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Multicenter Study

Pneumocystis jirovecii pneumonia in patients with or without AIDS, France

Antoine Roux et al. Emerg Infect Dis. 2014 Sep.

Abstract

Pneumocystis jirovecii pneumonia (PCP) in patients without AIDS is increasingly common. We conducted a prospective cohort study of consecutive patients with proven PCP; of 544 patients, 223 (41%) had AIDS (AIDS patients) and 321 (59%) had other immunosuppressive disorders (non-AIDS patients). Fewer AIDS than non-AIDS patients required intensive care or ventilation, and the rate of hospital deaths--17.4% overall--was significantly lower for AIDS versus non-AIDS patients (4% vs. 27%; p<0.0001). Multivariable analysis showed the odds of hospital death increased with older age, receipt of allogeneic bone marrow transplant, immediate use of oxygen, need for mechanical ventilation, and longer time to treatment; HIV-positive status or receipt of a solid organ transplant decreased odds for death. PCP is more often fatal in non-AIDS patients, but time to diagnosis affects survival and is longer for non-AIDS patients. Clinicians must maintain a high index of suspicion for PCP in immunocompromised patients who do not have AIDS.

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Figures

Figure 1
Figure 1
Flowchart of selection of patients with Pneumocystis jirovecii pneumonia (PCP) for study and underlying conditions among non-AIDS patients, France, January 1, 2007–December 31, 2010. Miscellaneous conditions: inflammatory diseases or automimmune (n = 4); common variable immunodeficiency (n = 2); focal segmental glomerulosclerosis (n = 2); sarcoidosis (n = 1); steroid-dependent asthma (n = 1); idiopathic pulmonary fibrosis (n = 1); acute alcoholic hepatitis (n = 3). ALL, acute lymphoid leukemia; AML, acute myeloid leukemia; CLL, chronic lymphoid leukemia; CML, chronic myeloid leukemia; HSCT, hematopoietic stem cell transplant; SOT, solid organ transplant.
Figure 2
Figure 2
Survival in 544 patients with Pneumocystis jirovecii pneumonia by A) number of days from admission to treatment initiation and B) patient age, France, January 1, 2007–December 31, 2010. p<0.0001 by log-rank test for both comparisons.
See this image and copyright information in PMC

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