ABSTRACT
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.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Pneumonia, Pneumocystis/diagnostic imaging , Retrospective Studies , Pneumocystis carinii , Hematologic Diseases/complications , Tomography, X-Ray Computed , FibrosisABSTRACT
Resumen La neumonía oportunista por Pneumocystis jirovecii en pacientes con una infección respiratoria grave por SARS-CoV-2 es una entidad recién reconocida, asociada a la terapia con corticoesteroides junto a otros factores de riesgo predisponentes. Supone un reto diagnóstico y, tras el tratamiento, el pronóstico es favorable. Presentamos el caso de un varón con neumonía grave por SARS-CoV-2 que recibió tratamiento corticoidal, desarrollando posteriormente una neumonía por P. jirovecii.
Abstract Infection by Pneumocystis jirovecii in patients with severe respiratory infection caused by SARS-CoV-2 is a situation that we must take into account today. Corticotherapy along with other risk factors predisposes to it. It is a diagnostic challenge and, after treatment, the prognosis is favorable. We report the case of a male with severe pneumonia due to SARS-CoV-2 who received corticosteroid treatment, later developing pneumonia due to P. jiroveci.
Subject(s)
Humans , Male , Aged , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/drug therapy , Pneumocystis carinii , COVID-19/complications , Adrenal Cortex Hormones , SARS-CoV-2ABSTRACT
In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency virus (HIV) patients, such as those with malignancies, post-transplantation and autoimmune diseases. Although the risk factors and management of PJP have been extensively studied in the hematologic tumor and post-transplant populations, the research on real tumor cases is insufficient. Lung cancer has been the most common tumor with the highest number of incidence and death worldwide, and the prognosis of lung cancer patients infected with PJP is poor in clinical practice. By reviewing the previous studies, this paper summarized the epidemiology and clinical manifestations of PJP in lung cancer patients, the risk factors and possible mechanisms of PJP infection in lung cancer patients, diagnosis and prevention, and other research progresses to provide reference for clinical application. .
Subject(s)
Humans , Incidence , Lung Neoplasms/complications , Pneumocystis carinii , Pneumonia, Pneumocystis/diagnosis , Risk FactorsABSTRACT
Pneumocystis jirovecii es un hongo oportunista, causante de neumonía en huéspedes inmunocomprometidos. Es una infección grave con elevada tasa de mortalidad en pacientes oncohematológicos y receptores de trasplante de células progenitoras hematopoyéticas. La administración de corticosteroides es el principal factor de riesgo para adquirir esta infección. Actualmente las infecciones ocurren en aquellos pacientes que no reciben adecuada profilaxis. Las técnicas de diagnóstico molecular son las recomendadas por su elevada sensibilidad, especificidad y rapidez. La frecuencia global de P. jirovecii en pacientes inmunocomprometidos de nuestro hospital, durante el período evaluado fue de 4,8%, con una mortalidad global del 20%. Como factores de mal pronóstico se reportan la presencia de coinfecciones y la necesidad de asistencia respiratoria mecánica. Es importante la sospecha precoz en pacientes de riesgo, confirmada con un diagnóstico preciso mediante métodos moleculares para una intervención adecuada y oportuna (AU)
Pneumocystis jirovecii is an opportunistic fungus, causing pneumonia in immunocompromised hosts. It is a severe infection with a high mortality rate in oncology/hematology patients and hematopoietic stem cell transplant recipients. The administration of corticosteroids is the main risk factor for acquiring this infection. Currently infections occur in patients who do not receive adequate prophylaxis. Molecular diagnostic techniques are recommended because of their high sensitivity, specificity, and speed. In the study period, the overall incidence of P. jirovecii in immunocompromised patients at our hospital was 4.8%, with an overall mortality rate of 20%. Factors of a poor prognosis are the presence of coinfections and the need for mechanical respiratory assistance. Early suspicion in high-risk patients is important to confirm the diagnosis through molecular studies and start adequate and early treatment (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Polymerase Chain Reaction/methods , Pneumocystis Infections/diagnosis , Pneumocystis Infections/epidemiology , Immunocompromised Host , Molecular Diagnostic Techniques/methods , Pneumocystis carinii/isolation & purification , Hospitals, Pediatric/statistics & numerical data , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Infections caused by uncommon and resistant pathogens in unusual sites have been increasingly reported in medical literature. We describe four cases of rare cytological findings and clinical impact for patients. In the first case, Aspergillus sp and Pneumocystis jirovecii were observed in the bronchoalveolar lavage of a patient with severe systemic lupus. In the second and third cases, we describe the presence of Trichomonas sp and Strongyloides sp larvae in samples of pleural and peritoneal fluid, respectively. The fourth report is about a patient with a wrist subcutaneous nodule whose synovial aspiration and cytology revealed the presence of brown septate hyphae. The early identification of the infectious agent in the cytological examination was essential for the introduction and/or re-adaptation of therapy in the four cases described. Patients in this report were immunocompromised with severe comorbidities, conditions often associated with unfavorable clinical outcomes.
Subject(s)
Humans , Animals , Male , Female , Middle Aged , Communicable Diseases/diagnosis , Cytodiagnosis/methods , Pleural Effusion/parasitology , Aspergillus/isolation & purification , Strongyloides/isolation & purification , Strongyloidiasis/diagnosis , Trichomonas/isolation & purification , Trichomonas Infections/diagnosis , Ascitic Fluid/parasitology , Bronchoalveolar Lavage Fluid/microbiology , Fatal Outcome , Pneumocystis carinii/isolation & purificationABSTRACT
Resumen El SARS-CoV-2 es el virus causante de la enfermedad COVID-19, desconocida antes del brote que ocurrió en diciembre de 2019 en Wuhan, China, y desencadenó la actual pandemia. Las manifestaciones de la infección por SARS-CoV-2 son muy variables entre los pacientes. Los peores desenlaces se suelen asociar a edad avanzada y factores de riesgo reconocidos. Entre estos sería razonable considerar los distintos tipos de inmunodeficiencia, en particular la producida por HIV. Sin embargo, no existen hasta el momento, estudios que demuestren que la infección HIV empeore la evolución y el pronóstico de COVID-19. La neumonía por el hongo Pneumocystis jirovecii (antes denominado P. carinii) afecta con mayor frecuencia a inmunodeprimidos y puede tener desenlace fatal. Exponemos el caso de una mujer de mediana edad con síndrome de Raynaud que ingresó con neumonía y durante la internación se le diagnosticó infección simultánea por HIV, SARS-CoV-2 y P. jirovecci. Evolucionó de forma favorable con tratamiento empírico sin requerir maniobras invasivas ni soporte ventilatorio, logrando el alta y seguimiento de forma ambulatoria.
Abstract SARS-CoV-2 causes the disease named COVID-19, which emerged in Wuhan, China, in December 2019 and developed into the current pandemic. The manifestations of SARS-CoV-2 infection are highly variable. The worst outcomes are usually associated with advanced age and known risk factors. Among these, it would be reasonable to consider conditions compromising the immune system, particularly the immunodeficiency associated to HIV. To date, however, there is no evidence of HIV infection worsening the evolution and prognosis of COVID-19. Pneumocystis jirovecii (previously-P. carinii) pneumonia, is a fungal disease that most commonly affects immunocompromised persons and can be life-threatening. Typically, patients at risk are those with any underlying condition altering host immunity. We present the case of a middle-aged woman with Raynaud's syndrome who was admitted with pneumonia. During hospitalization she was simultaneously diagnosed with infection by HIV, COVID-19 and P. jirovecci. The patient evolved favorably upon empirical treatment without requiring invasive maneuvers or ventilatory support. Outpatient follow-up after hospital discharge was uneventful.
Subject(s)
Humans , Female , Middle Aged , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Viral , HIV Infections/diagnosis , Coronavirus Infections/diagnosis , Pneumocystis carinii/isolation & purification , Pandemics , Coronavirus , Clinical Laboratory Techniques , Severe Acute Respiratory Syndrome , Betacoronavirus , COVID-19 Testing , SARS-CoV-2 , COVID-19ABSTRACT
Resumen Introducción: Pneumocystis jirovecii es un hongo atípico detectado particularmente en pacientes VIH-positivos o con trasplante. Objetivo: Detectar y genotipificar Pneumocystis jirovecii en muestras de pacientes de dos hospitales de la ciudad de México. Método: Fueron procesadas 89 muestras respiratorias, correspondientes a 53 pacientes (30 VIH positivos y 23 VIH negativos) con sintomatología respiratoria y 11 personas sanas incluidas como control negativo. El DNA fue extraído y amplificado por PCR anidada de la región del espaciador transcrito interno, obteniendo un fragmento en cada ronda (de 693 y 550 pb). Los genotipos y su relación filogenética fueron determinados por secuenciación del fragmento de 550 pb. Resultados: Cuarenta y ocho muestras de 30 pacientes VIH-positivos provenían de un solo hospital, de las cuales 11 (36.6 %) fueron positivas a Pneumocystis jirovecii. Ninguna fue positiva en pacientes VIH-negativos o personas sanas. Los haplotipos detectados con mayor frecuencia fueron Eg y Em. Conclusiones: La frecuencia de infección por Pneumocystis jirovecii fue alta en la población mexicana estudiada. El genotipo más frecuente fue diferente a los reportados en otros países. Es necesario encauzar este problema de salud hacia la detección temprana de esta infección.
Abstract Introduction: Pneumocystis jirovecii is an atypical fungus particularly detected in HIV-positive or transplant patients. Objective: To detect and genotype Pneumocystis jirovecii in patient samples from two hospitals in Mexico City. Method: Eighty-nine respiratory tract samples, corresponding to 53 patients (30 HIV-positive and 23 HIV-negative) with respiratory symptoms and to 11 healthy individuals included as negative control, were processed. DNA was extracted from the ITS region and amplified by nested polymerase chain reaction from the internal transcribed spacer, with one fragment being obtained at each round (693 and 550 bp). Genotypes and their phylogenetic relationship were determined by sequencing the 550 bp fragment. Results: Forty-eight samples from 30 HIV-positive patients were received from a single hospital, out of which 11 (36.6 %) were positive for Pneumocystis jirovecii. No sample was positive in HIV-negative patients or healthy subjects. The most frequently detected haplotypes were Eg and Em. Conclusions: The frequency of Pneumocystis jirovecii infection was high in the studied Mexican population. The most common genotype was different from those reported in other countries. It is necessary to address this health problem through early detection of this infection.
Subject(s)
Humans , Male , Female , Child, Preschool , Adult , Middle Aged , Aged , Young Adult , Pneumonia, Pneumocystis/epidemiology , HIV Infections/complications , Pneumocystis carinii/isolation & purification , Phylogeny , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/microbiology , Polymerase Chain Reaction , Cross-Sectional Studies , Prospective Studies , Pneumocystis carinii/genetics , Genotype , MexicoSubject(s)
Adult , Female , Humans , Male , HIV Infections/microbiology , Pneumocystis carinii/isolation & purification , Peru , DNA, Fungal/isolation & purification , Polymerase Chain Reaction/methods , Cross-Sectional Studies , Acquired Immunodeficiency Syndrome/microbiology , AIDS-Related Opportunistic Infections/microbiology , Pneumocystis carinii/geneticsABSTRACT
Pulmonary diseases are among the main causes of morbidity and mortality in HIV patients. Here, we present the fatal case of a 30 year-old AIDS patient, who did not undergo antiretroviral treatment, presenting pulmonary coinfection by Pneumocystis jiroveci, Cryptococcus neoformans and cytomegalovirus diagnosed in the postmortem histological examination. Concurrent pulmonary infection by these three agents is not common and, to date, apparently had not been reported in the literature.
Subject(s)
Pneumocystis carinii , HIV , Cryptococcus neoformans , CytomegalovirusABSTRACT
Pneumocystis jirovecii (PCP) es un hongo oportunista, que causa neumonía en pacientes con un sistema inmunitario seriamente comprometido. La prevalencia de la enfermedad disminuyó dramáticamente con la introducción de la terapia antirretroviral combinada (HAART) y actualmente las infecciones ocurren en aquellos pacientes que no reciben adecuada profilaxis o no la completan. Es una enfermedad grave con elevada tasa de mortalidad (30-60%) en pacientes oncohematológicos y receptores de trasplante de células progenitoras hematopoyéticas (HSCT), pero prevenible con profilaxis adecuada, por lo que el reconocimiento temprano de los pacientes en riesgo es crítico. El diagnóstico de certeza es de laboratorio ya que los hallazgos clínicos son inespecíficos y las imágenes no son patognomónicas de este agente. Actualmente las técnicas moleculares como la PCR en tiempo real son las metodologías recomendadas ya que poseen elevada sensibilidad, especificidad, rapidez y eficiencia. En el presente estudio se optimizó un método de PCR en tiempo real con iniciadores dirigidos al gen del ARNr de la subunidad grande mitocondrial, en formato dúplex junto con el gen constitutivo RNAsa P. El método demostró ser muy sensible y rápido para el diagnóstico clínico de PCP, con una concordancia Ò: 0,789 con el método convencional de PCR anidada que emplea como target a la región espaciadora transcrita interna (ITS) del gen del ARNr de PCP, a la vez de ser mucho menos laborioso y con menor riesgo de contaminación, lo que permite el manejo de un alto número de muestras clínicas (AU)
Pneumocystis jirovecii (PCP) is an opportunistic fungus causing pneumonia in severely immunocompromised patients. Prevalence of the disease has dramatically decreased after the introduction of combined antiretroviral therapy (HAART) and currently these infections occur in patients who do not receive adequate prophylaxis or do not complete treatment. PCP is a severe disease with a high mortality rate (30-60%) in oncology-hematology patients and hematopoietic stem-cell transplantation (HSCT) recipients, but is preventable with adequate prophylaxis. Therefore, early recognition of at-risk patients is essential. Laboratory studies are the gold standard for the diagnosis as clinical findings are unspecific and imaging studies are not pathognomonic for this agent. Currently, molecular techniques, such as real-time PCR, are the methodology of choice because of their high sensitivity, specificity, speed, and efficiency. In this study, a real-time PCR method was optimized with primers targeting the gene of the mitochondrial large subunit rRNA in a duplex format together with the constitutive gene RNAsa P. The method showed to be very sensitive and fast for the clinical diagnosis of PCP, with a concordance of Ò: 0.789 with the conventional nested PCR method targeting the internal transcribed spacer (ITS) region of the rRNA gene of PCP, and is much easier to perform with a lower contamination risk allowing a high through-put of clinical samples (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Pneumonia, Pneumocystis/diagnosis , Bronchoalveolar Lavage Fluid/microbiology , Pneumocystis carinii/isolation & purification , Real-Time Polymerase Chain Reaction/methods , Validation StudyABSTRACT
We describe an unusual case of severe pneumonia due to Pneumocystis jirovecii in a previously healthy 2-month-old patient who had been hospitalized for RSV bronchiolitis.
Se describe un caso inusual de neumonía grave por Pneumocystis jirovecci en un paciente de 2 meses de vida previamente sano, quien había sido hospitalizado por una bronquiolitis por VRS.
Subject(s)
Humans , Male , Infant , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/therapy , Pneumonia, Pneumocystis/microbiology , Radiography, Thoracic , Positive-Pressure Respiration , Pneumocystis carinii/isolation & purification , Immunocompetence , Anti-Bacterial Agents/therapeutic useABSTRACT
Resumen La neumonitis por Pneumocystis jirovecii es una infección infrecuente en pacientes con trasplante de riñón, que se presenta de forma aguda y puede progresar rápidamente hasta la insuficiencia respiratoria y la muerte. El período de mayor riesgo es el de los primeros seis meses después del trasplante, y se asocia con las altas dosis de medicamentos inmunosupresores que reciben los pacientes. La condición también puede presentarse de manera tardía, asociada con la suspensión de la profilaxis con trimetoprim-sulfametoxazol. Se reportan dos casos de pacientes con trasplante renal que presentaron insuficiencia respiratoria hipoxémica grave por P. jirovecii pasados seis años del trasplante, y que fueron tratados con trimetoprim-sulfametoxazol y esteroides. Uno de los pacientes murió y el otro se recuperó sin que hubiera efectos en la función del injerto renal.
Abstract Pneumonia caused by Pneumocystis jirovecii is an uncommon infection in kidney transplant patients that can have an acute and rapid progression to respiratory failure and death. The period of greatest risk occurs in the first six months after the transplant, and it relates to the high doses of immunosuppression drugs required by patients. However, it may occur late, associated with the suspension of prophylaxis with trimethoprim-sulfamethoxazole. We present two cases of renal transplant patients who had severe hypoxemic respiratory failure due to P. jirovecii six years after transplantation. In addition to steroids, they received treatment with trimethoprim-sulfamethoxazole. One patient died, while the other had clinical recovery, with preservation of the renal graft function.
Subject(s)
Humans , Respiratory Insufficiency/complications , Kidney Transplantation/adverse effects , Pneumocystis carinii/chemistry , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Pneumocystis carinii/isolation & purificationABSTRACT
BACKGROUND: Currently, trimethoprim-sulfamethoxazole is used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis, but it is associated with frequent adverse effects. This study evaluated the efficacy and safety of the current protocol and proposes an individualized risk-based prophylaxis protocol. METHODS: The PJP incidence and risk factors during the first 6 months (early PJP) and afterwards (late PJP) was assessed in renal transplant recipients with (prophylaxis group) and without (no-prophylaxis group) 6-month PJP prophylaxis. RESULTS: In 578 patients, there were 39 cases of PJP during a median follow-up of 51 months. Renal adverse events were encountered frequently during trimethoprim-sulfamethoxazole prophylaxis, leading to premature discontinuation. Patients without the prophylaxis had a significantly higher incidence of early PJP (n=27, 6.6%) compared to patients with the prophylaxis (n=0). The incidence of late PJP was 2.2%, without between-group differences. The factors associated with early PJP were preoperative desensitization and acute rejection within 1 month, whereas late PJP was associated with age, deceased donor transplant, and acute rejection requiring antithymocyte globulin treatment. CONCLUSIONS: Based on the simulation results of several risk-based scenarios, the authors recommend universal prophylaxis up to 6 months post-transplant and extended selective prophylaxis in patients aged ≥57 years and those with a transplant from deceased donors.
Subject(s)
Humans , Antilymphocyte Serum , Follow-Up Studies , Incidence , Kidney Transplantation , Pneumocystis carinii , Pneumocystis , Pneumonia , Risk Factors , Tissue Donors , Transplant Recipients , Trimethoprim, Sulfamethoxazole Drug CombinationABSTRACT
BACKGROUND: Pneumocystis is difficult to culture or detect in laboratory environments. Its ecology including the timing and method of transmission as well as environmental sources and communicability remain unclear. METHODS: We retrospectively evaluated the pattern and treatment outcome of Pneumocystis jirovecii pneumonia (PCP) in children with acute lymphoblastic leukemia (ALL) who received chemotherapy. RESULTS: A total of 56 patients with ALL were evaluated. While on chemotherapy, all patients received PCP prophylaxis. PCP were found in a total of 6 patients, including definite PCP in 2, probable PCP in 2, and possible PCP in 2 patients. There were no significant differences in sex, age group, National Cancer Institute risk group, or pneumocystis prophylaxis type between PCP and non-PCP groups. However, there was a significant statistical difference in the times of ALL diagnosis. Regarding recent chemotherapy at the time of PCP diagnosis, there were one induction, one consolidation, and four maintenance cases. All PCP patients were treated with high-dose sulfamethoxazole (100 mg/kg/day) and trimethoprim (20 mg/kg/day) intravenously. Five patients survived, while one patient with endotracheal mechanical ventilation therapy died due to respiratory failure in spite of aggressive treatment. CONCLUSION: Pediatric PCP became extremely rare due to routine prophylaxis in clinical practice of pediatric malignancy. Nevertheless, we analyzed patients with acute lymphoblastic leukemia who had received PCP prophylaxis for 14 years, and analyzed the clustered outbreaks of PCP. It is still important to emphasize the need for prophylaxis and to increase the level of attention and isolation under environmental and personal risk factors.
Subject(s)
Child , Humans , Compliance , Diagnosis , Disease Outbreaks , Drug Therapy , Ecology , Methods , Pneumocystis carinii , Pneumocystis , Pneumonia , Pneumonia, Pneumocystis , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Respiration, Artificial , Respiratory Insufficiency , Retrospective Studies , Risk Factors , Sulfamethoxazole , Treatment Outcome , TrimethoprimABSTRACT
No abstract available.
Subject(s)
Bronchoalveolar Lavage Fluid , Bronchoalveolar Lavage , Lymphocytes , Pneumocystis carinii , Pneumocystis , Risk FactorsABSTRACT
No abstract available.
Subject(s)
Bronchoalveolar Lavage Fluid , Bronchoalveolar Lavage , Lymphocytes , Pneumocystis carinii , Pneumocystis , Risk FactorsABSTRACT
BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
Subject(s)
Adult , Humans , Bronchoalveolar Lavage Fluid , Bronchoalveolar Lavage , Diabetes Mellitus , Drug-Related Side Effects and Adverse Reactions , Glomerular Filtration Rate , Korea , Lymphocyte Count , Lymphocytes , Medical Records , Multivariate Analysis , Odds Ratio , Pneumocystis carinii , Pneumocystis , Pneumonia , Risk Factors , Salvage Therapy , Seoul , Treatment FailureABSTRACT
No abstract available.
Subject(s)
Bronchoalveolar Lavage Fluid , Bronchoalveolar Lavage , Lymphocytes , Pneumocystis carinii , Pneumocystis , Risk FactorsABSTRACT
No abstract available.
Subject(s)
Bronchoalveolar Lavage Fluid , Bronchoalveolar Lavage , Lymphocytes , Pneumocystis carinii , Pneumocystis , Risk FactorsABSTRACT
BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.