Pneumocystis jiroveciiin Patients With Cystic Fibrosis: A Review
Résumé
Pneumocystispneumonia (PCP) remains the most frequent AIDS-defining illness in developed countries. This infection also occurs in non-AIDS immunosuppressed patients, e.g., those who have undergone an organ transplantation. Moreover, mildPneumocystis jiroveciiinfections related to low pulmonary fungal burden, frequently designated as pulmonary colonization, occurs in patients with chronic pulmonary diseases, e.g., cystic fibrosis (CF). Indeed, this autosomal recessive disorder alters mucociliary clearance leading to bacterial and fungal colonization of the airways. This mini-review compiles and discusses available information onP. jiroveciiand CF. It highlights significant differences in the prevalence ofP. jiroveciipulmonary colonization in European and Brazilian CF patients. It also describes the microbiota associated withP. jiroveciiin CF patients colonized byP. jirovecii. Furthermore, we have describedP. jiroveciigenomic diversity in colonized CF patients. In addition of pulmonary colonization, it appears that PCP can occur in CF patients specifically after lung transplantation, thus requiring preventive strategies. In other respects,Pneumocystisprimary infection is a worldwide phenomenon occurring in non-immunosuppressed infants within their first months. The primary infection is mostly asymptomatic but it can also present as a benign self-limiting infection. It probably occurs in the same manner in CF infants. Nonetheless, two cases of severePneumocystisprimary infection mimicking PCP in CF infants have been reported, the genetic disease appearing in these circumstances as a risk factor of PCP while the host-pathogen interaction in older children and adults with pulmonary colonization remains to be clarified.
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