Pneumocystis Pneumonia in Patients with Autoimmune Diseases: A Retrospective Study Focused on Clinical Characteristics and Prognostic Factors Related to Death

Abstract

BackgroundWith the increasing use of immunosuppressive agents, the number of opportunistic infections has risen in patients with autoimmune diseases. Pneumocystis pneumonia (PCP) is one of these opportunistic infections that have a high mortality rate. However, only a few studies have described PCP in these patients, and these studies are limited in scope. We conducted this retrospective study to describe the clinical characteristics and factors associated with outcomes of PCP in patients with autoimmune diseases.MethodsA retrospective study was performed in laboratory diagnosed PCP patients with autoimmune diseases in an academic hospital over a 10-year period. Patients with human immunodeficiency virus (HIV) infection were not included. Clinical characteristics were collected and the factors related to death were analysed.ResultsA total of 69 patients with PCP during the study period were included. Common clinical features included fever (81%), cough (56%), and dyspnea (35%). Ground glass opacity (81%) and reticulation (52%) were the most common radiological findings. Concurrent pulmonary infections including bacterium, aspergillus and cytomegalovirus were found in 34% of the patients. The overall in-hospital mortality rate was 32%. High mortality was associated with lower PaO2/FiO2 ratios and albumin levels. The lymphocyte count, CD4+ T cell count, previous usage of immunosuppressive agents, the duration and dose of glucocorticoids did not affect the outcome.ConclusionsThe mortality rate in PCP patients with autoimmune diseases is high. Low PaO2/FiO2 ratios and albumin levels are independent prognostic factors of mortality.

Pneumocystis Pneumonia with Atypical Presentation in an HIV Seronegative Patient with Systemic Lupus Erythematosus during Steroid Therapy

“…A CD4+ cell count of less than 200 cells/mm 3 after 1 month of immunosuppressive therapy is another alternative indication to provide PCP prophylaxis in this group. The CD4+ cell count should be monitored in patients who receive more than 15 mg prednisolone or equivalent per day, a corticosteroid for more than 3 months, or with a total lymphocyte count of less than 600 cell/mm 3 (2,14). The timing of the start of prophylaxis therapy as well as the duration and the timing of the discontinuation of therapy may need further investigation in this group.…”

“…including those with connective tissue disease, is increasing (1,2). Chen et al (3) found 69 (26.1%) patients with autoimmune diseases who were diagnosed with PCP over a 10-year period. PCP infection in systemic lupus erythematosus (SLE) patients is uncommon, but it may be fatal (4).…”

Pneumocystic Pneumonia in Rheumatic Diseases: Current Issues in Prophylaxis

“…В некоторых работах обращается внимание на сниже-ние абсолютного числа лимфоцитов у больных системны-ми РЗ, у которых в дальнейшем развилась ППн [3,9,[10][11][12][13]. Однако контрольная «точка отсечения» уровня лимфоцитов, при которой следует начинать профилакти-ку, до сих пор дебатируется.…”

“…[9]. Среди прочих факто-ров риска летального исхода при ППн называют пожилой возраст, мужской пол, сниженное содержание кислорода во вдыхаемом воздухе, необходимость меха нической венти-ляции легких, снижение содержания сывороточного альбу-мина [3,12]. В целом каких-либо определенных факторов риска летальности, ассоциированной с ППн, у больных системными РЗ не установлено.…”

“…Частота ее составляет 6%, или 20 случаев на 10 000 пациенто-лет [14,18]. Летальность от ППн в дан-ной группе больных колеблется от 33 до 56% [9,10,12,13,18]. Подобно другим системным РЗ факторы риска летальности от пневмоцистоза при ДМ/ПМ не определе-ны.…”