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Dockrell DH, Breen R, Collini P, Lipman MCI, Miller RF. British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of pulmonary opportunistic infections 2024. HIV Med 2024; 25 Suppl 2:3-37. [PMID: 38783560 DOI: 10.1111/hiv.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/25/2024]
Affiliation(s)
- D H Dockrell
- University of Edinburgh, UK
- Regional Infectious Diseases Unit, NHS Lothian Infection Service, Edinburgh, UK
| | - R Breen
- Forth Valley Royal Hospital, Larbert, Scotland, UK
| | | | - M C I Lipman
- Royal Free London NHS Foundation Trust, UK
- University College London, UK
| | - R F Miller
- Royal Free London NHS Foundation Trust, UK
- Institute for Global Health, University College London, UK
- Central and North West London NHS Foundation Trust, UK
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Kim D, Kim SB, Jeon S, Kim S, Lee KH, Lee HS, Han SH. No Change of Pneumocystis jirovecii Pneumonia after the COVID-19 Pandemic: Multicenter Time-Series Analyses. J Fungi (Basel) 2021; 7:jof7110990. [PMID: 34829277 PMCID: PMC8624436 DOI: 10.3390/jof7110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Consolidated infection control measures imposed by the government and hospitals during COVID-19 pandemic resulted in a sharp decline of respiratory viruses. Based on the issue of whether Pneumocystis jirovecii could be transmitted by airborne and acquired from the environment, we assessed changes in P. jirovecii pneumonia (PCP) cases in a hospital setting before and after COVID-19. We retrospectively collected data of PCP-confirmed inpatients aged ≥18 years (N = 2922) in four university-affiliated hospitals between January 2015 and June 2021. The index and intervention dates were defined as the first time of P. jirovecii diagnosis and January 2020, respectively. We predicted PCP cases for post-COVID-19 and obtained the difference (residuals) between forecasted and observed cases using the autoregressive integrated moving average (ARIMA) and the Bayesian structural time-series (BSTS) models. Overall, the average of observed PCP cases per month in each year were 36.1 and 47.3 for pre- and post-COVID-19, respectively. The estimate for residuals in the ARIMA model was not significantly different in the total PCP-confirmed inpatients (7.4%, p = 0.765). The forecasted PCP cases by the BSTS model were not significantly different from the observed cases in the post-COVID-19 (−0.6%, 95% credible interval; −9.6~9.1%, p = 0.450). The unprecedented strict non-pharmacological interventions did not affect PCP cases.
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Affiliation(s)
- Dayeong Kim
- Department of Internal Medicine, Division of Infectious Disease, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (D.K.); (S.K.); (K.H.L.)
| | - Sun Bean Kim
- Department of Internal Medicine, Division of Infectious Diseases, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea;
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea;
| | - Subin Kim
- Department of Internal Medicine, Division of Infectious Disease, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (D.K.); (S.K.); (K.H.L.)
| | - Kyoung Hwa Lee
- Department of Internal Medicine, Division of Infectious Disease, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (D.K.); (S.K.); (K.H.L.)
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea;
- Correspondence: (H.S.L.); (S.H.H.)
| | - Sang Hoon Han
- Department of Internal Medicine, Division of Infectious Disease, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (D.K.); (S.K.); (K.H.L.)
- Correspondence: (H.S.L.); (S.H.H.)
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Pougnet L, Hoffmann CV, Pougnet R, Le Ny F, Gaitan L, Cros P, Artus M, Le Gal S, Nevez G. Pneumocystis exhalation by infants developing Pneumocystis primary infection: putative infectious sources in hospitals and the community. J Hosp Infect 2021; 113:10-13. [PMID: 33894307 DOI: 10.1016/j.jhin.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
Pneumocystis jirovecii DNA was detected using a polymerase chain reaction assay in air samples collected using an air-liquid impaction device at 1 m distance from three out of 14 infants who had developed Pneumocystis primary infection. P. jirovecii genotype identification was successful in one out of three pairs of air samples. Matching of P. jirovecii genotypes between the nasopharyngeal and air samples suggested that P. jirovecii was effectively exhaled by the infected infant. These original results represent a proof of concept of the role of infants with primary pneumocystis infection as infectious sources of P. jirovecii in hospitals and in the community.
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Affiliation(s)
- L Pougnet
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Hôpital d'Instruction des Armées Clermont-Tonnerre, CC41, 29240 Brest Cedex 9, France.
| | - C V Hoffmann
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - R Pougnet
- Centre de Recherche de Pathologies Professionnelles et Environnementales, CHRU de Brest, Brest, France; Laboratoire d'études et de Recherche en Sociologie (LABERS), Université de Bretagne Occidentale, Brest
| | - F Le Ny
- Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - L Gaitan
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - P Cros
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - M Artus
- Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - S Le Gal
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - G Nevez
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France.
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Fennelly KP. Particle sizes of infectious aerosols: implications for infection control. THE LANCET. RESPIRATORY MEDICINE 2020; 8:914-924. [PMID: 32717211 PMCID: PMC7380927 DOI: 10.1016/s2213-2600(20)30323-4] [Citation(s) in RCA: 337] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
The global pandemic of COVID-19 has been associated with infections and deaths among health-care workers. This Viewpoint of infectious aerosols is intended to inform appropriate infection control measures to protect health-care workers. Studies of cough aerosols and of exhaled breath from patients with various respiratory infections have shown striking similarities in aerosol size distributions, with a predominance of pathogens in small particles (<5 μm). These are immediately respirable, suggesting the need for personal respiratory protection (respirators) for individuals in close proximity to patients with potentially virulent pathogens. There is no evidence that some pathogens are carried only in large droplets. Surgical masks might offer some respiratory protection from inhalation of infectious aerosols, but not as much as respirators. However, surgical masks worn by patients reduce exposures to infectious aerosols to health-care workers and other individuals. The variability of infectious aerosol production, with some so-called super-emitters producing much higher amounts of infectious aerosol than most, might help to explain the epidemiology of super-spreading. Airborne infection control measures are indicated for potentially lethal respiratory pathogens such as severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Kevin P Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Dellière S, Gits-Muselli M, Bretagne S, Alanio A. Outbreak-Causing Fungi: Pneumocystis jirovecii. Mycopathologia 2019; 185:783-800. [PMID: 31782069 DOI: 10.1007/s11046-019-00408-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/15/2019] [Indexed: 12/17/2022]
Abstract
Pneumocystis jirovecii pneumonia (PCP) is an important cause of morbidity in immunocompromised patients, with a higher mortality in non-HIV than in HIV patients. P. jirovecii is one of the rare transmissible pathogenic fungi and the only one that depends fully on the host to survive and proliferate. Transmissibility among humans is one of the main specificities of P. jirovecii. Hence, the description of multiple outbreaks raises questions regarding preventive care management of the disease, especially in the non-HIV population. Indeed, chemoprophylaxis is well codified in HIV patients but there is a trend for modifications of the recommendations in the non-HIV population. In this review, we aim to discuss the mode of transmission of P. jirovecii, identify published outbreaks of PCP and describe molecular tools available to study these outbreaks. Finally, we discuss public health and infection control implications of PCP outbreaks in hospital setting for in- and outpatients.
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Affiliation(s)
- Sarah Dellière
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Maud Gits-Muselli
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
- National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Institut Pasteur, Paris, France
| | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France.
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France.
- National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Institut Pasteur, Paris, France.
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Cillóniz C, Dominedò C, Álvarez-Martínez MJ, Moreno A, García F, Torres A, Miro JM. Pneumocystis pneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients. Expert Rev Anti Infect Ther 2019; 17:787-801. [PMID: 31550942 DOI: 10.1080/14787210.2019.1671823] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Pneumocystis pneumonia (PcP) has classically been described as a serious complication in patients infected with the human immunodeficiency virus (HIV). However, the emerging number of conditions associated with immunosuppression has led to its appearance in other patient populations. Areas covered: This article reviews the most recent publications on PcP in the HIV-infected and HIV-uninfected population, focusing on epidemiology, diagnostic, therapy and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles including randomized clinical trials, meta-analyses, observational studies and clinical reviews. Expert opinion: The growing incidence of Pneumocystis infection in the HIV-uninfected population suggests the need for new global epidemiological studies in order to identify the true scale of the disease in this population. These data would allow us to improve diagnosis, therapeutic strategies, and clinical management. It is very important that both patients and physicians realize that HIV-uninfected patients are at risk of PcP and that rapid diagnosis and early initiation of treatment are associated with better prognosis. Currently, in-hospital mortality rates are very high: 15% for HIV-infected patients and 50% in some HIV-uninfected patients. Therefore, adequate preventive measures should be implemented to avoid the high mortality rates seen in recent decades.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Hospital Clinic, Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS); University of Barcelona; SGR 911; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES) , Barcelona , Spain
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore , Rome , Italy
| | | | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clinic, Barcelona; IDIBAPS; University of Barcelona , Barcelona , Spain
| | - Felipe García
- Department of Infectious Diseases, Hospital Clinic, Barcelona; IDIBAPS; University of Barcelona , Barcelona , Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic, Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS); University of Barcelona; SGR 911; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES) , Barcelona , Spain
| | - José M Miro
- Department of Infectious Diseases, Hospital Clinic, Barcelona; IDIBAPS; University of Barcelona , Barcelona , Spain
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