Analysis of Underlying Diseases and Prognosis Factors Associated with Pneumocystis carinii Pneumonia in Immunocompromised HIV-Negative Patients

Abstract

The aim of this retrospective study was to determine the underlying diseases associated with Pneumocystis carinii pneumonia (PCP) in immunocompromised HIV-negative patients and to identify prognosis factors in this population. One hundred three cases of PCP were diagnosed over a 5-year period. Diagnosis was established on the basis of clinical features and by detection of Pneumocystis carinii cysts in bronchoalveolar lavage fluid. Underlying diseases comprised hematologic malignancies (n=60; 58%), inflammatory diseases (n=27; 26%), and solid tumors (n=18; 17.5%); 9 (8%) patients were solid organ transplant recipients. Seventy-one (69%) patients received cytotoxic drugs, 57 (55%) were treated with long-term corticotherapy, and 15 (14.7%) underwent bone marrow transplantation. Fifty-eight (56%) patients were admitted to the intensive care unit, and 52 (41%) required mechanical ventilation. Thirty-nine (38%) patients died of PCP; data from these patients were compared with those from surviving patients. The following factors were associated with a poor prognosis: high respiratory rate (P=0.005), high pulse rate (P=0.0003), elevated C-reactive protein (P=0.01), elevated serum lactate dehydrogenase level (P=0.02), and mechanical ventilation (OR, 14.4; 95%CI, 5-50). The results suggest that PCP can occur during the course of many immunosuppressive diseases, particularly various hematologic malignancies. The diagnosis of PCP should be considered more frequently and advocated earlier in immunocompromised HIV-negative patients, since prompt diagnosis may improve the prognosis of these patients.

Pneumocystis jiroveciiPneumonia in Patients with or without AIDS, France

“…Deaths were lowest for AIDS patients and highest for HSCT recipients, and rates in our study were consistent with earlier data ( 6 , 12 ). Microbial co-infection rates in our study were also in agreement with earlier data ( 22 ).…”

Cellular Profiles of Bronchoalveolar Lavage Fluid and Their Prognostic Significance for Non-HIV-Infected Patients with Pneumocystis jirovecii Pneumonia

“…Through multivariate analysis, we found that solid-organ transplantation was significantly associated with a better outcome. Previous reports have shown that mortality rates vary according to underlying disease or condition among non-HIV-infected patients with PCP (3)(4)(5). A Dutch group reported that the overall mortality rate was 35% among 78 HIV-negative patients, with the lowest rate (8%) among 13 kidney transplant recipients (25).…”

“…Recently, PCP has been reported with increasing frequency in non-HIV-infected patients, particularly in those with underlying immunosuppressive conditions such as hematologic malignancies, solid tumors, collagen vascular diseases, and solidorgan transplants and those receiving immunosuppressive therapies (2,3). Although clinical outcomes of PCP in HIV-infected patients have improved with the introduction of antiretroviral therapy, mortality rates among other immunocompromised patients with PCP who do not have HIV remain high at 30% to 60% (3)(4)(5). Identifying potential prognostic factors in non-HIV-infected patients with PCP could help clinicians make therapeutic decisions, such as choosing the appropriate site of care (intensive care unit versus general ward) or level of patient monitoring.…”

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

“…The clin-ical presentation of PCP in HIV-negative patients is more severe than in HIV-positive patients, leading to estimated mortality rates of 40% and 15%, respectively (20)(21)(22). This is probably due to differences in the pathophysiology of the disease, and particularly in the host immune response.…”