Relationship between Radiological Stages and Prognoses of Pneumocystis Pneumonia in Non-AIDS Immunocompromised Patients

Mu, Xiaojing; Jia, Peng; Gao, Li; Su, Li; Zhang, Cheng; Wang, Rengui; Wang, Guangfa

doi:10.4103/0366-6999.189068

Cited by 23 publications

(24 citation statements)

References 18 publications

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“…A similar trend has also been reported in other studies [5,19]. Interestingly, the dominant patient group in our sample was in middle-aged men, similar to the cohorts reported in other studies [5,19,21,25,26].…”

Section: Discussionsupporting

confidence: 92%

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Characterization of Pneumocystis jirovecii pneumonia at three tertiary comprehensive hospitals in southern China

Chen

Fang

et al. 2020

Braz J Microbiol

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Due to the increasing use of immunosuppressant therapy, Pneumocystis jirovecii pneumonia (PJP) has become an emerging concern in human immunodeficiency virus (HIV)-negative patients. In this study, we conducted a retrospective study of 96 hospitalized patients with PJP from January 2015 to June 2019 at three tertiary comprehensive hospitals in Southern China. Information was collected regarding patient demographics, clinical manifestations, risk factors, laboratory analyses, radiological images, and treatment outcomes. PJP infection was most commonly found in middle-aged men. Kidney diseases (35.5%) and connective tissue diseases (38.7%) were the predominant risk factors for PJP. About half of the patients (48.4%) received glucocorticoid, immunosuppressant, and/or chemotherapy in a low dose or in a short-term (< 3 months). None of the patients had previously received trimethoprim-sulfamethoxazole (TMP-SMX) for PJP prophylaxis. All patients had two or more clinical manifestations (cough, dyspnea, fever, and chest pain). Biochemical investigations of CRP, ESR, PaO 2 , LDH, and KL-6 showed that over 90% of the patients exceeded the reference range of indicators. Our analyses revealed the dominant risk factors (HIV, kidney diseases, and connective tissue diseases) and the most consistent biochemical indicators (LDH, BG, and KL-6) for PJP. Moreover, early prophylaxis, diagnosis, and treatment should contribute to improve the survival of these PJP patients.

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Section: Discussionsupporting

confidence: 92%

“…According to Mu et al [21], the manifestations of PJP based on chest computed tomography (CT) could be divided into three stages: early stage, middle stage, and late stage. In the early stage, the chest CT scans showed bilateral diffuse ground-glass opacities (GGOs).…”

Section: Data Collectionmentioning

confidence: 99%

Characterization of Pneumocystis jirovecii pneumonia at three tertiary comprehensive hospitals in southern China

Chen

Fang

et al. 2020

Braz J Microbiol

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“…Conversely, HIV-uninfected patients generally show diffuse lung infiltrates and evident consolidations, with few cases presenting pulmonary cysts or pneumatoceles (Figure 2, c, d In HIV-uninfected patients consolidations and GGO have been reported more frequently [80]. Interestingly, the study by Mu et al [83] investigated the relationship between radiological stages (early: early normal or nearly normal on chest x-ray or and specificity in BAL (99% and 100% respectively) or induced sputum (50% and 100% respectively) using other staining methods as a gold standard. This assay facilitates the identification of both cystic and trophic forms [89].…”

Section: Radiographic Featuresmentioning

confidence: 92%

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

Cillóniz

Dominedò

Álvarez-Martínez

et al. 2019

Expert Review of Anti-infective Therapy

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Introduction: Pneumocystis pneumonia (PcP) has classically been described as a serious complication in patients infected with the human immunodeficiency virus (HIV). However, the emerging number of conditions associated with immunosuppression has led to its appearance in other patient populations, such as those receiving chronic corticosteroid therapy, those with hematological or solid malignancies, transplant recipients and those who receive immunomodulatory or biological therapy. Areas covered: This article reviews the most recent publications on PcP in the HIVinfected and HIV-uninfected population, focusing on epidemiology, diagnostic, therapy and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles including randomized clinical trials, meta-analyses, observational studies and clinical reviews. Eligible studies were selected in two stages: sequential examination of title and abstract, followed by full text. Expert opinion: Widespread use of antiretroviral and prophylactic therapy in HIVinfected patients has decreased the incidence of PcP in this population. However, the growing incidence of Pneumocystis infection in the HIV-uninfected population suggests the need for new global epidemiological studies in order to identify the true scale of the disease in this population. These data would allow us to improve diagnosis, therapeutic strategies, and clinical management. It is very important that both patients and physicians realize that HIV-uninfected patients are at risk of PcP and that rapid diagnosis and early initiation of treatment are associated with better prognosis. Currently, in-hospital mortality rates are very high: 15% for HIV-infected patients and 50% in some HIV-uninfected patients. Therefore, adequate preventive measures should be implemented to avoid the high mortality rates seen in recent decades.

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“…Additionally, all-course mortality rates from patients receiving combination therapy decreased by ~50% when it was used as a first-line therapy compared with when it was used as a second-line therapy (33.33% vs. 60.00, respectively). The improvements in positive responses and all-course mortality rates were unrelated to factors that are regularly attributed to the prognosis of PCP (21)(22)(23)(24)(25), as many were similar between the two groups. These included: Immunosuppressive conditions, lymphocyte count, radiological manifestations, the need for invasive mechanical ventilation and transfer to the intensive care unit, PaO 2 /FiO 2 , APACE II score, and co-infection.…”

Section: Discussionmentioning

confidence: 83%

Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first‑line therapy to treat non‑HIV patients with severe pneumocystis pneumonia

et al. 2017

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Abstract. Combined treatment with caspofungin and trimethoprim/sulfamethoxazole (TMP/SMZ) as salvage therapy in non-HIV positive patients with severe pneumocystis pneumonia (PCP) yields poor outcomes. It remains unknown whether the use of this combination strategy as a first-line therapy would improve patient outcomes. The present study aimed to assess the efficacy of caspofungin combined with TMP/SMZ as a first-line therapy in non-HIV positive patients with severe PCP. A retrospective cohort study was conducted between March 2016 and February 2017. Patient clinical characteristics and outcomes were compared between two groups receiving first-line and second-line therapy respectively. In addition, similar cases from previous studies were assessed. A total of 14 patients were included in the present study (mean age, 58.79±14.41 years); including 9 patients receiving caspofungin and TMP/SMZ as a first-line therapy and 5 that received it as a second-line therapy. The overall positive response rate was 71.43% (10/14), with 88.89 (8/9) and 40.00% (2/5) in the first-line and second-line therapy groups, respectively (P=0.095). The positive response rates of patients requiring invasive mechanical ventilation differed significantly between the first-line (5/6, 83.33%) and the second-line (0/3, 0%) therapy groups (P=0.048). All-cause hospital mortality was 42.86% (6/14), with mortality rates of 33.33 (3/9) and 60.00% (3/5) in the first-line and second-line therapy groups, respectively (P=0.580). Combined with previously reported cases (n=27), the positive response rate was significantly greater in the first-line therapy group (11/12, 91.67%) than in the second-line therapy group (8/15, 53.33%, P= 0.043). No significant differences were in all-cause mortality rates between the two groups (25.00 vs. 46.67%, P=0.424) were identified, despite the fact that all-course mortality in the first-line therapy group was ~50% that of the second-line therapy group. Therefore, the results of the present study indicate that combined caspofungin and TMP/SMZ as first-line therapy may be a promising and effective strategy to treat non-HIV positive patients with severe PCP, particularly for those requiring invasive mechanical ventilation.

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Relationship between Radiological Stages and Prognoses of Pneumocystis Pneumonia in Non-AIDS Immunocompromised Patients

Cited by 23 publications

References 18 publications

Characterization of Pneumocystis jirovecii pneumonia at three tertiary comprehensive hospitals in southern China

Characterization of Pneumocystis jirovecii pneumonia at three tertiary comprehensive hospitals in southern China

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

Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first‑line therapy to treat non‑HIV patients with severe pneumocystis pneumonia

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