<i>Pneumocystis jiroveci</i> Pneumonia: High-Resolution CT Findings in Patients With and Without HIV Infection

Kanne, Jeffrey P.; Yandow, Donald R.; Meyer, Cristopher A.

doi:10.2214/ajr.11.7329

Cited by 219 publications

(166 citation statements)

References 16 publications

(29 reference statements)

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“…This makes it necessary to give this pathology more consideration and improve diagnostic testing in order to start treatment against PCP in this type of patients as early as possible. 23,24 In our study we have seen that the CAP and PCP had similar mortality knowing that they exhibit different immune status, probably this result reinforces the study of Bordon et al 25 which asserts that neither the levels of CD4 or viral load is a factor of poor prognosis in HIV patient CAP hospitalized. The management of CAP in patients with HIV infection should not be based on CD4+ cell counts or HIV-RNA levels of the HIV infection.…”

Section: Discussionsupporting

confidence: 87%

Changes in the etiology, incidence and prognosis of acute lower respiratory track infections in human immunodeficiency virus patients

Perelló

Escoda

Camón

et al. 2015

Enfermedades Infecciosas y Microbiología Clínica

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a b s t r a c tAim: To describe the, incidence, the changes in the etiology and the prognosis of lower respiratory tract infection (LRTI) in HIV infected patients, presenting by the first time to the Emergency Department (ED), during years 2000-2010. Study design: Prospective collection of data. Metbods: Data were collected on the first visit of HIV-infected patients at our ED due to a LRTI, (defined according to the criteria of the European Respiratory Society), between 1/1/2000 and 31/12/2010. A series of epidemiological and laboratory variables as well as the need for admission to the intensive care unit (ICU). LRTI etiology were also collected. The influence ofthe mentioned variables on 30-day mortality were analyzed. Results: One hundred thirty one patients were included. LRTI represented 27% of visits to the ED by HIV-infected patients. Mean age was 39±9 years. 72% of patients were males. 18% required admission to the ICU. The most frequent LRTI was pneumonia by P. jiroveci in 35 cases, bacterial penumonia in 27 and pulmonary tuberculosis in 20. LRTI incidence gradually reduced significantly over time from 6.13 × 1000 patients/year in year 2000 to 0.23 × 1000 patients/year in 2010 (p<0.05). Overall mortality was 14%. Logistic regression analysis showed that admission to ICU (p<0.004) and viral load (p<0.029) were independent variables predicting mortality. Conclusion: LRTI is a pathology with a decreasing incidence, probably related to the widespread utilization increased of HAART regimens. lts etiology has also been changing, but with a non negligible mortality, mostly when ICU admission was required.© 2014 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.Cambios en la etiología, incidencia y pronóstico de la infección respiratoria aguda de vías bajas en pacientes infectados por el virus de la inmunodeficiencia humana Infecc Microbiol Clin. 2014;xxx(xx):xxx-xxx así como la necesidad de ingreso en una unidad de cuidados intensivos (UCI). Se estudió la etiología de la IRVB y la incidencia. Finalmente se analizaron la influencia de las variables con la mortalidad a 30 días. Resultados: Se incluyeron un total de 131 pacientes. La edad media fue de 39 ± 9 años. El 72% de los pacientes eran varones y el 18% de los pacientes requirieron ingreso en la UCI. La IRVB más frecuente fue la neumonía por P. jirovecci, seguida de la neumonía bacteriana en 27 y la tuberculosis pulmonar en 20. La incidencia de IRVB se ha ido reduciendo gradualmente de forma significativa, 6,13 × 1.000 pacientes/año en 2000 a 0,23 × 1.000 pacientes/año en 2010 (p < 0,05). El análisis de regresión logística mostró que la única variable que predijo mortalidad fue el ingreso en UCI (p < 0,05; OR: 73,01). Conclusión: La IRVB es una enfermedad cuya incidencia y etiología han ido disminuyendo y cambiando respectivamente, probablemente en relación con la utilización generalizada del TAR. Sin embargo, todavía presenta una mortalidad nada despreciable, que es mayor cuando el paci...

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Section: Discussionsupporting

confidence: 87%

Changes in the etiology, incidence and prognosis of acute lower respiratory track infections in human immunodeficiency virus patients

Perelló

Escoda

Camón

et al. 2015

Enfermedades Infecciosas y Microbiología Clínica

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“…Thus, high-resolution chest CT can demonstrate disease that was not diagnosed by conventional X-ray. CT findings to be considered are: the ground-glass pattern, alveolar consolidations, bronchial dilatation, and bronchial wall and interlobular septa thickening, which may form a mosaic attenuation pattern, intralobular reticulation, cystic lesions and nodules [1,3,4]. Although the presence of ground-glass opacities is non-specific for PCP, their absence strongly argues against the diagnosis of PCP, and no further diagnostic testing for PCP or PCP treatment is generally warranted in these cases [3,5].…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jirovecii and Cytomegalovirus Co-Infection in AIDS Patients

Acar

2013

J Med Cases

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A case report of a young woman with insidious dyspnea, cough and weight loss that began 3 months before hospitalization. She referred to occasional cough, wheezing, and fever during the last 2 years. Over one year before, she performed a chest CT that showed diffuse ground-glass opacity (GGO) distributed in both lungs with predominance in the upper and middle areas. She immediately received standardized treatment with sulfamethoxazole-trimethoprim (SMZ-TMP), and ELISA and Western Blot tests for AIDS were performed, and both were positive. Pneumocystis Jirovecci (PCJ) staining and PCR from bronchoalveolar lavage were negative. The GGO seen in CT was inconclusive. After 10 days of treatment, she progressed to being respiratory insufficient. A lung biopsy was done and revealed co-infection of cytomegalovirus (CMV) and PCJ. Although first line therapy for both PCJ and CMV was instituted early, she had an unfavorable outcome. Despite following the recommendations for diagnosis and treatment of community-acquired pneumonia in immunosuppressed patients, the patient died. The use of molecular biomethods for recognizing sulfur resistance is not usually performed in daily practice and an old question regarding the aggressiveness of co-infection of PCJ and CMV returned in this case.

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“…PCP was diagnosed if all of the following clinical, radiological, and microbiological criteria were met: suitable case history, symptoms and clinical findings, immunosuppressive risk factors (amongst others: HIV, hematological diseases, drug-induced immunosuppression), typical interstitial pulmonary infiltrates in chest X-ray or computed tomography (CT), detection of a positive IFT from BAL or a strongly positive PCR result [5,12]. Furthermore, a usual PCP therapy, e.g.…”

Section: Methodsmentioning

confidence: 99%

High Diagnostic Value of a New Real-Time Pneumocystis PCR from Bronchoalveolar Lavage in a Real-Life Clinical Setting

Unnewehr

Friederichs²,

Bartsch³

et al. 2016

Respiration

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Background: To diagnose Pneumocystis jirovecii pneumonia (PCP), PCR testing in bronchoalveolar lavage (BAL) fluid has recently become an alternative to immunofluorescence testing (IFT); however, its diagnostic accuracy is less clear. Objective: To analyze the diagnostic value of a new semiquantitative real-time PCR (RT-PCR) in BAL in a real-life clinical setting. Methods: Retrospective analysis of all RT-PCR results [semiquantitative: negative, weakly positive, and strongly positive; measured in cycle thresholds (Ct)] in BAL in the period between 2010 and 2014. The diagnosis of PCP was defined by clinical, radiological, and laboratory signs and by treatment initiation. Any positive PCR was compared with subsequent IFT. Results: Of 128 patient samples, 32 had PCP. There is a relevant correlation of high significance between positive PCR Ct and IFT (r = -0.7781, p < 0.001), which amounts to about 60% of the variance. Sensitivity, specificity, and positive predictive values (PPV) of any positive RT-PCR were 100, 80, and 63%, respectively. No patient with negative RT-PCR had PCP. Specificity and PPV are 100% in strongly positive RT-PCR, whereas they decrease to 80 and 21% in weakly positive RT-PCR. Conclusion: A negative RT-PCR (Ct >45) rules out PCP. A strongly positive PCR (Ct <31.5) confirms PCP. In these cases, the diagnostic value of the new method is at least equal to the IFT. A weakly positive PCR probably represents pneumocystis colonization and can occur under PCP treatment.

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Pneumocystis jiroveci Pneumonia: High-Resolution CT Findings in Patients With and Without HIV Infection

Cited by 219 publications

References 16 publications

Changes in the etiology, incidence and prognosis of acute lower respiratory track infections in human immunodeficiency virus patients

Changes in the etiology, incidence and prognosis of acute lower respiratory track infections in human immunodeficiency virus patients

Pneumocystis jirovecii and Cytomegalovirus Co-Infection in AIDS Patients

High Diagnostic Value of a New Real-Time Pneumocystis PCR from Bronchoalveolar Lavage in a Real-Life Clinical Setting

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