Update on pulmonary Pneumocystis jirovecii infection in non-HIV patients

Roux, Antoine; Gonzalez, Florent; Roux, M; Mehrad, Mitra; Menotti, Jean; Zahar, Jean‐Ralph; Tadros, Victor-Xavier; Azoulay, Élie; Brillet, P.Y.; Vincent, François

doi:10.1016/j.medmal.2014.01.007

Cited by 116 publications

(127 citation statements)

References 44 publications

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“…Compared to HIV patients, a more rapid spread ground-glass opacity representing alveolitis and less formation of cyst lesions were shown to be the typical findings in non-HIV PCP infection (18). Centrilobular nodules, thickened interlobular septal lines, and tree-in-bud corresponding to bronchiolitis are sometimes present in non-HIV PCP infections (19). In our case, there were diffuse centrilobular nodules with tree-in-bud lesions.…”

Section: Laboratory Parameterssupporting

confidence: 51%

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

Chiu

Wen

Shu

2017

Iran Red Crescent Med J

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Introduction: Pneumocystis carinii pneumonia remains a crucial cause of morbidity and mortality in organ transplant recipients. Pneumocystis carinii pneumonia occurs most frequently within the first 6 months post-transplant. Onset is generally fulminant, and typical symptoms include fever and productive cough accompanied with respiratory distress. Case Presentation: Here, we present a case of a patient who developed P. carinii pneumonia 18 years after renal transplantation and referred to Taichung Veteran General hospital in Taiwan in September 2015. The disease course was indolent without hypoxemia and dyspnea, mimicking walking pneumonia. The risk factors in our case contributing to P. carinii pneumonia included increased doses of immunosuppressants due to recent rejection, treatment with tacrolimus rather than cyclosporine, lymphopenia, and possibly the occurrence of urothelial carcinoma, implying an immune-deficient state. The inflammatory response of P. carinii pneumonia was not intense and gave rise to an indolent disease course. Conclusions: This case should remind clinicians that P. carinii pneumonia could present atypically in an indolent form many years following organ transplantation, especially when predisposing factors are present. Longer duration of P. carinii pneumonia prophylaxis, especially for high-risk patients such as those with potent immunosuppressive regimen, or those who received recent treatment for acute cellular or humeral rejection may be considered.

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Section: Laboratory Parameterssupporting

confidence: 51%

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

Chiu

Wen

Shu

2017

Iran Red Crescent Med J

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“…[12] The early stage of PCP in AIDS patients last longer than that in non-AIDS immunosuppressed hosts. [45] Because of the more rapid progressions of PCP in non-AIDS immunosuppressed hosts, it is important to confirm the diagnosis of PCP in the early stage and begin specific anti-PCP therapy as early as possible, which can sharply reduce the mortality and improve prognosis. [11]…”

Section: Discussionmentioning

confidence: 99%

“…[23] Furthermore, PCP in non-AIDS immunocompromised patients is much more critical than that in AIDS patients. [45]…”

Section: Introductionmentioning

confidence: 99%

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

Jia

Gao

et al. 2016

Chinese Medical Journal

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Background:Although radiological features of pneumocystis pneumonia (PCP) in non-Acquired Immune Deficiency Syndrome (AIDS) immunocompromised patients have been reported by other authors, there were no studies on the radiological stages of PCP previously. This study aimed to elucidate the radiological stages and prognoses of PCP in non-AIDS immunocompromised patients.Methods:Retrospective analysis of radiological manifestations and prognoses of 105 non-AIDS PCP immunocompromised patients from August 2009 to April 2016 was conducted. Chest radiograph was divided into three stages: early stage (normal or nearly normal chest radiograph), mid stage (bilateral pulmonary infiltrates), and late stage (bilateral pulmonary consolidations); chest high-resolution computed tomography (HRCT) was also divided into three stages: early stage (bilateral diffuse ground-glass opacity [GGO]), mid stage (bilateral diffuse GGO and patchy consolidations), and late stage (bilateral diffuse consolidations).Results:The case fatality rate (CFR) of all patients was 34.3% (36/105), all of them took routine chest X-ray (CXR), and 84 underwent chest CT examinations. According to the CXR most near the beginning of anti-PCP therapy, 18 cases were at early stage and CFR was 0 (0/18, P < 0.01), 50 cases were at mid stage and CFR was 28.0% (14/50, P > 0.05), and 37 cases were at late stage and CFR was 59.5% (22/37, P < 0.01). According to the chest HRCT most near the beginning of anti-PCP therapy, 40 cases were at early stage and CFR was 20.0% (8/40, P > 0.05), 34 cases were at mid stage and CFR was 47.1% (16/34, P > 0.05), and 10 cases were at late stage and CFR was 80.0% (8/10, P < 0.05); barotrauma, including pneumothorax, pneumomediastinum, and pneumohypoderma, was found in 18 cases and the CFR was 77.8% (14/18, P < 0.01).Conclusions:Based on the radiological manifestations, the course of PCP in non-AIDS immunocompromised patients can be divided into three stages: early stage, mid stage, and late stage. The prognoses of patients treated at early stage are good, and those at late stage are poor. Furthermore, the CFR of patients with barotrauma is high.

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“…PCP was diagnosed if all of the following clinical, radiological, and microbiological criteria were met: suitable case history, symptoms and clinical findings, immunosuppressive risk factors (amongst others: HIV, hematological diseases, drug-induced immunosuppression), typical interstitial pulmonary infiltrates in chest X-ray or computed tomography (CT), detection of a positive IFT from BAL or a strongly positive PCR result [5,12]. Furthermore, a usual PCP therapy, e.g.…”

Section: Methodsmentioning

confidence: 99%

“…Frequently, it can be difficult to diagnose PCP because clinical signs and radiological results are often mild [5]. In order to complete the diagnosis, bronchoalveolar lavage (BAL) gained by bronchoscopy is recommended [6].…”

Section: Introductionmentioning

confidence: 99%

High Diagnostic Value of a New Real-Time Pneumocystis PCR from Bronchoalveolar Lavage in a Real-Life Clinical Setting

Unnewehr

Friederichs²,

Bartsch³

et al. 2016

Respiration

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Background: To diagnose Pneumocystis jirovecii pneumonia (PCP), PCR testing in bronchoalveolar lavage (BAL) fluid has recently become an alternative to immunofluorescence testing (IFT); however, its diagnostic accuracy is less clear. Objective: To analyze the diagnostic value of a new semiquantitative real-time PCR (RT-PCR) in BAL in a real-life clinical setting. Methods: Retrospective analysis of all RT-PCR results [semiquantitative: negative, weakly positive, and strongly positive; measured in cycle thresholds (Ct)] in BAL in the period between 2010 and 2014. The diagnosis of PCP was defined by clinical, radiological, and laboratory signs and by treatment initiation. Any positive PCR was compared with subsequent IFT. Results: Of 128 patient samples, 32 had PCP. There is a relevant correlation of high significance between positive PCR Ct and IFT (r = -0.7781, p < 0.001), which amounts to about 60% of the variance. Sensitivity, specificity, and positive predictive values (PPV) of any positive RT-PCR were 100, 80, and 63%, respectively. No patient with negative RT-PCR had PCP. Specificity and PPV are 100% in strongly positive RT-PCR, whereas they decrease to 80 and 21% in weakly positive RT-PCR. Conclusion: A negative RT-PCR (Ct >45) rules out PCP. A strongly positive PCR (Ct <31.5) confirms PCP. In these cases, the diagnostic value of the new method is at least equal to the IFT. A weakly positive PCR probably represents pneumocystis colonization and can occur under PCP treatment.

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Update on pulmonary Pneumocystis jirovecii infection in non-HIV patients

Cited by 116 publications

References 44 publications

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

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

High Diagnostic Value of a New Real-Time Pneumocystis PCR from Bronchoalveolar Lavage in a Real-Life Clinical Setting

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