Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness

Abstract

Objective Pneumocystis jirovecii pneumonia (PCP) is a fatal respiratory infection, mostly associated with immunocompromised conditions. Several reports have described PCP development in patients who were not immunocompromised, but the clinical course and prognosis of PCP are not well understood. We compared the clinical characteristics and prognoses between patients with and without immunocompromised conditions who developed PCP. Methods We retrospectively analyzed patients who had been treated for PCP from three hospitals. We defined immunocompromised (IC) status as following: human immunodeficiency virus (HIV) infection; hematological malignancy; solid organ tumor under chemotherapy; rheumatic disease; medication with immunosuppressive agents. Patients without immunocompromised status were defined as being non-immunocompromised (non-IC). Results The IC and non-IC groups comprised 173 and 14 patients. The median ages were 62.0 and 74.0 years in the IC and the non-IC group, respectively. The median interval between admission and anti-PCP treatment was significantly longer for patients in the non-IC group than that for patients in the IC group (7 vs. 2 days). The in-hospital mortality rates were significantly higher for patients in the non-IC group than that for patients in the IC group (71.4% vs. 43.9%; P = 0.047). A longer interval between admission and anti-PCP therapy was associated with increased 90-day mortality rate in patients with PCP (hazard ratio, 1.082; 95% confidence interval, 1.015–1.153; P = 0.016). Conclusions Patients with PCP with no predisposing illnesses were older and had higher mortality rates than IC patients with PCP. Delayed anti-PCP treatment was associated with increased 90-day mortality.

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

“…Therefore, the complications associated with PJP might be neglected or misdiagnosed in ILD patients. Concomitant ILD was associated with a poor prognosis for non-immunocompromised PJP patients [35]. The interval between the onset and the diagnosis of the ILD-PJP patients was longer than that of the non-ILD-PJP patients in our study.…”

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

“…Therefore, the complications associated with PJP might be neglected or misdiagnosed in ILD patients. Concomitant ILD is associated with a poor prognosis for non-immunocompromised PJP patients [ 39 ]. The interval between the onset and the diagnosis of the ILD-PJP patients is longer than that of the non-ILD-PJP patients in our study.…”

Clinical features and prognostic predictors in patients with rheumatic diseases complicated by Pneumocystis pneumonia

“…We retrospectively reviewed the medical records of patients with rheumatic diseases who had a positive quantitative polymerase chain reaction (PCR) assay for Pneumocystis jirovecii in respiratory tract specimens between November 2015 and April 2021 at the National Taiwan University Hospital (NTUH), a tertiary referral hospital in Northern Taiwan. The diagnosis of PCP requires fulfillment of clinical, radiographic, and microbiological criteria (Kim et al, 2021, Lagrou et al, 2021. Clinical criteria included fever, cough, dyspnea, and hypoxemia.…”

“…A score of 0 indicates the absence of comorbidity, and the maximum score is 29 (Charlson et al, 1987, Ward et al, 2006. All participants were categorized into survivors and non-survivors according to all-cause in-hospital mortality, 30-day, and 90-day mortality after the initiation of anti-Pneumocystis treatment (Assal et al, 2021, Gaborit et al, 2019, Ishikawa et al, 2021, Kim et al, 2021. The median daily adjunctive corticosteroid dosage was calculated according to the accumulated corticosteroid dose during the anti-Pneumocystis treatment (Assal et al, 2021).…”