Rise in Pneumocystis Pneumonia Highlights Need for Additional Prophylactic Measures

microscopic pneumonia in lungs
microscopic pneumonia in lungs
Researchers assessed the incidence of pneumocystis pneumonia among individuals in Germany between 2014 and 2019.

Although the incidence of Pneumocystis jirovecii (formerly Pneumocystis carinii) pneumonia (PCP) increased significantly for the general population in Germany between 2014 and 2019, it decreased among patients with HIV infection. These findings were published in The Lancet Regional Health Europe.

To elucidate the recent trends in PCP epidemiology in Germany, researchers analyzed all patients who were hospitalized with PCP between January 2014 and December 2019. At this time, a retrospective cohort study was conducted at 2 German university hospitals in which all patients with PCP were more thoroughly investigated.

During the study period, the researchers observed that the annual incidence of PCP increased from 2.3 to 2.6 per 100,000 individuals (P <.0001). Of individuals diagnosed with PCP, approximately 65.3% were men and 48.8% were among those aged between 50 and 75 years. In addition, the median patient age at receipt of diagnosis increased from 62 (IQR, 49-72) to 64 (IQR, 52-74) years. A significant increase in PCP incidence was observed among patients with solid malignancies, those with autoimmune disease, and those with rheumatic or kidney disease. Although patients with pulmonary disease and those with more than 1 underlying condition also experienced an increase in PCP incidence, the increase was not significant (P =.6010 and P =.94, respectively).

This increase in PCP incidence was not universal across all patient populations. Among patients with HIV infection, PCP diagnoses and PCP-related mortality decreased by 4.3% (P =.0046) and 34.2% (P =.019) between 2014 and 2019, respectively. Other patients for whom PCP-related mortality significantly decreased were those with hematologic malignancies, transplant recipients, and those who were receiving chemoprophylaxis against PCP.

Study limitations included the inability to verify patient data at the individual level, and that these findings may only be generalizable to countries with similar demographics.

The researchers concluded, “physicians must be aware of this changing patient population and the urgent need for comprehensive guidelines for PCP prophylaxis for patients with solid malignancies and pulmonary and autoimmune disorders, as well as multimorbid patients.”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Kolbrink B, Scheikholeslami-Sabzewari J, Borzikowsky C, et al. Evolving epidemiology of pneumocystis pneumonia: Findings from a longitudinal population-based study and a retrospective multi-center study in Germany. Lancet Reg Health Eur. Published online May 14, 2022. doi:10.1016/j.lanepe.2022.100400