Outcomes and prognostic factors of non-HIV patients with pneumocystis jirovecii pneumonia and pulmonary CMV co-infection: A Retrospective Cohort Study

Abstract

Background Pneumocystis jirovecii pneumonia (PJP) and pulmonary cytomegalovirus (CMV) infection are common opportunistic infections among immunocompromised patients. However, few studies have evaluated their co-infection, especially among non-HIV patients. Therefore, we aimed to evaluate the outcomes and prognostic factors among non-HIV patients with PJP according to their CMV infection status.MethodsThis retrospective study evaluated non-HIV patients who were diagnosed with PJP between January 2009 and January2016.The patients were classified and compared according to their pulmonary CMV infection status (positive infection: bronchoalveolar lavage fluid [BALF] CMV DNA loads of >500copies/mL).ResultsAmong 70 non-HIV patients with PJP, we identified 38 patients (54.3%) with pulmonary CMV infection. There was no significant difference in the mortality rates for the two groups (p = 0.15). Pulmonary CMV infection was significantly more common among patients who were receiving glucocorticoids and immunosuppressants, compared to corticosteroids only (p = 0.02). Pulmonary CMV infection was also significantly associated with severe dyspnea, a lower PaO2/FiO2, and the presence of centrilobular nodules (p = 0.008). Higher CMV DNA loads in the BALF were positively associated with mortality (p = 0.012).ConclusionsCombined therapy using corticosteroids and other immunosuppressants may be a risk factor for pulmonary CMV co-infection among patients with PJP. In addition, CMV pneumonia should be considered when centrilobular nodules and/or severe hypoxemia are observed in non-HIV patients with PJP. Furthermore, antiviral treatment should be promptly initiated for patients with a high CMV DNA load in BALF, based on their poor prognosis.

Clinical course, treatment and outcome of Pneumocystis pneumonia in immunocompromised adults: a retrospective analysis over 17 years

“…In general, HIV-infected patients require fewer ICU admissions and have better overall survival than non-HIV-infected patients, which is in line with previous reports [ 9 , 22 ]. The PcP mortality rate in HIV-positive patients was in the range of 1–15% [ 9 , 18 , 19 ] compared to 30–40% in HIV-negative patients [ 23 – 25 ]. The better outcome of HIV-positive patients might be the consequence of (1) lower age (− 3.8 years in our cohort), (2) fewer co-morbidities, (3) the reversible nature of the immune defect upon anti-viral treatment strategies and hypothetically (4) greater awareness of PcP in HIV-positive individuals, where it is the most common AIDS-defining disease.…”

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with <b><i>Pneumocystis jirovecii</i></b> Pneumonia

“…In contrast to HIV-infected patients, there is evidence for a more acute onset of symptoms, faster progression of disease, poorer outcome, higher mortality, and higher risk of coinfections [9, 21-24]. …”

Characteristics of Viral Pneumonia in Immunocompromised and Immunocompetent Patients: A Retrospective Cohort Study

“…CMV, especially with PCP coinfection, has a high mortality rate in immunocompromised patients [25,26]. However, at present, there are few comparative studies examining CMV and other respiratory viruses.…”