Abstract
P. jiroveci (Pj) causes a potentially fatal pneumonia in immunocompromised patients and the factors associated with a bad outcome are poorly understood. A retrospective analysis on Pj pneumonia (PjP) cases occurring in Tor Vergata University Hospital, Italy, during the period 2011–2015. The patients’ demographic, clinical and radiological characteristics and the Pj genotypes were considered. The study population included 116 patients, 37.9% of whom had haematological malignancy or underwent haematological stem cell transplantation (HSCT), 22.4% had HIV infection, 16.4% had chronic lung diseases (CLD), 7.8% had a solid cancer, and 3.4% underwent a solid organ transplant (SOT). The remaining 12.1% had a miscellaneous other condition. At univariate analysis, being older than 60 years was significantly correlated with a severe PjP (OR [95%CI] 2.52 [0.10–5.76]; p = 0.031) and death (OR [95%CI] 2.44 [1.05–5.70]; p = 0.036), while a previous trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were significantly associated with a less severe pneumonia (OR[95%CI] 0.35 [0.15–0.84], p = 0.023); moreover, death due to PjP was significantly more frequent in patients with CLD (OR[95%CI] 3.26 [1.17–9.05]; p = 0.019) while, admission to the Infectious Diseases Unit was significantly associated with fewer deaths (OR[95%CI] 0.10 [0.03–0.36], p = 0.002). At multivariate analysis, a better PjP outcome was observed in patients taking TMP/SMX prophylaxis and that were admitted to the Infectious Diseases Unit (OR[95%CI] 0.27 [0.07–1.03], p = 0.055, OR[95%CI] 0.16 [0.05–0.55]; p = 0.004, respectively).In conclusion, in our study population, TMP/SMX prophylaxis and infectious disease specialist approach were variables correlated with a better PjP outcome.
Highlights
Pneumocystis jiroveci pneumonia (PjP) is a serious and potentially life-threatening fungal infection that is mostly diagnosed in immune-compromised individuals
Forty percent of all PjP cases were admitted to the Infectious Diseases Unit
Most deaths were associated with P. jiroveci (Pj) genotype 1 infection, but the datum was not significant. In this retrospective study conducted on a cohort of human immunodeficiency virus (HIV)-positive and HIV-negative patients with PjP, in the univariate analysis, an age >60 years and chronic lung diseases (CLD) were significantly associated with more severe outcomes and death due to respiratory failure, whereas receiving TMP/SMX prophylaxis was associated with a reduced possibility of severe PjP
Summary
Pneumocystis jiroveci pneumonia (PjP) is a serious and potentially life-threatening fungal infection that is mostly diagnosed in immune-compromised individuals. Over the last several decades, the introduction of antiretroviral therapy (ARV) dramatically reduced the PjP incidence in HIV-positive patients; a new increase in the rate of this pneumonia was reported in large epidemiological studies from France and England [1, 2]. These studies documented a major incidence of PjP in non-HIV-infected patients reaching the levels observed in HIV-positive subjects. More efficient laboratory tools for P. jiroveci (Pj) diagnosis and the consequent better ascertainment of PjP cases were considered the basis for the recent increase in PjP incidence
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