Clinical characteristics of Pneumocystis carinii pneumonia in immunocompromised patients / 中华传染病杂志

ABSTRACT

Objective:To understand the clinical characteristics of Pneumocystis carinii pneumonia (PCP) in immunocompromised patients. Methods:Clinical data of 15 patients with PCP hospitalized in Shanghai East Hospital, Tongji University from March 2018 to March 2019 were retrospectively analyzed. Clinical manifestations, laboratory index examinations, imaging characteristics, comorbidities, treatment and outcome were observed.Results:Among the 15 cases, 11 were cases with hematological malignancies and four cases received allogenetic hematopoietic stem cell transplantation (AHSCT). The onset time was (5.82±2.33) months after transplantation. Chest computed tomography (CT) of all 15 patients showed diffuse ground glass-like exudation of the lungs surrounding hilar. Peripheral blood CD4 + T cell count decreased to (135.17±74.83)/μL and oxygenation index to (188.47±41.03) mmHg(1 mmHg=0.133 kPa), while lactic acid dehydrogenase (LDH) elevated to (576.18±228.01) U/L.Levels of 1, 3-β-D-glucan in serum and bronchoalveolar lavage fluid (BALF) increased to (1 862.81±157.73) ng/L and (1 216.97±957.16) ng/L, respectively. Metagenomic next-generation sequencing (mNGS) of BALF showed that the numbers of sequence of Pneumocystis carinii were 120 to 14 383. There were nine patients co-infected with cytomegalovirus (CMV), four patients with Epstein-Barr virus, and two patients with gram-negative bacilli. All the patients received compound sulfamethoxazole and caspofungin treatment, and 13 cases improved and two died. Conclusions:Patients with hematological malignancies and AHSCT are at high-risk of PCP. Serum counts of CD4 + T cells decrease, while serum levels of LDH and 1, 3-β- D-glucan increase.mNGS is valuable for early diagnosis.