[Pneumocystis jiroveci pneumonia in immunocompromised patients without AIDS -- a case series]

Abstract

Background and objective: Patients with pneumonia resistant to treatment are a common problem in chest hospitals. Pneumocystis jiroveci (Pc) should always be considered as an opportunistic pathogen in case of potential, especially T cell-related immunodeficiency, even if AIDS is not obvious. We report on cases of Pneumocystis jiroveci pneumonia (PcP) (n = 1921) without associated AIDS in a chest hospital.

Patients and methods: We assessed 1921 inpatients presenting with pneumonia during January 1 (st) 1996 and September 30 (th) 2005 in our hospital. Identification of the cases with PcP was based on discharge diagnosis as well as on our microbiological database (detection of Pc by immunofluorescence-test (IFT) and/or PCR).

Results: The diagnosis of PcP was made in 14 patients (11 males, 3 females) without associated AIDS. All patients were treated with immunosuppressive medication before admission. CD4 cell-counts were substantially decreased (CD4 cells < 200/microl) in 11 patients. To establish the diagnosis of PcP a Pc-PCR (using broncho-alveolar lavage (BAL) as the best material) was necessary in 8 patients, since the Pc-IFT proved positive only in 6 patients. Severe hypoxemia had to be managed by noninvasive ventilation in 3 patients, while another 4 patients had to be ventilated invasively. The mortality rate was 2 out of 14 patients.

Conclusions: PcP is an important disease in the differential diagnosis of pneumonia and at the same time constitutes a severe pulmonary complication in immunodeficient patients. If immunodeficiency is suspected, a CD4 cell-count as well as bronchoscopy with BAL should be performed to diagnose PcP. As expected, Pc-PCR was superior to Pc-IFT and should therefore be used on a routine basis for diagnosing PcP.