Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years' experience of infection in GIMEMA centres.
A retrospective survey was conducted over a 10-year period (1990-99) among 52 haematology divisions in order to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating haematological diseases. The study included 55 patients (18 with non-Hodgkin's lymphoma, 10 with acute lymphoblastic leukaemia, eight with acute myeloid leukaemia, five with chronic myeloid leukaemia, four with chronic lymphocytic leukaemia, four with multiple myeloma, three with myelodysplastic syndrome, two with myelofibrosis and one with thalassemia) who developed PCP. Among these, 18 (33%) underwent stem cell transplantation; only two received an oral prophylaxis with trimethroprim/sulphamethoxazole. Twelve patients (22%) developed PCP despite protective isolation in a laminar airflow room. The most frequent symptoms were: fever (86%), dyspnoea (78%), non-productive cough (71%), thoracic pain (14%) and chills (5%); a severe hypoxaemia was present in 39 patients (71%). Chest radiography or computerized tomography showed interstitial infiltrates in 34 patients (62%), alveolar infiltrates in 12 patients (22%), and alveolar-interstitial infiltrates in nine patients (16%). Bronchoalveolar lavage was diagnostic in 47/48 patients, induced sputum in 9/18 patients and lung biopsy in 3/8 patients. The diagnosis was made in two patients at autopsy. All patients except one started a specific treatment (52 patients trimethroprim/sulphamethoxazole, one pentamidine and one dapsone). Sixteen patients (29%) died of PCP within 30 d of diagnosis. Multivariate analysis showed that prolonged steroid treatment (P < 0.006) and a radiological picture of diffuse lung involvement (P < 0.003) were negative diagnostic factors.
Pagano
Livio
L
Institute of Hematology, Sacred Heart Catholic University, Largo Francesco Vito 1, I-00168 Rome, Italy. lpagano@rm.unicatt.it
Fianchi
Luana
L
Mele
Luca
L
Girmenia
Corrado
C
Offidani
Massimo
M
Ricci
Paolo
P
Mitra
Maria E
ME
Picardi
Marco
M
Caramatti
Cecilia
C
Piccaluga
Paolo
P
Nosari
Annamaria
A
Buelli
Massimo
M
Allione
Bernardino
B
Cortelezzi
Agostino
A
Fabbiano
Francesco
F
Milone
Giuseppe
G
Invernizzi
Rosangela
R
Martino
Bruno
B
Masini
Luciano
L
Todeschini
Giuseppe
G
Cappucci
Maria A
MA
Russo
Domenico
D
Corvatta
Laura
L
Martino
Pietro
P
Del Favero
Albano
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D008168:Lung / Q000000981:diagnostic imaging; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D055728:Primary Myelofibrosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D013789:Thalassemia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination