Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus (HIV)—Positive and HIV-Negative Immunocompromised Patients

Abstract

For 89 human immunodeficiency virus (HIV)-positive and 32 HIV-negative immunocompromised patients who had 121 episodes of Pneumocystis carinii pneumonia (PCP), clinical features and changes over time were compared. HIV-infected patients characteristically had a longer duration of symptoms (23 vs. 13 days; P<.005); were younger (39 vs. 48 years; P<.001); had a higher frequency of sweating, weight loss, and thoracic pain; and had fewer admissions to the intensive care unit (16% vs. 31%; P<.05). In addition, they had significantly higher hemoglobin levels, lower thrombocyte counts, lower C-reactive protein values, and a higher proportion of eosinophils and lymphocytes in bronchoalveolar lavage fluid. After 1995, HIV-negative patients' mean length of stay dropped from 34 days to 16 days (P<.005), and their hospital mortality rate dropped from 29% to 7% (P<.001). HIV-positive patients with PCP differed in several aspects from those without HIV infection. Knowledge gained from experience with treatment of opportunistic infections in patients with AIDS has improved the management of PCP in patients with other immunodeficiencies.

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

“…PCP in HIV patients has a slow and progressive onset, accompanied with non-specific symptoms such as fever, non-productive cough, weight loss, and cachexia (7). In contrast, PCP in non-HIV patients usually presents with abrupt dyspnea, hypoxemia, and respiratory failure (2). The outcome of PCP in non-HIV patients is usually worse than that of HIV patients (8).…”

“…The period of greatest risk for PCP is the first 6 months after transplantation (1). The onset of PCP in patients without human immunodeficiency virus infection (non-HIV) usually involves a more rapid respiratory insufficiency than in human immunodeficiency virus (HIV) patients (2).…”

Comparación de infecciones por Pneumocystis jiroveci en pacientes con y sin diagnóstico de infección por VIH

“…Las alteraciones anteriormente descritas, por lo tanto, podrían implicar una respuesta inmunológica e inflamatoria diferente, con una presentación clínica y una evolución distinta en ambas poblaciones 19 . Se ha reportado que los pacientes seropositivos para VIH son más jóvenes y presentan una mayor duración de los síntomas 13,20,21 . Asimismo, estos pacientes tienden a desarrollar fiebre, taquipnea e hipoxemia con mayor frecuencia, pero sin significancia estadística 13,21,22 .…”

“…Se ha reportado que los pacientes seropositivos para VIH son más jóvenes y presentan una mayor duración de los síntomas 13,20,21 . Asimismo, estos pacientes tienden a desarrollar fiebre, taquipnea e hipoxemia con mayor frecuencia, pero sin significancia estadística 13,21,22 . Sin embargo, los pacientes seronegativos para VIH muestran un peor pronóstico con mayor progresión a falla respiratoria, requerimiento de asistencia respiratoria mecánica (ARM) y mortalidad, no alcanzando esta última una diferencia estadísticamente significativa 19,20,[22][23][24][25][26] .…”

Do normal C-reactive protein levels exclude the diagnosis of cryptococcal meningitis?

“…3 There is some evidence that HIV-infected patients may have a suboptimal immune response to infections with lower CRP levels. 4,5 CRP values in HIV-positive patients with cryptococcal meningitis may therefore have been decreased falsely.…”