Underlying renal insufficiency: the pivotal risk factor for Pneumocystis jirovecii pneumonia in immunosuppressed patients with non-transplant glomerular disease

Zheng

Canadian Journal of Infectious Diseases and Medical Microbiolog

et al. 2020

Purpose. With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients.is study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. Methods. We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. e diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis. Results. A total of 57 patients were included in this study. e PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. e T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4 + T lymphocyte count (OR, 0.981; 95% CI, 0.967-0.996; p � 0.001). e cut-off value of 71 cells/μl for the CD4 + T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used. Conclusions. PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. e CD4 + T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes.

Section: Discussionmentioning

confidence: 95%

Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes

Zheng

Canadian Journal of Infectious Diseases and Medical Microbiolog

et al. 2020

“…PJP has been described with GC therapy at doses as low as 16 mg/d for 8 weeks (62), but is more common at higher doses, and when GCs are used in combination with other immunosuppression. Impaired kidney function and hypoalbuminemia have been described as risk factors for PJP infection in patients with IgA nephropathy (63). Prophylaxis is typically used in AAV, and often in LN in the setting of high-dose steroids with additional immunosuppressive agents.…”

Section: Infection Prophylaxismentioning

confidence: 99%

Complications of Immunosuppression in Glomerular Disease

Jefferson

2018

CJASN

Most glomerular diseases are immunologically mediated disorders of the kidney and are common causes of ESKD. In addition to supportive therapy, a wide range of immunosuppressive agents are used in the management of patients with these conditions. Immunosuppression requires a careful balance of risk and benefits, and many of these agents have a narrow therapeutic window and require close monitoring. This review describes the side effects of immunosuppressive agents used in recent randomized, controlled trials of glomerular disease, and highlights some of the key adverse events that determine the choice and prescription of these medications.

“…P. jirovecii infection may lead to a fatal P. jirovecii pneumonia (PJP) in immunocompromised patients, particularly in those infected with human immunodeficiency virus (HIV). While, the incidence of PJP in HIV-infected patients has decreased dramatically, mainly due to the widespread use of combination antiretroviral therapy, there are growing reports of PJP cases amongst HIV-negative individuals [3][4][5][6][7]. In addition, asymptomatic P. jirovecii colonization is being increasingly identified in immunocompetent individuals [2,8].…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis jirovecii colonization and its association with pulmonary diseases: a multicenter study based on a modified loop-mediated isothermal amplification assay

Xue

Fan

et al. 2020

BMC Pulm Med

Background: Pneumocystis jirovecii (P. jirovecii) is an opportunistic fungal pathogen and the role of its colonization in pulmonary diseases has become a popular focus in recent years. The aim of this study was to develop a modified loop-mediated isothermal amplification (LAMP) assay for detection of Pneumocystis jirovecii (P. jirovecii) DNA amongst non-HIV patients with various pulmonary diseases and use it to examine the prevalence and assess the association of P. jirovecii colonization with clinical characteristics of these diseases. Methods: We modified the previously reported LAMP assay for P. jirovecii by adding real-time detection. This method was used to detect P. jirovecii colonization in pulmonary samples collected from 403 non-HIV patients with various pulmonary diseases enrolled from 5 hospitals in China. We determined the prevalence of P. jirovecii colonization in 7 types of pulmonary diseases and assessed the association of P. jirovecii colonization with clinical characteristics of these diseases. Results: The modified LAMP assay showed no cross-reactivity with other common pulmonary microbes and was 1000 times more sensitive than that of conventional PCR. Using the modified LAMP assay, we detected P. jirovecii colonization in 281 (69.7%) of the 403 patients enrolled. P. jirovecii colonization was more common in interstitial lung diseases than in chronic obstructive pulmonary disease (COPD) (84.6% vs 64.5%, P < 0.05). Patients with acute exacerbation of COPD had a higher prevalence of P. jirovecii colonization compared to patients with stabilized COPD (67.4% vs 43.3%, P < 0.05). P. jirovecii colonization was associated with decreased pulmonary function, increased levels of 1,3-β-D-glucan and C-reactive protein, and decreased levels of CD4+ T-cell counts (P < 0.05 for each). Approximately 70% of P. jirovecii colonized patients had confections with other fungi or bacteria.