Clinical Manifestations and Prognostic Factors of <b><i>Pneumocystis jirovecii</i></b> Pneumonia without HIV

Abstract

Introduction:Pneumocystis jirovecii pneumonia (PCP) can occur in HIV patients but also in those without HIV (non-HIV PCP) but with other causes of immunodeficiency including malignancy or rheumatic diseases. Objective and Methods: To evaluate the clinical presentation and prognostic factors of non-HIV PCP, we retrospectively reviewed all patients diagnosed as having PCP without HIV at Kameda Medical Center, Chiba, Japan, from January 2005 until June 2012. For the purpose of examining a prognostic factor for non-HIV PCP with 30-day mortality, we compared the characteristics of patients, clinical symptoms, radiological images, Eastern Cooperative Oncology Group performance status (PS), and the time from the onset of respiratory symptoms to the start of therapy, in both survival and fatality groups. Results: A total of 38 patients were eligible in this study. Twenty-five survived and 13 had died. The non-HIV PCP patients in the survivor group had a better PS and received anti-PCP therapy earlier than those in the nonsurvivor group. Rales upon auscultation and respiratory failure at initial visits were seen more frequently in the nonsurvivor group than in the survivor group. Lactate dehydrogenase and C-reactive protein values tended to be higher in the nonsurvivor group, but this was not statistically significant. Multivariate analyses using 5 variables showed that a poor PS of 2-4 was an independent risk factor for non-HIV PCP patients and resulted in death (odds ratio 15.24; 95% confidence interval 1.72-135.21). Conclusion: We suggest that poor PS is an independent risk factor in non-HIV PCP, and a patient's PS and disease activity may correlate with outcome.

Pneumocystispneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients

“…However, several studies still report high mortality rates among HIV-uninfected patients probably due to the greater intensity of the inflammatory response, the acuteness of symptoms, the more frequent progression to respiratory failure requiring tracheal intubation [8], and also the influence of different management practices [9][10][11][12][13].…”

Lower Mortality Associated With Adjuvant Corticosteroid Therapy in Non-HIV-Infected Patients With Pneumocystis jirovecii Pneumonia: A Single-Institution Retrospective US Cohort Study

“…In HIV-positive patients, highly active antiretroviral therapy (HAART) and antimicrobial prophylaxis in high-risk patients have substantially lowered the incidence and mortality of PJP. PJP also occurs in HIV-uninfected immunocompromised patients, and in this population, PJP mortality has been increasing [ 1 , 2 ]. Mortality attributable to PJP in patients with HIV ranges between 10% and 20%, while mortality in HIV-negative patients ranges between 30% and 50% [ 3–5 ].…”

Non-HIV pneumocystis pneumonia

“…In other studies, it was reported that low serum albumin levels and mechanical ventilation were independent predictors of mortality by multivariate analyses (40,41). In our study, performance status of 2-4, treatment delay and high (severe) disease activity were unfavorable prognostic factors by an univariate analysis (42). More studies and analyses are needed.…”