Comparison of Clinical and Radiological Features of Pneumocystis Pneumonia Between Malignancy Cases and Acquired Immunodeficiency Syndrome Cases: A Multicenter Study (original) (raw)
Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients
International Journal of Infectious Diseases, 2016
Background: Pneumocystis pneumonia (PCP) is one of the most devastating fungal diseases in patients with impaired immunity. Effective antiviral therapies have reduced the burden of PCP among AIDS patients, but an increase in the prevalence of this disease among persons receiving immunosuppressive therapies has been reported. Methods: We retrospectively reviewed HIV and non-HIV PCP patients diagnosed in our department during a nine year period. Data were collected from the local database completed during the diagnosis procedure. For each patient, demographic, clinical, radiological, biological and therapeutic data were analyzed. Results: A total of 21,274 bronchoalveolar samples were received from patients suspected of pneumocystosis during the study period, leading to a discharge diagnosis of PCP for 604 patients (143 HIV-positive and 461 HIV-negative). The ratio of non-HIV versus HIV patients presenting PCP increased from 1.7 to 5.6 during the study period. The mortality rate at day 14 was 16%, occurring mostly in non-HIV patients (20.6% compared to 1.4%, P < 0.0001), while non-HIV patients were less symptomatic at diagnosis than AIDS patients. Conclusions: This study presents one of the higher number of HIV and non-HIV patients presenting with PCP in a single center. Pneumocystosis is now a crucial health challenge for patients receiving immunosuppressive therapy, with a high mortality rate. This study highlights the need for international guidelines for prophylaxis of PCP in non-HIV patients.
Pneumocystis Pneumonia in Patients with Human Immunodeficiency Virus
Tanaffos, 2007
A retrospective study was performed on 12 HIV-infected patients who were hospitalized at the Masih Daneshvari Hospital (NRITLD) and diagnosed as having PCP during 2003PCP during -2007. . In patients suspected of PCP with symptoms such as exertional dyspnea, fever, cough and related radiological findings, bronchoscopy including bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) were performed and high resolution computed tomography (HRCT) was obtained from all patients. Results: Mean age of the understudy patients was 32.8±5.02 yrs. The most common symptom was exertional dyspnea (91.7% of cases). Mean duration from the onset of symptoms until diagnosis was 27.4±18.7 days. All patients were treated with Co-Trimoxazole and no adverse effects were detected. Mortality rate was 25%. In Iran PCP is one of the common opportunistic infections in HIV-positive patients which is accompanied by a high mortality rate.
Biology and Medicine, 2018
Background: Pneumocystis pneumonia (PCP) is the most common opportunistic infection, and it is difficult to diagnose as PCP. The aim of this study was to assess whether CT findings or clinical characteristics contribute to early diagnosis of PCP. Method: Twenty-six patients with AIDS and PCP received medical treatment at the Kurume University Hospital between 1999 and 2018. None of the patients with AIDS had been diagnosed as HIV positive until the episode of PCP. In this study, the correlation between computed tomography (CT) findings and clinical characteristics were analyzed in patients with AIDS and PCP. The number of patients with PCP is not that high in Japan; therefore, it is difficult to diagnose patients with PCP in the clinic. Results: This study included 24 men and 2 women, and the mean age was 47.8 years. The mean CD4 cell count was 65.7 cells/μl, HIV-viral load was 680 × 10 4 copy, β-D-glucan (βDG) level was 234 pg/ml, and mean time till diagnosis was 41.3 days; 14 patients had hypoxemia. Twelve patients had PCP, 10 had cytomegalovirus (CMV) infection, 2 had Cryptococcus infection, 1 had Entamoeba histolytica infection, 1 had non-tuberculous mycobacteria infection, and 1 had Toxoplasma infection. CT images of the patients showed 10 cases with ground-glass opacity (GGO), 13 with consolidation, 1 with small nodules, 2 with a cavity, and 1 with cyst formation. Nine cases revealed peripheral distribution with peripheral sparing, 1 had pleural fluid, and 6 had lymph node enlargement. The mean time till diagnosis and cough were significantly correlated with lymphadenopathy. Patients with consolidation were more likely to be infected with CMV. Conclusion: GGO, combined with peripheral distribution and peripheral sparing, was the most common CT finding. When consolidation was present in PCP patients as shown in CT images, the patients were more likely to be infected with CMV.
Pneumocystis pneumonia in HIV patients: a diagnostic challenge till date
Medical Mycology, 2015
HIV has become a major health problem in India, patients commonly succumb to opportunistic infections (OIs), respiratory infections being an important cause of morbidity and their accurate diagnosis is still a challenge. Our aim was to study the occurrence of Pneumocystis pneumonia (PCP) in HIV/AIDS patients with respiratory complaints attending ART clinic and to compare various diagnostic methodologies. One hundred and twenty five HIV/AIDS patients presenting with respiratory symptoms like cough, fever, breathlessness etc, were enrolled, and induced sputum samples were collected. Samples were homogenized using glass beads and Dithiothretol. Smears were prepared and examined by Immunoflourescent staining (IFAT), Gomori methanamine silver staining (GMSS), Toludine blue O staining (TBO) and Giemsa staining for Pneumocystis jiroveci. Among the 125 patients who presented with respiratory complaints, 34 cases (27.2%) were diagnosed as having PCP. All 34 cases were detected by IFAT followed by GMSS, Giemsa and Toludine blue O staining in decreasing order. The mean CD4 count was 67.27cells/μl. PCP has become an important health problem in HIV/AIDS patients with low CD4 counts in India. IFAT remains the most sensitive method for the detection of this uncultivable organism. In resource poor settings where an immunoflourecent microscope is not available, diagnosis of PCP still remains problematic.
Pneumocystis carinii Pneumonia in HIV-negative patients with haematologic disease
Infection, 1997
Pneumocystis carinii pneumonia (PCP) was diagnosed in 15 adult HIV-negative haematologic patients in our hospital. None of them had received PCP prophylaxis. All except one had been treated with prednisone.: Symptoms usually started after stopping or tapering. In six patients the diagnosis of PCP was delayed because of confounding bacterial isolates from blood, sputum or urine leading to unsuccessful antibiotic treatment. PCP was diagnosed by demonstrating pneumocysts in bronchoaiveolar lavage fluid. In four patients additional fungal or viral pathogens were identified. The infections were not clustered. The patients were treated with co-trimoxazole and, in case of a pO 2 < 60 mmHg, with prednisone. Three patients died (20%); they all had a coinfection with cytomegalovirus and/or aspergillus. The others recovered completely. There were no relapses. Primary PCP prophylaxis should be considered in patients with lympho-proliferative disease and exposure to prednisone.
Internal Medicine, 2008
Objective To elucidate the clinical and radiological features of Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA), compared with methotrexate (MTX) pneumonitis in RA and Pneumocystis pneumonia in acquired immunodeficiency syndrome (AIDS). Subjects and Methods Retrospective analysis of 14 PCP cases in RA (RA-PCP), 10 MTX pneumonitis cases in RA (MTX-P) and 11 PCP cases in AIDS (AIDS-PCP) from 9 centers in the Kanto area in the last 6 years. Results Compared with AIDS-PCP, both RA-PCP and MTX-P developed more rapidly, showing higher serum CRP and lower plasma β-D-glucan levels, and more severe oxygenation impairment. In most of the RA-PCP cases, a high dose of corticosteroid was administered as adjunctive therapy, resulting in a favorable outcome. The mortality was 14% in RA-PCP, 0% in AIDS-PCP and 0% in MTX-P cases. In RA-PCP patients the CD4 cell count showed only mild suppression, not reaching the predisposing level for PCP in HIV infection, suggesting that there are risk factors for RA-PCP other than immunosuppression. Radiologic analysis revealed some characteristic patterns of each disease. In MTX-P, diffuse homogeneous ground glass opacity (GGO) with sharp demarcation by interlobular septa (type A GGO) was found in 70%, while in AIDS-PCP diffuse, homogeneous or nonhomogeneous GGO without interlobular septal boundaries (type B GGO) was predominant (91%). In RA-PCP, type A GGO was found in 6 cases and type B GGO in 5 cases, showing the complex nature of this disease. Conclusion RA-PCP differed considerably from AIDS-PCP clinically and radiologically. Clinically it occurred without severe immunosuppression, and showed characteristic aspects, with more intense inflammation and less parasite burden. Radiologically it mimicked MTX-P in some cases sharing the conspicuous CT features of MTX-P, rendering the distinction of these two disorders difficult.
PLOS ONE, 2016
Background Pneumocystis jirovecii pneumonia (PCP) is a frequent opportunistic infection in immunocompromised patients. In literature, presentation and outcome of PCP differs between patients with human immunodeficiency virus (HIV) infection and renal transplant recipients (RTRs). Methods We conducted a cross-sectional study of patients with PCP based on the HIV and renal transplant registries at our institution. Radiological and clinical data from all confirmed PCP cases between 2005 and 2012 were compared. Results Forty patients were included: 16 with HIV and 24 RTRs. Radiologically, HIV patients had significantly more areas of diffuse lung affection (81% HIV vs. 25% RTR; p = 0.02), more ground glass nodules 5-10 mm (69% vs. 4%; p = <0.001) and enlarged hilar lymph nodes were found only in HIV patients (44%). Cough and dyspnea were the most common clinical signs (>80%) in both groups. Duration from illness onset to hospital presentation was longer in the HIV patients (median of 18 vs. 10 days (p = 0.02)), implying a less fulminant PLOS ONE |