Pneumocystis jirovecii Pneumonia: 14 Years of Experience in an Intensive Care Unit
DOI:
https://doi.org/10.24950/rspmi.775Keywords:
Critical Care, HIV Infections, Pneumocystis jirovecii, Pneumonia, PneumocystisAbstract
Background: Pneumocystis jirovecii pneumonia (PJP) is a condition
that affects immunocompromised individuals. It is the most common
opportunistic infection in human immunodeficiency virus (HIV) infected
individuals. Despite a decline in its incidence, severe PJP continues to
be a common cause of intensive care unit (ICU) admission.
Material and Methods: Retrospective study (2000-2013) of patients
with PJP admitted to an ICU at a university hospital. Data regarding
risk factors, diagnosis, treatment, length of stay and mortality was
analyzed.
Results: A total of 27 patients with a mean age of 47.7 (+13.4) years
were identified, from which 81.7% were male. Identified risks factors
were HIV infection (44.4%), transplant (18.5%), neoplasms (7.4%), vasculitis
and hepatitis C (3.7%). No risk factor was identified for 22.2%. In
83.3% of the HIV patients, this diagnosis was unknown and none was
on prophylaxis. All HIV patients had CD4+ < 200 cells/microL. PJ was
mainly (96.3%) identified on bronchoalveolar lavage (BAL). Invasive
mechanical ventilation and vasopressors were necessary for 6.3% and
62.9% of the patients, respectively. Three HIV positive patients stayed
on ART during treatment. Seven patients (25.9%) developed pneumothorax.
The mean length of hospital stay was 17.4 days. Mortality
reached 51.9%.
Conclusion: PJP affected mainly young male individuals with HIV
infection and CD4+ < 200 cells/μL. A significant number of patients
had no identifiable risk factor for PJP. In most cases, the diagnosis
was carried out in BAL. The co-trimoxazole was the first therapeutic
option in all cases. The number of individuals under ART was low. Both
severity and mortality of the patients were high.
Downloads
References
Edman JC, Kovacs JA, Masur H, Santi DV, Elwood HJ, Sogin ML. Ribosomal RNA sequence shows Pneumocystis carinii to be a member
of the fungi. Nature. 1988;334:519-22.
Thomas CF, Jr., Limper AH. Pneumocystis pneumonia. New Engl J Med.2004;350:2487-98.
Sepkowitz KA. Opportunistic infections in patients with and patients without Acquired Immunodeficiency Syndrome. Clin Infect Dis.
;34:1098-107.
Jacobs JL, Libby DM, Winters RA, Gelmont DM, Fried ED, Hartman BJ, et al. A cluster of Pneumocystis carinii pneumonia in adults without predisposing illnesses. New Engl J Med. 1991;324:246-50.
Cano S, Capote F, Pereira A, Calderon E, Castillo J. Pneumocystis carinii pneumonia in patients without predisposing illnesses. Acute
episode and follow-up of five cases. Chest. 1993;104:376-81.
Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc. 1996;71:5-13.
DeLorenzo LJ, Huang CT, Maguire GP, Stone DJ. Roentgenographic patterns of Pneumocystis carinii pneumonia in 104 patients with AIDS. Chest. 1987;91:323-7.
Catherinot E, Lanternier F, Bougnoux ME, Lecuit M, Couderc LJ, Lortholary O. Pneumocystis jirovecii Pneumonia. Infect Dis Clin North
Am. 2010;24:107-38.
Miller RF, Huang L, Walzer PD. Pneumocystis pneumonia associated with human immunodeficiency virus. Clin Infect Dis. 2013;34:229-41.
Murry CE, Schmidt RA. Tissue invasion by Pneumocystis carinii: a possible cause of cavitary pneumonia and pneumothorax. Hum
Pathol. 1992;23:1380-7.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.[accessed Dec 2015] Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf.
12. Curtis JR, Yarnold PR, Schwartz DN, Weinstein RA, Bennett CL. Improvements in outcomes of acute respiratory failure for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia. AmJ Respir Crit Care Med. 2000;162:393-8.
Pareja JG, Garland R, Koziel H. Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest.
;113:1215-24.
Roembke F, Heinzow HS, Gosseling T, et al. Clinical outcome and predictors of survival in patients with pneumocystis jirovecii pneumonia-results of a tertiary referral centre. Clin Respir J. 2014;8:86-92.
15. Solano LM, Alvarez Lerma F, Grau S, Segura C, Aguilar A. Neumonia por Pneumocystis jiroveci: caracteristicas clinicas y factores de riesgo asociados a mortalidad en una Unidad de Cuidados Intensivos. Med Intensiva. 2015;39:13-9.
KIofteridis DP, Valachis A, Velegraki M, Antoniou M, Christofaki M, Vrentzos GE, et al. Predisposing factors, clinical characteristics
and outcome of Pneumonocystis jirovecii in HIV-negative patients. Kansenshogaku Zasshi. 2014;88:21-5.
Monnet X, Vidal-Petiot E, Osman D, Hamzaoui O, Hamzaoui O, Durrbach A, Goujard C, et al. Critical care management and outcome
of severe Pneumocystis pneumonia in patients with and without HIV infection. Crit Care. Cr2008;12; R28.
Fei M, Sant C, Kim E, Swartzman A, Davis JL, Jarlsberg LG, et al. Severity and outcomes of Pneumocystis pneumonia in patients newly
diagnosed with HIV infection: an observational cohort study. Scand J Infect Dis 2009;41:672-8.
Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15:1143-238.
Martin SI, Fishman JA, Practice ASTIDCo. Pneumocystis pneumonia in solid organ transplantation. Am J Transplant.2013;13 Suppl
:272-9.
Suryaprasad A, Stone JH. When is it safe to stop Pneumocystis jiroveci pneumonia prophylaxis? Insights from three cases complicating autoimmune diseases Arthritis Rheum. 2008;59:1034-9.
Zaman M, Wooten O, Suprahmanya B, Ankobiah W, Finch P, Kamholz S. Rapid noninvasive diagnosis of Pneumocystis carinii from induced liquefied sputum. Ann Intern Med.1988;109:7.
Cruciani M, Marcati P, Malena M, Bosco O, Serpelloni G, Mengoli C. Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients. Eur Respir J. 2002;20:982.
Willocks L, Burns S, Cossar R, Brettle R. Diagnosis of Pneumocystis carinii pneumonia in a population of HIV-positive drug users, with particular reference to sputum induction and fluorescent antibody techniques. J Infect. 1993;26:257.
Sarkar P, Rasheed HF. Clinical review: Respiratory failure in HIVinfected patients--a changing picture. Crit Care 2013;17:228.
Zolopa A, Andersen J, Powderly W, Sanchez A, Sanne I, Suckow C, et al. Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PloS One 2009;4:e5575.
Miller RF, Allen E, Copas A, Singer M, Edwards SG. Improved survival for HIV infected patients with severe Pneumocystis jirovecii pneumonia is independent of highly active antiretroviral therapy. Thorax. 2006;61:716-21.
Monnet X, Vidal-Petiot E, Osman D, Hamzaoui O, Durrbach A, Goujard C, et al. Critical care management and outcome of severe
Pneumocystis pneumonia in patients with and without HIV infection. Crit Care. 2008;12:R28.
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Medicina Interna
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
