<p>Clinical characteristics, treatment outcomes, and prognostic factors of <em>Pneumocystis</em> pneumonia in non-HIV-infected patients</p>

Abstract

Objectives: The incidence of Pneumocystis pneumonia (PCP) has been increasing among non-HIV-infected patients. Here, we investigated the clinical characteristics, treatment outcomes, and prognostic factors of PCP in non-HIV-infected patients. Patients and methods: Information on clinical characteristics, treatment outcomes, and prognostic factors of PCP patients who were treated at a medical center in northern Taiwan from October 2015 to October 2016 were retrieved from medical records and evaluated. Results: Among the patients with PCP included in the study, 84 were non-HIV-infected and 25 were HIV-infected. Non-HIV-infected patients with PCP had a longer duration between radiographic findings and treatment ( P <0.001), and a higher rate of hospital-associated PCP ( P <0.001), hypoxia ( P= 0.015), respiratory failure ( P <0.001), and mortality ( P= 0.006) than HIV-infected patients with PCP. Among non-HIV-infected patients, non-survivors had a higher fungal burden (46.2% vs 22.2%, P =0.039), higher requirement for adjunctive steroid treatment (94.9% vs 71.1%, P= 0.011), and higher rate of pneumothorax (17.9% vs 2.2%, P= 0.038) than survivors. Multiple logistic regression revealed that lymphopenia (odds ratio [OR] =3.24, 95% confidence interval [CI] =1.07–9.79; P= 0.037), adjunctive steroid use (OR =6.23, 95% CI =1.17–33.14; P= 0.032), and pneumothorax (OR =10.68, 95% CI =1.00–113.93; P= 0.050) were significantly associated with increased 60-day mortality among non-HIV-infected PCP patients. Conclusion: Lymphopenia, adjunctive steroid therapy, and pneumothorax were significantly associated with higher mortality in non-HIV-infected patients with PCP.

Aetiology and prognostic risk factors of mortality in patients with pneumonia receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study

“… 41 42 Lymphocytopenia has also been shown to be significantly associated with increased mortality in non-HIV-infected patients with PCP or viral pneumonias. 27 43 Vial-Dupuy et al indicated that high-dose steroid use during an ICU stay (OR=0.19; 95% CI 0.04 to 0.99) was an independent determinant of in-hospital mortality in patients with interstitial lung disease admitted to the ICU. 44 Kotani et al ’s study indicated that interstitial lung disease was a risk factor associated with mortality in patients with PCP who required mechanical ventilation.…”

Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

“…Opportunistic infection has become a global pandemic and major public health concern in immunocompromised patients ( 1 , 2 ). Pneumocystis jiroveci pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP), is the most common opportunistic infection, causing high mortality and morbidity in developing countries.…”

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

“…c c e p t e d M a n u s c r i p tTable 1summarizes the clinical presentation, radiographic features and outcomes of PcP in HIV-infected and HIV-uninfected patients. HIV-infected patients typically show a sub-acute onset of the infection, longer symptoms duration (3 weeks), low-grade fever with progressive dyspnea and less severe course with a mortality rate of 15%[46,51,67]. HIV-uninfected individuals, by contrast, typically have a rapid onset, fast progression to respiratory failure, shorter symptoms duration (4-7 days) , are more likely to require ICU admission and fulminant course with a mortality rate of 30%-60%.The different clinical presentation is not associated with the pulmonary fungal load; in fact, it seems to be related to pneumonia severity and the degree of lung inflammation.…”