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Journal of the American Academy of Dermatology
Volume 80, n° 6
pages 1602-1607 (juin 2019)
Doi : 10.1016/j.jaad.2018.12.052
accepted : 27 December 2018
Original Articles

Incidence of pneumocystosis among patients exposed to immunosuppression
 

Sergey Rekhtman, MD, PharmD, MPH, Andrew Strunk, MA, Amit Garg, MD
 Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York 

Correspondence to: Amit Garg, MD, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, Ste 300, New Hyde Park, NY 11042.Donald and Barbara Zucker School of Medicine at Hofstra/Northwell1991 Marcus AveSte 300New Hyde ParkNY11042
Abstract
Background

The decision to administer prophylaxis to patients receiving immunosuppression against pneumocystosis remains a dilemma.

Objective

To determine overall and age-specific 5-year pneumocystosis incidence within a population exposed to immunosuppressants.

Methods

Retrospective cohort analysis identifying incident pneumocystosis cases among adults without HIV, AIDS, or cancer exposed to immunosuppressant, corticosteroid therapy, or both.

Results

We identified 406 new cases among patients prescribed an immunosuppressant, corticosteroid, or both. Overall incidence of pneumocystosis was 0.012% (406/3,366,086). Incidence was highest in those exposed to immunosuppressant and corticosteroid medications (0.199%), followed by those exposed to immunosuppressant alone (0.012%), corticosteroid alone (0.008%), and neither medication (0.001%) (P  < .001). The greatest risk differences were noted between groups exposed to immunosuppressant and corticosteroid compared with neither (0.198%, 95% confidence interval [CI] 0.166%-0.230%) or immunosuppressant alone (0.188%, 95% CI 0.155%-0.221%). The greatest relative risks (RRs) were noted among those receiving immunosuppressant and corticosteroid compared with those exposed to neither (RR 122.5, 95% CI 100.9-148.8) or immunosuppressant alone (RR 16.5, 95% CI 7.3-37.4).

Limitations

We could not confirm dose and duration of exposures.

Conclusion

Incidence of pneumocystosis among patients exposed to immunosuppressants is very low. Prophylaxis for patients receiving combination immunosuppressant and corticosteroid therapy, the group at highest risk, might be warranted.

The full text of this article is available in PDF format.

Key words : corticosteroid, Explorys, immunosuppression, Pneumocystis jirovecii pneumonia, pneumocystosis, prophylaxis, Steven-Johnson syndrome, sulfamethoxazole, toxic epidermal necrolysis, trimethoprim

Abbreviations used : CI, PJP, RR, SJS, TEN, TSX



 Funding sources: None.
 Conflicts of interest: Dr Garg has served as an advisor for AbbVie, Pfizer, Janssen, and Asana Biosciences, and has received honoraria. Dr Rekhtman and Mr Strunk have no conflicts of interest to disclose.
 Reprints not available from the authors.



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