Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes

Abstract

BackgroundThe number of patients with non-HIV Pneumocystis pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We investigated the clinical characteristics of non-HIV PCP and its association with microbiological genotypes.MethodsBetween January 2005 and March 2010, all patients in 2 university hospitals who had been diagnosed with PCP by PCR were enrolled in this study. Retrospective chart review of patients, microbiological genotypes, and association with 30-day mortality were examined.ResultsOf the 82 adult patients investigated, 50 patients (61%) had inflammatory diseases, 17 (21%) had solid malignancies, 12 (15%) had hematological malignancies, and 6 (7%) had received transplantations. All patients received immunosuppressive agents or antitumor chemotherapeutic drugs. Plasma (1→3) β-D-glucan levels were elevated in 80% of patients, and were significantly reduced after treatment in both survivors and non-survivors. However, β-D-glucan increased in 18% of survivors and was normal in only 33% after treatment. Concomitant invasive pulmonary aspergillosis was detected in 5 patients. Fifty-six respiratory samples were stored for genotyping. A dihydropteroate synthase mutation associated with trimethoprim-sulfamethoxazole resistance was found in only 1 of the 53 patients. The most prevalent genotype of mitochondrial large-subunit rRNA was genotype 1, followed by genotype 4. The most prevalent genotype of internal transcribed spacers of the nuclear rRNA operon was Eb, followed by Eg and Bi. Thirty-day mortality was 24%, in which logistic regression analysis revealed association with serum albumin and mechanical ventilation, but no association with genotypes.ConclusionsIn non-HIV PCP, poorer general and respiratory conditions at diagnosis were independent predictors of mortality. β-D-glucan may not be useful for monitoring the response to treatment, and genotypes were not associated with mortality.

Risk Factors for <i>Pneumocystis jiroveci</i> Pneumonia in Glomerulonephritis Patients Receiving Immunosuppressants

“…Because the sensitivity for PJP is very high, serum β-D-glucan can be used as a screening tool for PJP, especially for patients who are not suitable for the BAL procedure (23,24). Nevertheless, some studies did not find its prognostic value in PJP patients (26,27).…”

Infections in myelodysplastic syndromes

“…144,145 Pneumocystis jirovecii pneumonia appears to be very uncommon in MDS patients. In two large series of P. jirovecii pneumonia in non-HIV patients, MDS was the underlying disease in 3 of 55 (5.4%) 146 and 3 of 82 (4%) 147 of the reported cases, respectively.…”

Características clínicas, diagnósticas y pronosticas de pacientes con neumonía por Pneumocystis jiroveci en individuos infectados por virus de inmunodeficiencia humana e individuos inmunocomprometidos por otra etiología: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients

“…En nuestro estudio, los pacientes no infectados por VIH presentaron más frecuentemente co-infecciones pulmonares por otros microorganismos, encontrándose que un tercio de ellos se diagnosticó la enfermedad por P. jiroveci en forma posterior a otra infección pulmonar en curso. Aun cuando hay pocos estudios que hagan alusión a la concomitancia de otras infecciones pulmonares 16,26,27 y su efecto en el pronóstico, es planteable que la doble infección generaría mayor inflamación e injuria pulmonar, incidiendo en una peor evolución; en nuestro estudio no logramos determinar una correlación entre co-infección y un riesgo aumentado de mortalidad.…”