title: Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients.
abstract: Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from that associated with HIV infection, with the disease being acute and more often severe, having a lower fungal burden and being more frequently linked to treatment with corticosteroids. Most cases occur in patients not receiving adequate prophylaxis. The development of new therapies, including targeted treatments and monoclonal antibodies in various haematological diseases, justifies constant vigilance in order to identify new at-risk populations and give prophylaxis accordingly. The fifth and sixth European Conferences on Infections in Leukaemia (ECIL-5 and ECIL-6) aimed to review risk factors for PCP in haematology patients and to establish evidence-based recommendations for PCP diagnosis, prophylaxis and treatment. This article focuses on the magnitude of the problem, the main differences in clinical presentation between haematology patients and other immunocompromised populations, especially HIV-infected patients, and the main risk factors.
authors.affiliation: Department of Haematology, Henri Mondor Teaching Hospital, Assistance Publique-hôpitaux de Paris, and Université Paris-Est-Créteil, Créteil, France catherine.cordonnier@aphp.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.affiliation: Department of Haematology, Oncoematologia Pediatrica, Policlinico G. B. Rossi, Verona, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.affiliation: Department of Haematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Maschmeyer
authors.affiliation: Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.affiliation: Department of Haematology Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Donnelly
authors.affiliation: Parasitology-Mycology Laboratory, Groupe Hospitalier Lariboisière Saint-Louis Fernand Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Diderot, Sorbonne Paris Cité, and Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Alanio
authors.affiliation: Institute of Microbiology, Lausanne University Hospital and University, Lausanne, Switzerland.
authors.forename: Philippe M
authors.initials: PM
authors.lastname: Hauser
authors.affiliation: Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium and National Reference Center for Mycosis, Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Lagrou
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Willem J G
authors.initials: WJ
authors.lastname: Melchers
authors.affiliation: Department of Infectious Diseases, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jannik
authors.initials: J
authors.lastname: Helweg-Larsen
authors.affiliation: Medical Parasitology Unit, Group of Opportunistic Protozoa/HIV and Other Protozoa, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Olga
authors.initials: O
authors.lastname: Matos
authors.affiliation: Parasitology-Mycology Laboratory, Groupe Hospitalier Lariboisière Saint-Louis Fernand Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Diderot, Sorbonne Paris Cité, and Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bretagne
authors.affiliation: Department of Haematology, Acute Leukaemia and Stem Cell Transplantation Unit, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D066027:Transplant Recipients
chemical_list: D000935:Antifungal Agents