Clinical and Radiological Features of Pneumocystis Pneumonia in Patients with Rheumatoid Arthritis, in comparison with Methotrexate Pneumonitis and Pneumocystis Pneumonia in Acquired Immunodeficiency Syndrome: A Multicenter Study (original) (raw)
Related papers
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.
Internal Medicine, 2011
Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids.
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 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.