title: Human herpes virus co-infection is associated with mortality in HIV-negative patients with Pneumocystis jirovecii pneumonia.
abstract: The purpose of this investigation was to characterize the management and prognosis of severe Pneumocystis jirovecii pneumonia (PJP) in human immunodeficiency virus (HIV)-negative patients. An observational cohort study of HIV-negative adults with PJP documented by bronchoalveolar lavage (BAL) through Gomori-Grocott staining or immunofluorescence, admitted to one intensive care unit (ICU) for acute respiratory failure, was undertaken. From 1990 to 2010, 70 patients (24 females, 46 males) were included, with a mean age of 58.6 ± 18.3 years. The mean Simplified Acute Physiology Score (SAPS)-II was 36.9 ± 20.4. Underlying conditions included hematologic malignancies (n = 21), vasculitis (n = 13), and solid tumors (n = 13). Most patients were receiving systemic corticosteroids (n = 63) and cytotoxic drugs (n = 51). Not a single patient received trimethoprim-sulfamethoxazole as PJP prophylaxis. Endotracheal intubation (ETI) was required in 42 patients (60.0 %), including 38 with acute respiratory distress syndrome (ARDS). In-ICU mortality was 52.9 % overall, reaching 80.9 % and 86.8 %, respectively, for patients who required ETI and for patients with ARDS. In the univariate analysis, in-ICU mortality was associated with SAPS-II (p = 0.0131), ARDS (p < 0.0001), shock (p < 0.0001), and herpes simplex virus (HSV) or cytomegalovirus (CMV) on BAL (p = 0.0031). In the multivariate analysis, only ARDS was associated with in-ICU mortality (odds ratio [OR] 23.4 [4.5-121.9], p < 0.0001). PJP in non-HIV patients remains a serious disease with high in-hospital mortality. Pulmonary co-infection with HSV or CMV may contribute to fatal outcome.
authors.affiliation: Service des Maladies Infectieuses et de Réanimation Médicale, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Fillatre
authors.forename: S
authors.initials: S
authors.lastname: Chevrier
authors.forename: M
authors.initials: M
authors.lastname: Revest
authors.forename: A
authors.initials: A
authors.lastname: Gacouin
authors.forename: S
authors.initials: S
authors.lastname: Jouneau
authors.forename: H
authors.initials: H
authors.lastname: Leroy
authors.forename: F
authors.initials: F
authors.lastname: Robert-Gangneux
authors.forename: S
authors.initials: S
authors.lastname: Minjolle
authors.forename: Y
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: P
authors.initials: P
authors.lastname: Tattevin
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000401:mortality*; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000401:mortality*; D012189:Retrospective Studies; D018139:Simplexvirus / Q000302:isolation & purification