Incidence of Pneumocystosis Among Patients Exposed to Immunosuppression

Publication date: Available online 9 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Sergey Rekhtman, Andrew Strunk, Amit Garg

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 and/or corticosteroid therapy.

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 immunosuppresssant and corticosteroid medications (0.199%), followed by groups exposed to immunosuppresssant alone (0.012%), corticosteroid alone (0.008%), and neither medication (0.001%) (p<0.001). Greatest risk differences were noted between groups exposed to immunosuppresssant and corticosteroid compared with neither [0.198% (95% CI 0.166% - 0.230%)] and with immunosuppresssant alone [0.188% (95% CI 0.155% - 0.221%)]. Greatest relative risks were noted among those receiving immunosuppresssant and corticosteroid compared with those exposed to neither [RR 122.5 (95% CI 100.9-148.8)] or to immunosuppresssant alone [RR 16.5 (95% CI 7.3-37.4)].

Limitations

We could not confirm dose and duration of exposures.

Conclusions

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

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