{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:14:51Z","timestamp":1760148891214,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T00:00:00Z","timestamp":1686614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Pneumocystis pneumonia (PcP) is a serious complication of many significant immunocompromising conditions. Prior incidence estimates in Wales are based on PcP\u2019s presentation in the HIV and transplant populations. The objectives were to describe the incidence of PcP in Wales using laboratory reporting measures and assess the impact of underlying immunosuppression cause on mortality. All positive PCR results for PcP between 2015 and 2018 were identified. The total number of unique positives with clinical and radiological correlation was 159 patients, a mean of 39.75 annually. The healthcare records of these patients were reviewed. The mortality at one month was 35.2% and 49.1% at one year. HIV remains the commonest cause of immunosuppression but has lower mortality than non-HIV conditions (12% vs. 59% at one year, p &lt; 0.00001). Non-HIV conditions were categorised as life-threatening and non-life threatening but had a non-significant mortality (66% vs. 54%; p = 0.149), highlighting the negative impact of PcP. An incidence of PcP in Wales of 1.23\u20131.26 cases per 100,000 has been identified, 32\u201335% greater than the upper limit previously estimated. There is high mortality in non-HIV patients regardless of immunosuppression cause. A heightened awareness of PcP in these groups will hasten diagnosis and potentially improve mortality.<\/jats:p>","DOI":"10.3390\/jof9060660","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T02:56:34Z","timestamp":1686624994000},"page":"660","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Gaining an Understanding of Pneumocystosis in Wales"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2479-854X","authenticated-orcid":false,"given":"Jonathan","family":"Ayling-Smith","sequence":"first","affiliation":[{"name":"Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, UK"},{"name":"College of Biomedical and Life Sciences, Cardiff University, Cardiff CF10 3AT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4162-4405","authenticated-orcid":false,"given":"Matthijs","family":"Backx","sequence":"additional","affiliation":[{"name":"Public Health Wales, Cardiff CF10 4BZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Grant","sequence":"additional","affiliation":[{"name":"Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rishi","family":"Dhillon","sequence":"additional","affiliation":[{"name":"Public Health Wales, Cardiff CF10 4BZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3004-279X","authenticated-orcid":false,"given":"Jamie","family":"Duckers","sequence":"additional","affiliation":[{"name":"All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Penarth CF64 2XX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5268-8631","authenticated-orcid":false,"given":"Kerenza","family":"Hood","sequence":"additional","affiliation":[{"name":"College of Biomedical and Life Sciences, Cardiff University, Cardiff CF10 3AT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3056-4205","authenticated-orcid":false,"given":"P. Lewis","family":"White","sequence":"additional","affiliation":[{"name":"Public Health Wales, Cardiff CF10 4BZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"White, P.L., Price, J.S., and Backx, M. (2018). Therapy and Management of Pneumocystis jirovecii Infection. J. Fungi, 4.","DOI":"10.3390\/jof4040127"},{"key":"ref_2","unstructured":"WHO (2022). WHO Fungal Priority Pathogens List to Guide Research, Development and Public Health Action, World Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jinf.2016.10.005","article-title":"Estimating the Burden of Invasive and Serious Fungal Disease in the United Kingdom","volume":"74","author":"Pegorie","year":"2017","journal-title":"J. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e00035-19","DOI":"10.1128\/CMR.00035-19","article-title":"Infectious Complications of Biological and Small Molecule Targeted Immunomodulatory Therapies","volume":"33","author":"Davis","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","first-page":"100400","article-title":"Evolving Epidemiology of Pneumocystis Pneumonia: Findings from a Longitudinal Population-Based Study and a Retrospective Multi-Center Study in Germany","volume":"18","author":"Kolbrink","year":"2022","journal-title":"Lancet Reg. Health-Eur."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1177\/1060028016650107","article-title":"Pneumocystis jirovecii Pneumonia in the Non\u2013HIV-Infected Population","volume":"50","author":"Avino","year":"2016","journal-title":"Ann. Pharmacother."},{"key":"ref_7","unstructured":"(2023, May 10). Quality Statement for Respiratory Disease\u2014Welsh Government, Available online: https:\/\/www.gov.wales\/quality-statement-respiratory-disease-html."},{"key":"ref_8","unstructured":"(2023, May 10). Organ Donation and Transplantation Activity Report 2021\u20132022\u2014NHS Blood and Transplant. Available online: https:\/\/www.organdonation.nhs.uk\/helping-you-to-decide\/about-organ-donation\/statistics-about-organ-donation\/transplant-activity-report\/."},{"key":"ref_9","unstructured":"(2023, April 02). HIV: Annual Data Tables\u2014GOV.UK, Available online: https:\/\/www.gov.uk\/government\/statistics\/hiv-annual-data-tables."},{"key":"ref_10","unstructured":"(2023, February 21). HIV Testing, PrEP, New HIV Diagnoses, and Care Outcomes for People Accessing HIV Services: 2022 Report\u2014GOV.UK, Available online: https:\/\/www.gov.uk\/government\/statistics\/hiv-annual-data-tables\/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2022-report#cd4-count-at-diagnosis-and-late-hiv-diagnoses."},{"key":"ref_11","unstructured":"(2023, May 10). HIV Action Plan for Wales Eliminating HIV-Improving Quality of Life and Tackling Stigma Associated with the Virus\u2014An Action Plan for 2023\u20132026\u2014Welsh Government, Available online: https:\/\/www.gov.wales\/sites\/default\/files\/publications\/2023-03\/hiv-action-plan-for-wales-2023-to-2026.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e02201-17","DOI":"10.1128\/mBio.02201-17","article-title":"Functional and Expression Analyses of the Pneumocystis MAT Genes Suggest Obligate Sexuality through Primary Homothallism within Host Lungs","volume":"9","author":"Richard","year":"2018","journal-title":"mBio"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1093\/mmy\/myz115","article-title":"The Fungal PCR Initiative\u2019s Evaluation of in-House and Commercial Pneumocystis jirovecii QPCR Assays: Toward a Standard for a Diagnostics Assay","volume":"58","author":"White","year":"2020","journal-title":"Med. Mycol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.3760\/cma.j.issn.0366-6999.20122506","article-title":"Use of Real-Time Polymerase Chain Reaction for the Diagnosis of Pneumocystis Pneumonia in Immunocompromised Patients: A Meta-Analysis","volume":"126","author":"Summah","year":"2013","journal-title":"Chin. Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1111\/hiv.13014","article-title":"Pneumocystis jirovecii Pneumonia PCR Test on Upper Respiratory Tract Swab","volume":"22","author":"Sivaraj","year":"2021","journal-title":"HIV Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.cmi.2021.08.017","article-title":"Systematic Review Non-Invasive Diagnosis of Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-Analysis","volume":"28","author":"Smyth","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1093\/cid\/ciy1072","article-title":"Clinical Performance of (1,3) Beta-D Glucan for the Diagnosis of Pneumocystis Pneumonia (PcP) in Cancer Patients Tested with PcP Polymerase Chain Reaction","volume":"69","author":"Morjaria","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","unstructured":"(2022, May 30). Population Estimates for the UK, England and Wales, Scotland and Northern Ireland\u2014Office for National Statistics, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/bulletins\/annualmidyearpopulationestimates\/mid2020."},{"key":"ref_20","unstructured":"(2023, May 10). Cancer Survival in Wales, 2002\u20132018\u2014Public Health Wales. Available online: https:\/\/phw.nhs.wales\/services-and-teams\/welsh-cancer-intelligence-and-surveillance-unit-wcisu\/cancer-survival-in-wales-2002-2018\/."},{"key":"ref_21","unstructured":"(2022, June 01). Oesophageal Cancer Survival Statistics\u2014Cancer Research UK. Available online: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/oesophageal-cancer\/survival#heading-Zero."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11926-017-0664-6","article-title":"Pneumocystis Pneumonia and the Rheumatologist: Which Patients Are at Risk and How Can PcP Be Prevented?","volume":"19","author":"Wolfe","year":"2017","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00296-016-3638-5","article-title":"Mortality in Patients with Rheumatoid Arthritis: A 15-Year Prospective Cohort Study","volume":"37","author":"Boshuizen","year":"2017","journal-title":"Rheumatol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jhin.2016.01.018","article-title":"Systematic Review of Outbreaks of Pneumocystis jirovecii Pneumonia: Evidence That P. Jirovecii Is a Transmissible Organism and the Implications for Healthcare Infection Control","volume":"93","author":"Yiannakis","year":"2016","journal-title":"J. Hosp. Infect."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/6\/660\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:53:41Z","timestamp":1760126021000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/6\/660"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,13]]},"references-count":24,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["jof9060660"],"URL":"https:\/\/doi.org\/10.3390\/jof9060660","relation":{},"ISSN":["2309-608X"],"issn-type":[{"type":"electronic","value":"2309-608X"}],"subject":[],"published":{"date-parts":[[2023,6,13]]}}}