Characteristics and risk factors for Pneumocystis jirovecii pneumonia in patients with idiopathic membranous nephropathy

Yang, Lie; Xia, Peng; Zhou, Yangzhong; Cui, Quexuan; Chen, Gang; Zheng, Ke; Qin, Yan; Li, Xuemei

doi:10.1007/s10096-021-04227-0

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…Although peripheral lymphocytopenia, especially a low CD4 + T-cell count, is a recognized risk factor for HIV-PJP, the peripheral lymphocyte percentage, absolute lymphocyte count, and subtype features are variable among the different studies of non-HIV-PJP patients administered corticosteroids [ 4 , 10 , 29 , 30 , 31 ]. A low peripheral lymphocyte percentage is more common than a low lymphocyte count for our PJP patients, which might be caused by the elevation of the WBC count after corticosteroid administration.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Analysis of Pneumocystis Jirovecii Pneumonia in Interstitial Lung Disease Patients: A Retrospective Clinical Study

et al. 2022

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(1) Background: The clinical characteristics and the prognostic factors of HIV-negative Pneumocystis jirovecii pneumonia (PJP) patients (non-HIV-PJP) with interstitial lung disease (ILD) remain unclear. Our objectives were to describe the clinical characteristics and to explore the prognostic factors of non-HIV-ILD-PJP patients. (2) Methods: The enrolled patients in this retrospective study were stratified based on the presence or absence of ILD and fibrotic ILD (FILD). The log-rank test and Cox regression models were used to analyze the prognostic factors. (3) Results: Among 378 non-HIV-PJP patients, there were 133 patients with ILD-PJP, and 70 patients were classified as having FILD-PJP. The all-cause mortality rate for the ILD-PJP group is higher than that of the ILD-PJP group (57.9% vs. 38.4%, p < 0.001). However, the all-cause mortality is similar between the FILD-PJP group and non-FILD-PJP group. Preexisting ILD (HR: 2.156, p = 0.003) and honeycomb appearance on the chest HRCT (HR = 16.3, p < 0.001) are independent survival risk factors for ILD-PJP. Non-invasive ventilation is an independent survival risk factor for ILD-PJP patients (HR = 928.56, p < 0.01) and FILD-PJP patients (HR = 33.86, p < 0.001). (4) Conclusions: Pre-existing ILD and honeycomb appearance on the chest HRCT are independent survival risk factors for PJP patients. Non-invasive ventilation is associated with poor survival for both ILD-PJP and FILD-PJP patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic Analysis of Pneumocystis Jirovecii Pneumonia in Interstitial Lung Disease Patients: A Retrospective Clinical Study

et al. 2022

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“…Although peripheral lymphocytopenia, especially a low CD4 + T cell count, was a recognized risk factor for HIV-PJP, the peripheral lymphocyte percentage, absolute lymphocyte count and subtype features have been variable among the different studies of non-HIV-PJP patients who were administered corticosteroids [4,10,[25][26][27]. A low peripheral lymphocyte percentage was more common than a low lymphocyte count for our PJP patients, which might be caused by the elevation of the WBC count after corticosteroid administration.…”

Section: Discussionmentioning

confidence: 99%

Prognostic analysis of Pneumocystis jirovecii pneumonia in interstitial lung disease patients: a retrospective clinical study

Sun

Shao

Huang

et al. 2022

Preprint

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Background Pre-exiting chronic lung disease was a poor prognostic factor for pneumocystis jiroveci pneumonia (PJP). However, the clinical characteristics and the prognostic factors of HIV negative PJP patients (non-HIV-PJP) with interstitial lung disease (ILD) remains unclear. Methods This was a retrospective study of hospitalized patients with confirmed PJP and ILD at Peking Union Medical College Hospital between January 2014 and December 2020. The enrolled patients were stratified based on the presence or absence of ILD and the presence of fibrotic ILD (FILD) or nonfibrotic ILD (non-FILD). The log-rank test and Cox regression models were used to analyze the prognostic factors for PJP patients with different pre-existing statuses. Results Among 836 hospitalized individuals with PJP, there were 378 non-HIV-PJP with complete clinical-radiological-follow-up data. Among them, there were 133cases (35.2%) with non-HIV-ILD-PJP, and 70 patients were classified as fibrotic ILD-PJP. The all-cause mortality rate for ILD-PJP group was higher than that of non-ILD-PJP group (57.9% vs 38.4%, Log-rank = 12.2, p < 0.001, However, the all-cause mortality was similar between FILD-PJP and non-FILD-PJP (Log-rank = 0.03, p > 0.05). Co-infection with aspergillosis(HR = 2.89, χ2 = 5.0, p = 0.02, 95%CI:1.14–7.28), honeycomb in the chest HRCT(HR = 16.3, χ2 = 16.8, p < 0.001, 95%CI:4.3–62), invasive ventilation(HR = 3.02, χ2 = 7.1, p < 0.01, 95%CI:1.34–6.82) and non- invasive ventilation(HR = 6.2, χ2 = 16.7, p < 0.001, 95%CI:2.58–14.9 ) were independent survival risk factors for non-HIV-ILD-PJP. Non-invasive ventilation support (HR = 928.56, χ2 = 7.3, p < 0.01, 95%CI:6.6-130796.5) and the serum D-dimer (HR = 1.2, χ2 = 10.9, p < 0.001, 95%CI:1.01–1.34) were independent survival risk factors for fibrotic ILD-PJP patients. Conclusions Pre-exiting ILD is independently associated with poor survival of PJP patients. Co-infection with aspergillosis, honeycomb in the chest HRCT, invasive ventilation and non- invasive ventilation were independent survival risk factors for ILD patients complicated with PJP.

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“…Previous observational studies showed that high-dose and long-term glucocorticoid therapy and low LYMP count in non-HIV and non-organ transplant patients were highly associated with PCP. [54][55][56][57][58] A study showed a decrease in the percentage of CD4+, CD4+/ CD8 + ratios and NK cell in patients with Cushing's syndrome compared to controls. [59] The stimulating signals from dendritic cells (DCs) are the beginning of T cell mediated adaptive immune response.…”

Section: Casementioning

confidence: 99%

Case report: A HIV-negative hemodialysis patient positive for pANCA with severe pneumocystis pneumonia: A case report and review of literature

Jingda

Zeng

et al. 2023

Medicine

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Rationale: Pneumocystis pneumonia (PCP) is an opportunistic fungal infection that occurs in people with impaired or suppressed immunity such as patients with human immunodeficiency virus or organ transplant. However, the incidence and characteristics of PCP in the population with long-term hemodialysis is poorly described in the literature. Patient concerns: We present a case of a 50-year-old female patient being transferred to our hospital in February 2022 with a 20-day history of cough and tight breath. She received amoxicillin and cephalosporin anti-infection treatment successively in local hospital but no significant improvement in symptoms. She had a 2-year history of hemodialysis and no relevant transplantation and human immunodeficiency virus infection. She was diagnosed as ANCA associated vasculitis (AAV) and given oral prednisone acetate (20 mg/day) and methotrexate (2.5 mg/week) half a year ago. Diagnoses: Based on the patient’s medical history, Lung computerized tomography image, the Next generation sequencing report, the patient was diagnosed with renal failure, anti-neutrophil cytoplasmic antibody associated vasculitis, and Pneumocystis pneumonia. Interventions: The dosage of immunosuppressant was reduced due to leucocyte dripping and fever, and antibiotic and antifungal treatment were also given. The patient’s lung condition was getting worse and noninvasive ventilator was required to maintain blood oxygen. Blood filtration is used to remove toxins. Ganciclovir and trimethoprim-sulfamethoxazole was used based on the next generation sequencing report. Outcomes: The patient died of respiratory failure. Lessons: The risk of PCP in hemodialysis patients may be higher than that in ordinary population, and the prognosis of patients with immunosuppression may be worse. Dynamic assessment of vasculitis activity is necessary for hemodialysis patients with AAV because infections may obscure lung symptoms of AAV. It is not recommended that hemodialysis patients with long-term immunosuppression should reduce or stop the dosage of immunosuppressive drugs during the treatment because it may aggravate the condition of PCP. There is still no clear conclusion on whether hemodialysis patients need preventive medicine, but the identification of risk factors and early diagnosis and treatment are important for the prognosis of PCP on hemodialysis population.

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Characteristics and risk factors for Pneumocystis jirovecii pneumonia in patients with idiopathic membranous nephropathy

Cited by 8 publications

References 37 publications

Prognostic Analysis of Pneumocystis Jirovecii Pneumonia in Interstitial Lung Disease Patients: A Retrospective Clinical Study

Prognostic Analysis of Pneumocystis Jirovecii Pneumonia in Interstitial Lung Disease Patients: A Retrospective Clinical Study

Prognostic analysis of Pneumocystis jirovecii pneumonia in interstitial lung disease patients: a retrospective clinical study

Case report: A HIV-negative hemodialysis patient positive for pANCA with severe pneumocystis pneumonia: A case report and review of literature

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