Pneumocystis pneumonia in non-HIV immunocompromised patients in 2026: evolving therapeutic standards.

INTRODUCTION

Pneumocystis jirovecii pneumonia (PJP) remains a life-threatening lower respiratory tract infection associated with respiratory failure in patients with impaired T-cell immunity. Its incidence is increasing in non-HIV patients, who typically experience a more severe disease course and poorer outcomes than HIV patients. Keeping a high level of suspicion for PJP when confronted to an immunocompromised patient presenting with an acute respiratory failure (ARF) is essential to start promptly the treatment and thereby reduce associated morbidity and mortality.

AREAS COVERED: The mechanism of Pneumocystis jirovecii infestation and the immune cells implicated in the host response are discussed. The clinical and patterns on imaging are reported. The need for prompt treatment initiation, even before diagnostic confirmation is emphasized. The prophylactic and therapeutic arsenal is listed and discussed, as well as adverse events and additional measures.

EXPERT OPINION: The research field for PJP in non-HIV patients in the next years should focus on: individualize the risk prediction of PJP, define an international quantitative PCR threshold, improve diagnostic criterion, optimize the treatment.