Pneumocystis jiroveci pneumonia in immunocompromised patients: delayed diagnosis and poor outcomes in non-HIV-infected individuals.
BACKGROUND
Pneumocystis jiroveci pneumonia (PJP) is a life-threatening disease in immunocompromised patients. Improved knowledge about the varied characteristics and management in different populations may guide treatment.


METHODS
We evaluated the clinical characteristics, management, and outcomes of patients with PJP diagnosed by nested polymerase chain reaction at a medical center in southern Taiwan from 2008 to 2011. The risk factors of mortality among non-human immunodeficiency virus (HIV)-infected patients were analyzed.


RESULTS
During the study period, there were 43 cases of PJP, and the common underlying diseases were HIV infection (23 patients, median CD4 count: 19/μl) and malignancy. The HIV-infected patients had a younger age (36.9 ± 13.7 vs. 50.2 ± 16.2 years, p = 0.006), a lower body mass index (19.9 ± 2.3 vs. 22.0 ± 3.7 kg/m(2), p = 0.035), a longer duration of symptoms before admission (24 ± 29 vs. 7 ± 15 days, p = 0.035), and a lower pneumonia severity index (56 ± 25 vs. 99 ± 35, p < 0.001) than non-HIV-infected patients. A delay between admission and starting antimicrobial therapy for PJP (10 ± 10 days vs. 1 ± 3 days, p = 0.004) and a high crude mortality (12/20, 60% vs. 2/23, 9%, p = 0.001) were noted in non-HIV-infected patients. In the univariate analysis, the risk factors for mortality were a low lymphocyte count (p < 0.05) and shock during hospitalization (p = 0.004).


CONCLUSIONS
A delay in the initiation of antimicrobial therapy for PJP and severe pneumonia were more common in the non-HIV-infected patients and were most likely related to the poor prognosis. The utilization of sensitive diagnostic tools to facilitate early diagnosis and treatment may improve the clinical outcomes of non-HIV-infected patients with PJP.
Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan.
Ming-Chi
MC
Li
Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan.
Nan-Yao
NY
Lee
Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan.
Ching-Chi
CC
Lee
Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan.
Hsin-Chun
HC
Lee
Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan.
Chia-Ming
CM
Chang
Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
Wen-Chien
WC
Ko
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome