Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes

BMC Infectious Diseases

Research Article

Shunji Takakura¹  Yasufumi Matsumura¹  Satoshi Ichiyama¹  Masaki Yamamoto¹  Aki Matsushima¹  Miki Nagao¹  Yoshitsugu Iinuma²  Michinori Shirano³  Yutaka Ito⁴  Yoshinori Hasegawa⁵  Yuichiro Shindo⁵ 

[1] Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan;Department of Infectious Diseases, Kanazawa Medical University, Kanazawa, Japan;Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan;Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan;Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan;

关键词: Human Immunodeficiency Virus;    Internal Transcribe Spacer;    Aspergillosis;    Sequential Organ Failure Assessment Score;    Human Immunodeficiency Virus Patient;   

DOI  :  10.1186/1471-2334-11-76

 received in 2010-11-19, accepted in 2011-03-25,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe number of patients with non-HIV Pneumocystis pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We investigated the clinical characteristics of non-HIV PCP and its association with microbiological genotypes.MethodsBetween January 2005 and March 2010, all patients in 2 university hospitals who had been diagnosed with PCP by PCR were enrolled in this study. Retrospective chart review of patients, microbiological genotypes, and association with 30-day mortality were examined.ResultsOf the 82 adult patients investigated, 50 patients (61%) had inflammatory diseases, 17 (21%) had solid malignancies, 12 (15%) had hematological malignancies, and 6 (7%) had received transplantations. All patients received immunosuppressive agents or antitumor chemotherapeutic drugs. Plasma (1→3) β-D-glucan levels were elevated in 80% of patients, and were significantly reduced after treatment in both survivors and non-survivors. However, β-D-glucan increased in 18% of survivors and was normal in only 33% after treatment. Concomitant invasive pulmonary aspergillosis was detected in 5 patients. Fifty-six respiratory samples were stored for genotyping. A dihydropteroate synthase mutation associated with trimethoprim-sulfamethoxazole resistance was found in only 1 of the 53 patients. The most prevalent genotype of mitochondrial large-subunit rRNA was genotype 1, followed by genotype 4. The most prevalent genotype of internal transcribed spacers of the nuclear rRNA operon was Eb, followed by Eg and Bi. Thirty-day mortality was 24%, in which logistic regression analysis revealed association with serum albumin and mechanical ventilation, but no association with genotypes.ConclusionsIn non-HIV PCP, poorer general and respiratory conditions at diagnosis were independent predictors of mortality. β-D-glucan may not be useful for monitoring the response to treatment, and genotypes were not associated with mortality.

【 授权许可】

Unknown   
© Matsumura et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.