The association between Cytomegalovirus co‐infection with Pneumocystis pneumonia and mortality in immunocompromised non‐HIV patients

Abstract

Introduction: Impact of Cytomegalovirus (CMV) co-infection pneumonia in non-HIV patients with Pneumocystis jirovecii pneumonia (PCP) is unclear. Objectives: The aim of our study was to determine whether CMV co-infection is associated with an increased risk of mortality. Methods: Our study was conducted at Ege University Hospital, Turkey. We used molecular assays to diagnose Pneumocystis jirovecii in respiratory samples, and CMV in both respiratory and blood samples. We compared morbidity and mortality stratified by CMV co-infection status. Results: Between 2009 and 2015, 43 patients (mean age: 56.7 ± 15.3 years) were diagnosed with PCP. Only 3 of 43 patients had received PCP prophylaxis. We microbiologically confirmed CMV co-infection in 28 of 43 (65.1%) patients. Acute respiratory distress syndrome (ARDS) and requirement of mechanical ventilation were more common in the CMV co-infection group (P = .019 and P = .031 respectively), and duration of intensive care unit was also longer (P = .006). In univariate analyses, mortality at 30 days was higher in the CMV co-infection group as compared to the group with PCP alone (78.6% and 46.7% respectively; P = .046). In multivariate analyses, mortality was independently associated only with the presence of ARDS [OR: 6.22 95% CI 1.3-29.32] and the association with CMV co-infection was no longer significant [OR: 2.6 95% CI 0.49-13.72, P = .257]. Conclusion: The risk of mortality appears to be increased in the setting of CMV and PCP co-infection in HIV-uninfected immunocompromised patients. PCP prophylaxis use was lower than expected, suggesting low physician awareness of the risks of PCP in this population. K E Y W O R D S cytomegalovirus (CMV), HIV-negative (non-HIV), mortality, Pneumocystis jirovecii, pneumonia | 2591 KORKMAZ EKREN et al.

Evaluation of the performance of DiaSorin molecular Pneumocystis jirovecii-CMV multiplex real-time PCR assay from bronchoalveolar lavage samples

“…The PJ-CMV PCR assay detects both of these pathogens in a single sample, eliminating the need for a separate assay for CMV PCR testing in respiratory specimens. Previous studies have reported that 23.4-61.5% of PJP patients also exhibit co-infection with CMV [7,17,19,20]. The percentage of CMV co-infection of this study was found to be 36% of patients, which is consistent with previous studies.…”

Pneumocystis jirovecii Colonization and Its Association with Pulmonary Diseases Based on a Multicenter Study by an Improved Loop-Mediated Isothermal Amplification Assay

“…Despite increasing reports of P. jirovecii colonization, there are only a few studies of coinfection with other respiratory pathogens in patients with P. jirovecii colonization [40][41][42]. Our study found that the majority of individuals with P. jirovecii colonization had concurrent infections with other fungal or bacterial pathogens (Table 4).…”

A Rare Case of Multipathogenic Pneumonia in a Patient With Human Immunodeficiency Virus

“…As such, it is an extremely rare finding and was reported in only 5%-8% of HIV patients undergoing BAL [5]. CMV coinfection has been previously reported in the literature with PCP [8]. CMV pneumonia should be treated similar to other tissue-invasive CMV disease with full treatment doses of antivirals such as IV ganciclovir or IV foscarnet, and the duration of therapy depends on the severity of disease, as well as the clinical and virologic response to treatment ranging from 14 to 28 days or longer [1,6].…”