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Incidence of Pneumocystis jiroveci Pneumonia among Groups at Risk in HIV-negative Patients.
[waldenström macroglobulinemia]
Pneumocystis
jiroveci
pneumonia
in
HIV-negative
immunocompromised
patients
is
associated
with
high
mortality
rates
.
Although
trimethoprim-sulfamethoxazole
(
TMP-SMX
)
provides
a
very
effective
prophylaxis
,
pneumocystosis
still
occurs
and
may
even
be
emerging
,
due
to
sub-optimal
characterization
of
patients
most
at
risk
,
hence
precluding
targeted
prophylaxis
.
We
retrospectively
analyzed
all
cases
of
documented
pneumocystosis
in
HIV-negative
patients
admitted
in
our
institution
,
a
referral
center
in
the
area
,
from
January
1990
to
June
2010
,
and
extracted
data
on
their
underlying
condition
(
s
)
.
To
estimate
incidence
rates
within
each
condition
,
we
estimated
the
number
of
patients
followed-up
in
our
area
for
each
condition
,
by
measuring
the
number
of
patients
admitted
with
the
corresponding
international
classification
diagnostic
code
,
through
the
national
hospital
discharge
database
(
PMSI
)
.
From
1990
to
2010
,
293
cases
of
pneumocystosis
were
documented
,
of
whom
154
(
52
.
6
%
)
tested
negative
for
HIV
.
The
main
underlying
conditions
were
hematological
malignancies
(
32
.
5
%
)
,
solid
tumors
(
18
.
2
%
)
,
inflammatory
diseases
(
14
.
9
%
)
,
solid
organ
transplant
(
12
.
3
%
)
,
and
vasculitis
(
9
.
7
%
)
.
Estimated
incidence
rates
could
be
ranked
in
three
categories
:
i
)
high
risk
(
incidence
rates
>
45
cases
per
100
,
000
patient-
year
)
:
polyarteritis
nodosa
,
granulomatosis
with
polyangiitis
,
polymyositis
/
dermatopolymyositis
,
acute
leukemia
,
chronic
lymphocytic
leukemia
,
and
non-
Hodgkin
lymphoma
;
ii
)
intermediate
risk
(
25
-
45
cases
per
100
,
000
patient-
year
)
:
Waldenström
macroglobulinemia
,
multiple
myeloma
,
and
central
nervous
system
cancer
;
and
iii
)
low
risk
(
<
25
cases
per
100
,
000
patient-
year
)
:
other
solid
tumors
,
inflammatory
diseases
,
and
Hodgkin
lymphoma
.
These
estimates
may
be
used
as
a
guide
to
better
target
pneumocystosis
prophylaxis
in
the
groups
most
at
risk
.
Diseases
Validation
Diseases presenting
"pneumonia"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
allergic bronchopulmonary aspergillosis
alpha-thalassemia
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
heparin-induced thrombocytopenia
hydrocephalus with stenosis of the aqueduct of sylvius
junctional epidermolysis bullosa
lamellar ichthyosis
legionellosis
liposarcoma
lymphangioleiomyomatosis
monosomy 21
oculocutaneous albinism
omenn syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
scrub typhus
severe combined immunodeficiency
triple a syndrome
waldenström macroglobulinemia
wiskott-aldrich syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated