Journal of Fungi Review Therapy and Management of Pneumocystis jirovecii Infection P. Lewis White *, Jessica S. Price and Matthijs Backx Public Health Wales Microbiology Cardiff, UHW, Heath Park, Cardiff CF14 4XW, UK;
[email protected] (J.S.P.);
[email protected] (M.B.) * Correspondence:
[email protected]; Tel.: +44-(0)29-2074-6581; Fax: +44-(0)29-2074-2161 Received: 10 October 2018; Accepted: 11 November 2018; Published: 22 November 2018 Abstract: The rates of Pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the prophylaxis and treatment of PcP in HIV, haematology, and solid-organ transplant (SOT) recipients is available, although for many other populations (e.g., auto-immune disorders) there remains an urgent need for recommendations. The main drug for both prophylaxis and treatment of PcP is trimethoprim/sulfamethoxazole, but resistance to this therapy is emerging, placing further emphasis on the need to make a mycological diagnosis using molecular based methods. Outbreaks in SOT recipients, particularly renal transplants, are increasingly described, and likely caused by human-to-human spread, highlighting the need for efficient infection control policies and sensitive diagnostic assays. Widespread prophylaxis is the best measure to gain control of outbreak situations. This review will summarize diagnostic options, cover prophylactic and therapeutic management in the main at risk populations, while also covering aspects of managing resistant disease, outbreak situations, and paediatric PcP. Keywords: Pneumocystis pneumonia; PcP therapy; PcP diagnosis 1. Introduction The incidence of Pneumocystis pneumonia (PcP) is rising as a result of an increase in the susceptible patient population.