title: Rising incidence of Pneumocystis jirovecii pneumonia suggests iatrogenic exposure of immune-compromised patients may be becoming a significant problem.
abstract: Against a background of point-source outbreaks of Pneumocystis pneumonia (PCP) in renal transplant units in Europe, we undertook a retrospective 3 year observational review of PCP in Northern Ireland. This showed an unexpected increase in incidence, with a mortality rate of 30 %. Fifty-one cases were confirmed compared to 10 cases confirmed in the preceding 7 years. Where undiagnosed HIV infection had previously been the main risk factor for PCP, this was now equally matched by chemotherapy for haematological and non-haematological malignancy and immune suppression for a range of autoimmune conditions. Congenital immunodeficiency and transplantation were less common predisposing factors, but renal grafts also showed a rising incidence. Asymptomatic carriage was uncommon. At presentation both upper and lower respiratory samples were of equal use in establishing the diagnosis, and treatment resulted in rapid clearance. These data suggest the need for considering PCP in at-risk patients, reviewing its mode of acquisition and whether iatrogenic colonization is a treatable pre-condition.
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Coyle
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Conall
authors.initials: C
authors.lastname: McCaughey
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Aaron
authors.initials: A
authors.lastname: Nager
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: James
authors.initials: J
authors.lastname: McKenna
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: O'Neill
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Feeney
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Fairley
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Watt
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Ciara
authors.initials: C
authors.lastname: Cox
authors.affiliation: Regional Virus Laboratory, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: Tanya
authors.initials: T
authors.lastname: Curran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005060:Europe; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult