title: Pneumocystis jirovecii pneumonia in patients with autoimmune disease on high-dose glucocorticoid.
abstract: OBJECTIVE
  Indications for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in patients with autoimmune disease remain unclear. We aimed to determine (1) the incidence of PCP in patients with autoimmune disease in general, in a clinical setting where prophylaxis is not routine, and (2) whether high-dose glucocorticoid (≥30 mg oral prednisolone or equivalent per day) is a risk factor for PCP infection.
  
  
  METHODS
  A retrospective review of the medical records of patients with autoimmune diseases hospitalized to a tertiary center over a 5-year study period was carried out. Patient demographics, mean glucocorticoid dose (in the last 1 month), and the outcomes of patients who developed PCP were analyzed.
  
  
  RESULTS
  The incidence rate of PCP infection was 75 per 100,000 patients per year. The in-hospital mortality was 50%, and all those who died were on high-dose glucocorticoid at the time of PCP diagnosis. There was a significant difference between the occurrence of PCP in patients who were on high-dose vs non-high-dose glucocorticoid (df = 1, P = 0.009), with a relative risk of 19 (P = 0.010; 95% confidence interval, 2.0-182.8). The mean oral prednisolone dose of patients who developed PCP and those who did not were 55.5 versus 10.7 mg, respectively, P = 0.002.
  
  
  CONCLUSIONS
  High-dose glucocorticoid may be associated with an increased risk of PCP infection in patients with autoimmune diseases.
authors.affiliation: From the *Department of Rheumatology and Immunology, Singapore General Hospital; †Duke-NUS Graduate Medical School; and ‡Yong Loo Lin School of Medicine, National University of Singapore, Singapore; §Section of Rheumatology, Makati Medical Center, Manila, Philippines; and ‖Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Chew
authors.forename: Liza Marie
authors.initials: LM
authors.lastname: Maceda-Galang
authors.forename: York Kiat
authors.initials: YK
authors.lastname: Tan
authors.forename: Bibhas
authors.initials: B
authors.lastname: Chakraborty
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
chemical_list: D000890:Anti-Infective Agents; D005938:Glucocorticoids; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011239:Prednisolone