Clinical Microbiology and Antimicrobial Chemotherapy. 2024; 26(3):370-377
To evaluate the involvement of P. jirovecii in the infectious and other diseases in children and adults with immunosuppression of various origin. To assess the risk of infection with P. jirovecii, pneumocystosis and its spread by healthcare workers.
An analysis of the results of a study of 1,446 samples of peripheral blood sera from patients, both children and adults, who were treated in hospitals of various profiles in Moscow and represented an increased risk group for pneumocystosis. IgM and IgG class antibodies were determined by enzyme immunoassay (ELISA). Indirect immunofluorescence assay was used to detect all forms of pneumocysts (cyst, precyst, trophozoite) in sputum.
The incidence of pneumocystosis infection was significantly higher in children with druginduced immunodeficiency after a related liver transplant (70.1%) than among children with HIV-related immunodeficiency (36.7%), t = 2.4. Markers of acute pneumocystosis were found in 36.7% of children who underwent transplantation and 10.0% with HIV infection (t = 2.4). The examination of HIV-infected adults, as well as patients whose HIV infection is complicated by tuberculosis, tuberculosis patients without HIV infection and healthy adults of the comparison group (donors) showed that markers of acute pneumocystosis were most often detected in tuberculosis patients – in 27.1% of cases, in 22.8% of HIVinfected with tuberculosis and in 21.1% of patients with HIV infection, while in the comparison group, markers of acute pneumocystosis were found in only 2.7% of donors. Markers of pneumocystosis were found in 62.6% of children with obstructive bronchitis, of whom 30.4% of patients had an active infection. In children with long-term subfebrile temperature, these indicators were 56.4% and 36.9%. Observation of frequently ill children revealed markers of pneumocystosis in 21.0%, more than half of them were carriers of P. jirovecii (11.3%), and 6.4% were diagnosed with acute pneumocystosis, but only 3.2% of the children had asymptomatic infection. According to a study of healthcare workers in several Moscow hospitals, they should be considered as a double-risk group due to the possibility of both infection and spread of pneumocystosis. Markers of acute infection (IgM, IgM + IgG) were found in 20.0–28.6% of healthcare workers. Acute pneumocystosis was diagnosed 2.4–3.4 times more frequently among healthcare workers than in the comparison group (8.3%).
All of the studied pediatric and adult populations are at increased risk of contracting and spreading of pneumocystosis, which makes it necessary to monitor this infection in high-risk groups.