Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis

Rheumatology (Oxford). 2012 Dec;51(12):2120-30. doi: 10.1093/rheumatology/kes244. Epub 2012 Sep 22.


Accompanying the increased use of biologic and non-biologic antirheumatic agents, patients with RA have been exposed to an increased risk of Pneumocystis jirovecii infection, which causes acute fulminant P. jirovecii pneumonia (PCP). Mortality in this population is higher than in HIV-infected individuals. Several guidelines and recommendations for HIV-infected individuals are available; however, such guidelines for RA patients remain less clear. Between 2006 and 2008 we encountered a clustering event of P. jirovecii infection among RA outpatients. Through our experience with this outbreak and a review of the recent medical literature regarding asymptomatic colonization and its clinical significance, transmission modes of infection and prophylaxis of PCP, we have learned the following lessons: PCP outbreaks among RA patients can occur through person-to-person transmission in outpatient facilities; asymptomatic carriers serve as reservoirs and sources of infection; and short-term prophylaxis for eradication of P. jirovecii is effective in controlling PCP outbreaks among RA outpatients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • Arthritis, Rheumatoid / complications*
  • Contact Tracing
  • Disease Reservoirs / microbiology
  • Humans
  • Immunologic Deficiency Syndromes / complications
  • Immunosuppressive Agents / adverse effects
  • Infectious Disease Transmission, Professional-to-Patient
  • Kidney Transplantation
  • Opportunistic Infections / complications
  • Opportunistic Infections / prevention & control*
  • Opportunistic Infections / transmission
  • Pneumocystis carinii*
  • Pneumonia, Pneumocystis / complications
  • Pneumonia, Pneumocystis / prevention & control*
  • Pneumonia, Pneumocystis / transmission
  • Postoperative Complications / microbiology
  • Risk Factors
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use


  • Anti-Infective Agents
  • Immunosuppressive Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination