Clinical characteristics of severe pneumocystis pneumonia in children without human immunodeficiency virus infection

Abstract

Objective To investigate the clinical parameters, risk factors, treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective analysis was made for the clinical features, risk factors, treatment and prognoses of the non-HIV infected severe PCP patients hospitalized at Pediatric Intensive Care Unit(PICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics. Results During April of 2010 to April of 2014, there were 10 cases of non-HIV infected severe PCP in PICU of Children's Hospital Affiliated to Capital Institute of Pediatrics.All of the patients had predisposing diseases, in which 3 cases had connective tissue diseases, 2 cases had acute leukemia, 3 cases had severe pneumonia and 2 cases had congenital immunodeficiency.The main clinical manifestations of those 10 patients were fever, cough, tachypnea and obvious dyspnea.All patients developed respiratory failure.The median value of Pediatric Critical Illness Score was 79.The median arterial oxygen pressure was 58 mmHg(1 mmHg=0.133 kPa). The median oxygenation index was 103 mmHg. The median alveolo-arterial oxygen partial pressure difference was 43.8 mmHg. The median CD4+ T-lymphocytes counts was 169×106/L. Eight patients on admission had mixed infection.Acute respiratory distress syndrome(ARDS) occurred in all of the patients, and 7 cases of them had multiple organ dysfunctions.All of the patients required ventilation support.The median day for invasive mechanical ventilation days was 11 and the median day for noninvasive ventilation days was 6.The pneumothorax occurred in 5 patients.All patients received trimethoprim-Sulfamethoxazole as initial therapy and Caspofungin treatment in combination in 7 cases of the patients.Six patients had nosocomial infection. The median time of PICU stay was 15.5 days.Six patients survived and the mortality was 40%(4/10 cases). Conclusions PCP is a kind of fatal diseases which occurred in patients with immunocompromised conditions and concurrent ARDS or multiple organ dysfunctions.Diagnostic suspicion and mechanical ventilation therapy with lung protective ventilation strategies may improve the clinical outcomes of non-HIV-infected PCP in children. Key words: Pneumocystis pneumonia; Acute respiratory distress syndrome; Treatment; Child