Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases / 中华血液学杂志

Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.

Clinical parameters of pneumocystis pneumonia in 36 patients with glomerular disease / 中华肾脏病杂志

Objective To investigate the clinical features and prognostic risk factors of pneumocystis pneumonia (PCP) in patients with glomerular disease. Methods The medical charts of all patients with confirmed PCP, diagnosed in Peking University First Hospital from August 2006 to February 2018 were retrospectively reviewed, and 36 cases with glomerular disease were enrolled. Clinical and imaging data were collected and analyzed. Thirty-six patients were divided into survival group and death group. The clinical data, baseline estimated glomerular filtration rate (eGFR), mechanical ventilation and APACHE II score were compared. Results A total of 27 males and 9 females were included, with age of (49.6 ± 17.5) years. All patients were receiving immunosuppressive therapy at the PCP onset, with a median duration of 2.5 months, and none of them was receiving PCP prophylaxis. The main clinical manifestations included fever (100.0% ), dyspnea (75.0% ) and dry cough (61.1% ). Hypoxemia occurred in 97.2% of patients and 17 cases presented as type 1 respiratory failure. Fifteen out of 30(50.0%) patients had CD4+ T cell counts below 200 cells/mm3. Ground glass opacity was the most common finding in CT imaging of 28 patients, followed with grid shadows, consolidation and nodules. Thirty-five patients received trimethoprim-sulfamethoxazole (TMP-SMX) as initial therapy, and 17.1% (6/35) of them developed acute kidney injury due to sulfonamide use. Ten patients died during hospitalization, with respiratory failure as the only direct cause of death. Elder age, delayed diagnosis of PCP, mechanical ventilation and high APACHEⅡscores were associated with poor survival. Conclusions PCP is a severe complication of immunosuppressive therapy in patients with glomerular disease. Early diagnosis and prompt treatment are critical to improve prognosis. Hydration prior to sulfonamide treatment and alkalization of urine are necessary to reduce the incidence of acute kidney injury.

Analysis of diagnosis and treatment of pneumocystis pneumonia in the non-HIV-infected patients with acute respiratory failure / 天津医药

@#Objective To improve diagnostic and therapeutic levels of pneumocystis pneumonia (PCP) in non-HIVinfected patients. Methods The clinical data (including clinical manifestation，laboratory examination, imaging features, diagnosis, treatment and prognosis) of sixteen non-HIV-infected patients with acute respiratory failure caused by PCP who were diagnosed in our intensive care units (ICU) during January 2015 to December 2017, were summarized and discussed. Results Almost all patients were immunocompromised by hormone or immunosuppresant before PCP (15/16). Fever, dry cough, and dyspnea were the first symptoms in all patients. The development of PCP was rapid. All patients showed acute respiratory failure [oxygen index: (85.8±16.8) mmHg]. Invasive ventilator support was required in 11 patients (68.8%), high flow oxygen therapy was used in 5 patients (31.2%). The chest CT characteristics indicated diffuse ground glass opacity. Two patients were found methenamine silver-stained positive in bronchoalveolar lavage fluid. Sixteen cases were positive for pneumocystis detected by PCR. Sixteen patients were treated with compound sulfonamide (SMZco)，caspofungin and corticosteroid. Eight patients were cured, 7 died and 1 case was given up and then died. The ICU length of stay was 3-29 days, average days (13.0±7.1). Conclusion PCP is a kind of opportunistic infection among patients who are treated with immunosuppressive agents. SMZco combined with caspofungin and corticosteroid is effective in the treatment of severe PCP patients.

Correlation Between CT Manifestation Types and CD4+T Lymphocytes in AIDS Combined with Pneumocystis Pneumonia / 中国医学影像学杂志

Purpose To investigate the CT features of different pneumocystis pneumonia (PCP) types in AIDS as well as the relationship between different PCP types and CD4+ T lymphocyte count,in order to deepen the understanding and improve the diagnosis and treatment of PCP.Materials and Methods The CT examination data of 102 AIDS patients with PCP were retrospectively analyzed,the CT findings were divided into 6 types,and CD4+ T lymphocyte count of the 6 PCP types was statistically analyzed.Results ① The CT findings of PCP were divided into the following 6 types:transparent ground-glass type (42 cases,41.2％),muddy ground-glass type (17 cases,16.7％),solid variant (11 cases,10.8％),cystic variant (6 cases,5.9％),interstitial type (19 cases,18.6％),and mixed type (7 cases,6.9％).② The CD4+ T lymphocyte count of different PCP types was analyzed,and the difference was statistically significant (F=2.672,P＜0.05).Further pairwise comparison showed that the CD4+T lymphocyte count of transparent ground-glass type was higher than that of solid variant and cystic variant (P＜0.05),and there was no significant difference between the other groups (P＞0.05).Conclusion CT findings of AIDS with PCP have certain characteristics,and it is helpful to deepen the understanding of PCP through imaging classification.There is a certain correlation between different PCP types and CD4+T lymphocyte count,and it is helpful to improve the diagnosis and treatment of PCP by analyzing the correlation.

Pneumothorax in HIV/AIDS patients / 中华全科医师杂志

A total of 3 177 HIV/AIDS patients were admitted in Beijing Ditan Hospital,Capital Medical University from January 2009 to December 2015,among whom pneumothorax developed in 50 cases with a morbidity rate of 1.6％.Twenty six HIV/AIDS patients with pneumothorax died with a case fatality rate of 52.0％ (26/50).Pneunocystis jirovecii pneumonia (PCP) was the dominant lung disease related to pneumothorax (37/50).Risk factors of pneumothorax were assessed among 40 HIV/AIDS patients with PCP undergoing mechanical ventilation in ICU,including 20 cases with pneumothorax and 20 cases without pneumothorac.Multivariate logistic regression analysis revealed that positive end-expiratory pressure (PEEP) was independent risk factor of pneumothorax in HIV/AIDS patients with PCP under mechanical ventilation (OR =2.490,95 ％ CI:1.302-4.763,P =0.01).

Clinical analysis of connective tissue disease patients with mycophenolate mofetil and with Pneumocystis jirovecii pneumonia / 中华风湿病学杂志

Objective The objective of this study is to describe the clinical features and outcomes of connective tissue disease (CTD) patients with mycophenolate mofetil (MMF) and with Pneumocystis jirovecii pneumonia (PJP).Methods We retrospectively reviewed the characteristics,clinical features,treatment and outcomes of PJP in patients with CTD.The clinical variables were compared between groups using t-test.Results ① A total of 17 cases were reviewed.② Sixteen patients were treated with glucocorticoids(GCs) plus immunosuppressive drugs.Only one patient had GCs without immunosuppressive drugs.Sixteen patients were with PJP,10 (63％) patients had MMF.③ Ten MMF patients and 7 non-MMF patients had absolute lymphocyte counts with the average being (557±170)/` and (926±162)/μl,respectively (t=-4.481,P＜0.05).④ Six of 17 patients died during the hospitalization.Five patients of 10 patients with MMF died 1 of 7 patients without MMF died.Fifteen of 17 patients were treated by trimethoprim-sulfamethoxazole (TMP-SMX).Conclusion MMF may be risk factors of PJP in CTD.

Clinical application of low-dose chest CT on diagnostic imaging for AIDS patients with normal PCP weight / 重庆医学

Objective To evaluate the feasibility and establish the corresponding scanning plan through the clinical application of low-dose CT on diagnostic imaging for 111 AIDS patients with pnenmocystsis carinii pneumonia (PCP)and normal weight .Methods The thesis applied American GE(General Electric Company )FII double-row spiral CT scanner and the kV value is fixed to be 120 kV with the conventional dose (automatic mAs) and low-dose scanning applied respectively during the diagnosis .Meanwhile ,the low-dose scanning was carried out randomly in 50 mAs(50 mAs group) ,40 mAs(40 mAs group) and 30 mAs(30 mAs group) ,and then ,the iconographical imaging quality and radiation dose were analyzed ,the respective low-dose scanning plans was formulated at last .Results The high-quality film ratios for conventional close and 50 mAs group were 70 .3% and 62 .2% respectively ,and the good film ratios were 29 .7% and 37 .8% ,while no poor films occurred in both groups .The high-quality film ratios for conventional close and 40 mAs were 67 .6% and 56 .8% ,the the good film ratios were 32 .4% and 43 .2% and no poor films ,either .The high-quality film ratios for conventional close and 30 mAs were 70 .3% and 56 .8% ,the good were 29 .7% ,43 .2% and no poor films showed between both groups .From the results ,the consequential imaging films mainly show high and good quality ,all films meet the imaging diagnosis requirements and the difference are not statistically significant (P> 0 .05) .The radiation doses of conventional dose and low dose scanning (50 mAs ,40 mAs and 30 mAs groups) were 7 .6 mGy ,2 .6 mGy ,2 .1 mGy and 1 .5 mGy respectively , while the least radiation doses was for 30 mAs group and the corresponding dose is only 19 .8% of the original .The results from 111 patients applied conventional dose (automatic mAs) and low dose scanning all meet the imaging diagnosis requirements without any missed or erroneous diagnosis .Conclusion The chest low-dose CT scanning for AIDS patients with PCP and normal weight can fully meet the clinical diagnosis and treatment ,so it is practical and feasible .Meanwhile ,the conventional-dose scanning can be ap-plied at first and low-dose CT scanning later for reexamination to ensure the stability of image quality .For low-dose chest CT scan-ning ,the voltage fixed is 120 kV and the current 30 mAs .

Neumotórax en pacientes con SIDA: Actualización sobre el tema / Pneumothorax in patients with AIDS: Update on the theme

La aparición de neumotórax como complicación de la neumonía por Pneumocistis carinii (PCP) en pacientes con SIDA, es muy frecuente desde los inicios de la pandemia en 1982, y comporta gran mortalidad. En este trabajo se reporta una serie de 25 pacientes con neumotórax como complicación de la Pneumocistis carinii en pacientes con SIDA, tratado por los autores durante cinco a ños de trabajo discontinuos en el cono sur africano: tres en Sudáfrica y dos en Zimbabwe. Se reportan los datos demográficos y el estado de los mismos al llegar a la sala de cirugía y su evolución después de tratados quirúrgicamente. La toracotomía fue necesaria en ocho pacientes (32 por ciento), diez pacientes necesitaron cuidados de terapia intensiva (40 por ciento), y la mortalidad global fue del 32 por ciento. Se revisa la información actualizada sobre el tema, destacando las pautas terapéuticas más aceptadas internacionalmente. Conflictos de interés: Los autores no declaran conflicto de interés con editores, patrocinadores ni otros autores.

Pneumothorax as a Pneumocistis carinii pneumonia complication in patients with AIDS is very frequent since the pandemic beginnings in 1982, and it is accompanied by a high mortality. In this work we report a series of 25 patients with Pneumothorax as a Pneumocistis carinii pneumonia complication in patients with AIDS, treated by the authors during five years of discontinuous work in the Southern Africa cone: three years in South Africa and two years in Zimbabwe. We report demographic data, the status of the patients when they arrived to the Surgery Service and their evolution after surgery. Thoracotomy was needed in eight patients (32 percent), ten patients needed intensive care (40 percent), and the global mortality was 32 percent. We review the updated information on the theme, emphasizing the most accepted therapeutic guidelines at the international level.

Diagnosis and treatment of pneumocystis carinii pneumonitis after renal transplantation / 中华泌尿外科杂志

Objective To improve the awareness,diagnosis and treatment of pneumocystis carinii pneumonia (PCP) after renal transplantation.Methods A retrospective review was performed in 28 patients who underwent renal transplantation and developed PCP afterwards.The main clinical manifestations were fever(28 cases),nonproductive cough(28 cases),chest distress (12 cases).Occurrences of PCP were described 1.5 to 7 months after the renal transplantation.There were 10 patients treated with tacrolimus (FK506 2-6 rag/d,FK506 concentration 4-10 ng/ml) and 18 patients treated with cyclosporine (CsA 200-500 mg/d,CsA trough level:150-250 ng/ml) based immunosuppressive regimen.Anti-CD_(25)~+ monoclonal antibody (anti-CDCD_(25)~+mAb) was used in 10 cases for immune induction before operation while single steroid in 18 cases.Creatinine of patients with PCP was 70 to 106 μmol/L.CD_4~+ lymphocyte counts of the peripheral blood were 245±32/μl before PCP treatment and 536±25/μl after recovery.The most abnormal chest radiological findings were bilateral patchy ground-glass opacity.All the patients were diagnosed with PCP by bronchoalveolar lavage.Treatment was performed by reducing immunosuppressive agents and giving SMZco.Nineteen patients who had a PaP2 less than 70 mm Hg were given intravenous small-dose steroid.Results All the patients recovered from PCP 2 to 3 weeks after treatment.One patient experienced recurrence half year later.Five patients with higher creatinine after treatment recovered to normal levels after stopping the treatment of SMZco.No significant differences were seen in PCP patients treated with CsA and FK506,P＞0.05.The similar results were observed in use of anti-CDCD_(25)~+ mAb and single steroid,P＞0.05.Significant differences were observed in PCP patient peripheral blood CD_4~+ lymphocyte counts before and after treatment (P=0.001).Conclusions Patients who have fever,cough and hypoxia,chest imaging showing bilateral lung interstitial inflammation,might be PCP patients in the early post-renal transplantation period.Effective treatment should be performed by reducing immunosuppressive agents and giving SMZco.

Clinical study on 69 cases of pneumocystis pneumonia in patients with acquired immunodeficiency syndrome / 中华传染病杂志

Objective To study the clinical characteristics, diagnostic methods and therapeutic efficacy of pneumocystis pneumonia (PCP) in patients with acquired immunodeficiency syndrome (AIDS). Methods Sixty-nine AIDS cases of PCP were diagnosed according to the criteria of USA Centers for Disease Control and Prevention revised in 1993. The clinical symptoms and signs of the patients were observed. The peripheral blood lymphocyte counts, blood gas analysis and bronchoalveolar lavage fluid (BALF) were checked and transbronchoscopic lung biopsy was performed. Results All studied patients were in the late stage of AIDS. The main clinical manifestations included fever (100.0%), cough (97.1%), and dyspnea (92.80%). Pulmonary rales could be heard in 42 cases (60.9% ). Peripheral CD4+ T lymphocyte counts ranged from 1 × 106 -88 × 106/L. Fifty-two cases (75.4% ) had low arterial partial pressure of oxygen value of less than 10.7 kPa (1 kPa = 7.5 mm Hg). Sixty-one cases (88.4 %) had elevated serum lactate dehydrogenase (LDH) level. Bilateral diffused interstitial change (46.4%) and ground-glass shadow (29.0%) were the most common abnormal chest radiological findings. Pneumocystis organisms were detected in the BALF from 2 patients and in the transbronchial biopsy (TBB) tissue from 35 patients. All patients were treated with compound sulfamethoxazole. Thirty-three were treated with corticosteroid simultaneously and 27 were assisted with mechanical ventilation. Fifty patients recovered or got improved, eleven died, and eight left hospital because of deteriorated condition. Conclusions When an AIDS patient represents with fever, cough, dyspnea, hypoxemia, elevated serum I.DH level, CD4+ T lymphocyte count below 100 × 106/L, and interstitial pneumonia or ground-glass shadow in chest images, the diagnosis of PCP could be made presumptively. It is difficult to make a nosogenic diagnosis of PCP, but TBB considerably increases the positive rate of pneumocystis. Compound sulfamethoxazole is recommended as the first selected drug. In severe cases, corticosteroid and assisted mechanical ventilation combined with compound sulfamethoxazole could remarkably improve the prognosis of PCP.

An initially clinical study of pneumocystis carinii pneumonia during early stage after orthotopic liver transplantation / 中华器官移植杂志

Objective To investigate the etiology, diagnosis and treatment of pneumocystis cari-nii pneumonia (PCP) at early stage after orthotopic liver transplantation (OLT). Method The clinical data of 276 patients undergoing OLT were retrospectively analyzed and those of 6 cases complicated with PCP were summarized from January 2005 to December 2005. Results The morbidity of PCP in our group was 2.17% and occurred in early stage after OLT. The average time on set was (11.17?2.50) days and uneasily controlled hypoxemia was the main manifestation. The diagnosis of PCP was established by clinical symptoms, chest X-ray, chest CT, pneumocystis carinii PCR detection and visualization of PC encysts from sputum samples under a microscope. SMZco was the initial choice of treatment combined with immunosuppressive regimen regulation. Five cases were cured and 1 case died from septic shock. Conclusion PCP can occur among OLT patients in the early stage, and aggressive early diagnosis and treatment were critical to improve the prognosis.

Diagnosis and treatment of pneumocystosis after renal transplantation / 中华器官移植杂志

Objective To investigate the early diagnosis and treatment of pneumocystosis after renal transplantation. Methods The clinical data of 6 cases of renal transplant recipients from 2000-2001 who developed pneumocystosis were discussed. Results Six patients were diagnosed as having pneumocystosis and subjected to the treatment of SMZ_ CO (SMZ 60-70 mg/kg daily, TMP 12-14 mg/kg daily) for 3 weeks. Immunosuppressive regimene was regulated. Except one case died due to abandonment of treatment, the remaining 5 cases were cured and had normal renal function. Conclusion The diagnosis of pneumocystosis was established by visualization of pathogen in bronchialveolar lavage (BAL) samples. SMZ_ CO is still the most commonly used drug for pneumocystosis at present and administration for individual is important because of its renal toxicity. The dosage of immunosuppressive agent for each patient with pneumocystosis must be adjusted.

Systemic lupus erythematosus complicated with Pneumocystis carinii pneumonia / 中华风湿病学杂志

Objective To explore the clinical manifestation of systemic lupus erythematosus (SLE) complicated with Pneumocystis carinii pneumonia (PCP).Methods Retrospective analysis of the clinical data of two cases of SLE complicated with PCP.Results The two patients were both aged 31 years and have had SLE disease for 4 and 7 years respectively.Both had lupus nephritis and were previously treated with high dose corticosteroid and cyclophosphadmide.Both patients had ceased immunosuppressive drug treatment for 6 and 12 months respectively at the time of diagnosis of PCP infection.Both patients presented with acute fever with dry cough,shortness of breath at rest,progressive hypoxia and diffuse reticular shadows on chest X ray. Pneumocystis carinii were identified in the bronchoalveolar lavage fluid (BAF) in both cases.SMZ was used to treat the PCP infection.The first patient recovered with improvement in her clinical well being and chest X ray appearance,while the second failed to respond and eventually succumbed.Conclusion One should be alert to the occurrence of PCP when patients with SLE present with rapidly progressive hypoxemia and type I respiratory failure.The mortality rate is high in SLE patients complicated with PCP and early diagnosis and treatment are the key to improving survial in these patients.Recurrence of PCP is common and adequate duration of treatment is essential.

Imaging of pneumocystis carinii pneumonia in AIDS / 中华放射学杂志

Objective To study the X ray and CT findings of pneumocystis carinii pneumonia in AIDS. Methods Five AIDS patients who had chest abnormalities were analyzed. Results Pneumocystis carinii pneumonia appeared as diffuse infiltrative and interstitial fine nodules. Conclusion If the diffuse and infiltrative interstitial fine nodule are the appearances in patients with AIDS, the pneumocystis carinii pneumonia should be considered.

Pneumocystis carinii pneumonia in 12 patients with autoimmune diseases / 中华传染病杂志

Objective To investigate the clinical features of pneumocystis carinii pneumonia (PCP)in patients with autoimmune diseases.Methods The data from 12 patients with autoimmune diseases who were hospitalized in Peking Union Medical College Hospital because of developing PCP were retrospectively reviewed.Clinical characteristics and T cell subsets in the peripheral blood were analyzed.Results The main clinical manifestations of these 12 patients were fever(12/12),cough(9/ 12),expectoration(9/12)and obvious dyspnea(12/12),which were progressive.Blood gas analysis presented with typeⅠrespiratory failure.Bilateral interstitial and alveolar infiltrates were observed in chest X-ray film.The counts of peripheral blood lymphocytes(0.44?0.31)?10~9/L,CD4~+ T-lymphocytes (0.120?0.079)?10~9/L and CD8~+ T-lymphocytes were(0.248?0.252)?10~9/L decreased significantly and the CD4/CD8 ratio reversed,which were significantly different from those of healthy person(P