SynthesisPloS one2013
Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systematic review and meta-regression.
Synthesis in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 67 citations in OpenAlex.
- Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: a systematic review and meta-analysis.BMC infectious diseases · 2016Pooled it
- Recreational drug inhalation and socioenvironmental determinants of pulmonary infection in patients with HIV: a hospital-based case control study.BMC public health · 2026Article
- Pulmonary Immunocompromise in Human Immunodeficiency Virus Disease.Clinics in chest medicine · 2025Review
- Article
- Early changes in the gut microbiome among HIV-infected Individuals in Uganda initiating daily TMP/SMX.medRxiv : the preprint server for health sciences · 2024Article
- Chest X-ray Features of HIV-AssociatedOpen forum infectious diseases · 2024Article
- Alterations of lung microbiota in lung transplant recipients with pneumocystis jirovecii pneumonia.Respiratory research · 2024Observational
- Review
- Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study.Southern African journal of HIV medicine · 2024Article
- Clinical Characteristics and Prognostic Predictors of PneumocystisInfection and drug resistance · 2024Article
- Emerging and re-emerging fungal threats in Africa.Parasite immunology · 2023Review
- Sero-Epidemiology ofJournal of fungi (Basel, Switzerland) · 2022Article
- Evaluation of the performance of DiaSorin molecular Pneumocystis jirovecii-CMV multiplex real-time PCR assay from bronchoalveolar lavage samples.Journal de mycologie medicale · 2020Article
- Pulmonary coinfection byBMJ case reports · 2020Article
- Etiology of Pulmonary Infections in Human Immunodeficiency Virus-infected Inpatients Using Sputum Multiplex Real-time Polymerase Chain Reaction.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Article
- Molecular diagnosis and genotyping ofCurrent medical mycology · 2019Article
- Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study.Environmental health : a global access science source · 2019Article
- Estimated Burden of Serious Fungal Infections in Ghana.Journal of fungi (Basel, Switzerland) · 2019Article
- Pneumocystis pneumonia: still a serious disease in children.Developmental period medicine · 2019Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 5 institutions in 3 countries.
Funding
Abstract
objectivePneumocystis jirovecii pneumonia (PCP), the commonest opportunistic infection in HIV-infected patients in the developed world, is less commonly described in tropical and low and middle income countries (LMIC). We sought to investigate predictors of PCP in these settings.
designSystematic review and meta-regression.
methodsMeta-regression of predictors of PCP diagnosis (33 studies). Qualitative and quantitative assessment of recorded CD4 counts, receipt of prophylaxis and antiretrovirals, sensitivity and specificity of clinical signs and symptoms for PCP, co-infection with other pathogens, and case fatality (117 studies).
resultsThe most significant predictor of PCP was per capita Gross Domestic Product, which showed strong linear association with odds of PCP diagnosis (p<0.0001). This was not explained by study design or diagnostic quality. Geographical area, population age, study setting and year of study also contributed to risk of PCP. Co-infection was common (444 episodes/1425 PCP cases), frequently with virulent organisms. The predictive value of symptoms, signs or simple tests in LMIC settings for diagnosis of PCP was poor. Case fatality was >30%; treatment was largely appropriate. Prophylaxis appeared to reduce the risk for development of PCP, however 24% of children with PCP were receiving prophylaxis. CD4 counts at presentation with PCP were usually <200×10(3/)ml.
conclusionsThere is a positive relationship between GDP and risk of PCP diagnosis. Although failure to diagnose infection in poorer countries may contribute to this, we also hypothesise that poverty exposes at-risk patients to a wide range of infections and that the relatively non-pathogenic P. jirovecii is therefore under-represented. As LMIC develop economically they eliminate the conditions underlying transmission of virulent infection: P. jirovecii, ubiquitous in all settings, then becomes a greater relative threat.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.