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Background
Pneumocystis jirovecii (p.jirovecii) is a fungus responsible for causing opportunistic
Pneumocystis pneumonia (PCP) in immunocompromised patients. Currently the Centers
for Disease Control and Prevention (CDC) recommends following standard precautions
while also avoiding placing a PCP patient in the same room with an immunocompromised
patient. There has been recent scientific evidence that indicates P.jirovecii may
be transmitted by the airborne route. The purpose of this literature review is to
evaluate the recent research findings to assess whether escalating transmission-based
precautions from droplet to airborne isolation is necessary to best prevent transmission
of P.jirovecii in the immunocompromised oncologic patient population at a 514-bed
inpatient comprehensive cancer center.
Methods
PubMed was utilized to identify articles describing PCP outbreaks, the fungal characteristics,
and mode of transmission. The articles reviewed comprised of systematic reviews, case
control, and case report studies published between years 2016 through 2021, with one
influential case control study published in 2010. The patient population studied in
the outbreaks included those with heart, kidney, or liver transplants and patient
populations with other immunocompromising conditions.
Results
Nine articles, including 4 systematic reviews, 4 case control studies, and 1 case
report were reviewed. The scientific evidence of the fungal characteristics, mode
of transmission, and occurrence of clusters of PCP cases favored the hypothesis that
airborne transmission is possible. There are still some unknowns including the length
of time that the fungal cysts can remain in the air and if the cysts are spread via
droplet or aerosolized route.
Conclusions
Despite the recent findings demonstrating possible airborne transmission, until further
studies increase the strength of evidence for airborne transmission, droplet precautions
should be considered for PCP patients to prevent transmission in the immunocompromised
population.
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Copyright
© 2022 Published by Elsevier Inc.
