title: Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  Between 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.
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  In 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.
authors: Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Yasufumi
authors: Y
authors: Matsumura
authors: Yuichiro
authors: Y
authors: Shindo
authors: Yoshitsugu
authors: Y
authors: Iinuma
authors: Masaki
authors: M
authors: Yamamoto
authors: Michinori
authors: M
authors: Shirano
authors: Aki
authors: A
authors: Matsushima
authors: Miki
authors: M
authors: Nagao
authors: Yutaka
authors: Y
authors: Ito
authors: Shunji
authors: S
authors: Takakura
authors: Yoshinori
authors: Y
authors: Hasegawa
authors: Satoshi
authors: S
authors: Ichiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004269:DNA, Bacterial / Q000235:genetics; D004272:DNA, Mitochondrial / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D045363:Pneumocystis carinii / Q000235:genetics*; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult; D047071:beta-Glucans / Q000032:analysis
chemical_list: D004269:DNA, Bacterial; D004272:DNA, Mitochondrial; D047071:beta-Glucans