title: Analysis of clinical features of non-HIV Pneumocystis jirovecii pneumonia.
abstract: Pneumocystis jirovecii pneumonia (PCP) is classified as PCP with human immunodeficiency virus (HIV) and non-HIV PCP, and the two forms differ in progression and prognosis. Although early treatment is necessary, the diagnosis of non-HIV PCP is often difficult because of the underlying diseases. However, the outcome with treatment delay remains unclear because there are no concrete data indicating a worsened clinical situation or increased complications related to delayed therapy initiation. We retrospectively examined patients with non-HIV PCP admitted to Tokyo Women's Medical University Hospital from November 2008 to October 2010. The relationship between intubation with mechanical ventilation (within 1 week after starting treatment) and treatment delay was investigated. Treatment delay was defined as the period, in days, from onset to therapy initiation. In total, 24 confirmed non-HIV PCP cases were included. Median treatment delay was 7 ± 4.83 days (1-20 days). Twelve of 24 cases (50 %) were intubated, and 11 (45.8 %) died of their underlying diseases within 90 days. Treatment delay was more than 7 days in the intubation group, but was within 7 days in 9 of 12 nonintubation cases. The difference in treatment delay was significant (p = 0.0071) between the intubation and nonintubation groups, but there were no significant differences in survival rate at 90 days or other findings. We conclude that starting treatment within 7 days after onset is important because intubation and mechanical ventilation may be avoided in many cases.
authors.affiliation: Department of Infectious Disease, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. y_ainoda@clabo.twmu.ac.jp
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ainoda
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hirai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujita
authors.forename: Noriko
authors.initials: N
authors.lastname: Isoda
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Totsuka
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000473:pathology*; D012189:Retrospective Studies; D014041:Tokyo