The Prevalence, Predisposing Factors, and Outcomes of Pneumocystis jirovecii Pneumonia among Pediatric Inpatients, Northeastern Iran

Abstract

Objective Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii, is one of the opportunistic fungal infections that can cause life-threatening pneumonia in children with underlying diseases. Due to the similarity of the symptoms of PJP with other lung infections, such as tuberculosis, differential and accurate diagnosis is necessary. The current study investigated the molecular diagnosis of P. jirovecii, predisposing factors and the outcomes, among pediatric inpatients in Northeastern Iran.

Methods In this study, 180 bronchoalveolar lavage specimens were obtained from hospitalized children with respiratory disorders. The specimens were examined using Giemsa stain, and the genomic DNA was extracted according to the protocol of the AmpliSens kit. A real-time polymerase chain reaction (PCR) technique was used to detect P. jirovecii by the AmpliSens Pneumocystis jirovecii (carinii)-FRT PCR kit.

Results Among the patients studied, 34 (18.9%) were positive and 8 (4.4%) were suspicious of the presence of P. jirovecii. Among the 34 positive cases, 12 (35%) were diagnosed before, and 22 (65%) during the coronavirus 2019 (COVID-19) pandemic. Only two cases (5.88%) among the positive ones detected by the real-time PCR method were observed using Giemsa staining. Also, no correlation was observed between positive cases of infection and the sex, the outcomes, and underlying diseases.

Conclusion The results showed that PJP has a relatively high prevalence among pediatric inpatients with respiratory disorders. Neutropenia is a significant predisposing factor in these patients. However, there is no correlation between PJP cases and outcomes and underlying diseases. Most of the patients with PJP were affected during the COVID-19 pandemic, probably due to treatment with corticosteroids.

Keywords

Pneumocystis jirovecii - real-time PCR - Pneumonia - COVID-19 - pediatric

Authors' Contribution

N. H. collected specimens and performed the project. H. Z. interpreted the data and prepared the manuscript. S. J. S. designed and planned the study. H. M. M. and M. J. N. analyzed the data. All authors read and approved the final manuscript.

Financial Disclosure

The authors declare no financial interests related to the materials of the study.

Publikationsverlauf

Eingereicht: 29. Oktober 2023

Angenommen: 05. Juni 2024

Artikel online veröffentlicht:
28. Juni 2024

• References

• 1 Stringer JR, Beard CB, Miller RF, Wakefield AE. A new name (Pneumocystis jiroveci) for Pneumocystis from humans. Emerg Infect Dis 2002; 8 (09) 891-896
• 2 Khodadadi H, Mirhendi H, Mohebali M, Kordbacheh P, Zarrinfar H, Makimura K. Pneumocystis jirovecii colonization in non-HIV-infected patients based on nested-PCR detection in bronchoalveolar lavage samples. Iran J Public Health 2013; 42 (03) 298-305
• 3 Jay A. Fishman, 'Pneumocystis jiroveci'. In: Seminars in Respiratory and Critical Care Medicine. Thieme Medical Publishers; 2020: 141-157
• 4 Youssef J, Novosad SA, Winthrop KL. Infection Risk and Safety of Corticosteroid Use. Rheum Dis Clin North Am 2016; Feb; 42 (01) 157-176
• 5 Ewald H, Raatz H, Boscacci R, Furrer H, Bucher HC, Briel M. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection. Cochrane Database Syst Rev 2015; 2015 (04) CD006150
• 6 Overgaard UM, Helweg-Larsen J. Pneumocystis jiroveci pneumonia (PCP) in HIV-1-negative patients: a retrospective study 2002-2004. Scand J Infect Dis 2007; 39 (6-7): 589-595
• 7 Fillaux J, Malvy S, Alvarez M. et al. Accuracy of a routine real-time PCR assay for the diagnosis of Pneumocystis jirovecii pneumonia. J Microbiol Methods 2008; 75 (02) 258-261
• 8 Arastehfar A, Shaban T, Zarrinfar H. et al. Candidemia among Iranian patients with severe COVID-19 admitted to ICUs. J Fungi (Basel) 2021; 7 (04) 280
• 9 Izadi M, Jonaidi Jafari N, Sadraei J. et al. The prevalence of Pneumocystis jiroveci in bronchoalveolar lavage specimens of lung transplant recipients examined by the nested PCR. Jundishapur J Microbiol 2014; 7 (12) e13518
• 10 Tuncer S, Ergüven S, Kocagöz S, Unal S. Comparison of cytochemical staining, immunofluorescence and PCR for diagnosis of pneumocystis carinii on sputum samples. Scand J Infect Dis 1998; 30 (02) 125-128
• 11 Hosseinikargar N, Basiri R, Asadzadeh M, Najafzadeh MJ, Zarrinfar H. First report of invasive Aspergillus rhinosinusitis in a critically ill COVID-19 patient affected by acute myeloid leukemia, northeastern Iran. Clin Case Rep 2021; 9 (10) e04889
• 12 Kashefi E, Seyedi SJ, Zarrinfar H, Fata A, Mehrad-Majd H, Najafzadeh MJ. Molecular identification of Candida species in bronchoalveolar lavage specimens of hospitalized children with pulmonary disorders. J Babol Univ Med Sci 2021; 23 (01) 331-336
• 13 Zarrinfar H, Kaboli S, Dolatabadi S, Mohammadi R. Rapid detection of Candida species in bronchoalveolar lavage fluid from patients with pulmonary symptoms. Braz J Microbiol 2016; 47 (01) 172-176
• 14 Zarrinfar H, Makimura K, Satoh K, Khodadadi H, Mirhendi H. Incidence of pulmonary aspergillosis and correlation of conventional diagnostic methods with nested PCR and real-time PCR assay using BAL fluid in intensive care unit patients. J Clin Lab Anal 2013; 27 (03) 181-185
• 15 Brancart F, Rodriguez-Villalobos H, Fonteyne P-A, Peres-Bota D, Liesnard C. Quantitative TaqMan PCR for detection of Pneumocystis jiroveci. J Microbiol Methods 2005; 61 (03) 381-387
• 16 Parian M, Fata A, Najafzadeh MJ, Rezaeitalab F. Molecular detection of Pneumocystis jirovecii using polymerase chain reaction in immunocompromised patients with pulmonary disorders in northeast of Iran. Curr Med Mycol 2015; 1 (02) 13-18
• 17 Samuel CM, Whitelaw A, Corcoran C. et al. Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study. BMC Infect Dis 2011; 11: 329
• 18 Wang H-W, Lin C-C, Kuo C-F, Liu C-P, Lee C-M. Mortality predictors of Pneumocystis jirovecii pneumonia in human immunodeficiency virus-infected patients at presentation: experience in a tertiary care hospital of northern Taiwan. J Microbiol Immunol Infect 2011; 44 (04) 274-281
• 19 Liu Y, Su L, Jiang S-J, Qu H. Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis. Oncotarget 2017; 8 (35) 59729-59739
• 20 Hoenigl M, Seidel D, Carvalho A. et al; ECMM and ISHAM collaborators. The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. Lancet Microbe 2022; 3 (07) e543-e552
• 21 Kubin CJ, McConville TH, Dietz D. et al. Characterization of bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 and factors associated with health care-associated infections. Open Forum Infect Dis 2021; 8 (06) ofab201
• 22 Sasso M, Chastang-Dumas E, Bastide S. et al. Performances of four real-time PCR assays for diagnosis of Pneumocystis jirovecii pneumonia. J Clin Microbiol 2016; 54 (03) 625-630
• 23 Mekinian A, Durand-Joly I, Hatron P-Y. et al. Pneumocystis jirovecii colonization in patients with systemic autoimmune diseases: prevalence, risk factors of colonization and outcome. Rheumatology (Oxford) 2011; 50 (03) 569-577
• 24 Botterel F, Cabaret O, Foulet F, Cordonnier C, Costa J-M, Bretagne S. Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients. J Clin Microbiol 2012; 50 (02) 227-231
• 25 Mantadakis E. Pneumocystis jirovecii pneumonia in children with hematological malignancies: diagnosis and approaches to management. J Fungi (Basel) 2020; 6 (04) 331
• 26 Catherinot E, Lanternier F, Bougnoux M-E, Lecuit M, Couderc L-J, Lortholary O. Pneumocystis jirovecii pneumonia. Infect Dis Clin North Am 2010; 24 (01) 107-138
• 27 Coleman H, Snell LB, Simons R, Douthwaite ST, Lee MJ. COVID-19 and Pneumocystis Jirovecii pneumonia: a diagnostic dilemma in HIV. AIDS 2020
• 28 Pasic S, Jankovic I, Rosic R, Ognjanovic M. Pneumocystis carinii pneumonitis in haemophagocytic lymphohistiocytosis. Acta Paediatr 2001; 90 (12) 1480-1482
• 29 Janka G, zur Stadt U. Familial and acquired hemophagocytic lymphohistiocytosis. Hematology (Am Soc Hematol Educ Program) 2005; 2005: 82-88