract

Abstract This systematic review evaluates the current global impact of invasive infections caused by Pneumocystis jirovecii (principally pneumonia: PJP), and was carried out to inform the World Health Organization Fungal Priority Pathogens List. PubMed and Web of Science were used to find studies reporting mortality, inpatient care, complications/sequelae, antifungal susceptibility/resistance, preventability, annual incidence, global distribution, and emergence in the past 10 years, published from January 2011 to February 2021. Reported mortality is highly variable, depending on the patient population: In studies of persons with HIV, mortality was reported at 5%–30%, while in studies of persons without HIV, mortality ranged from 4% to 76%. Risk factors for disease principally include immunosuppression from HIV, but other types of immunosuppression are increasingly recognised, including solid organ and haematopoietic stem cell transplantation, autoimmune and inflammatory disease, and chemotherapy for cancer. Although prophylaxis is available and generally effective, burdensome side effects may lead to discontinuation. After a period of decline associated with improvement in access to HIV treatment, new risk groups of immunosuppressed patients with PJP are increasingly identified, including solid organ transplant patients.

Publisher

Oxford University Press (OUP)

Reference98 articles.

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