title: Pneumocystis pneumonia in non-HIV children: a 10-year retrospective study.
abstract: BACKGROUND
  Pneumocytis pneumonia (PCP) is a life-threatening disease in non-HIV infected children. However, there have been few studies that have examined the clinical characteristics associated with PCP and outcomes for these pediatric patients.
  
  
  OBJECTIVE
  A retrospective review was performed over a 10-year period to evaluate the clinical characteristics and outcome of non-HIV children diagnosed with PCP at Beijing Children's Hospital in China.
  
  
  RESULTS
  A total of 60 non-HIV children diagnosed with PCP were included in the study. The overall mortality was 41.7% (25/60). Underlying diseases included connective tissue disease (n = 23; 38.3%), hematological disease (n = 14; 23.3%), nephrotic disease (n = 8; 13.3%) and immunodeficiency disease (n = 10; 16.7%). In all, 26/40 (65.0%) children developed PCP after receiving a follow-up large dose of glucocorticoid because of recurrent disease. Median time from beginning glucocorticoid medication to PCP diagnosis was 245.9 days (range: 14-2100 days). The area under the ROC curve of CD4/CD8 T cell levels for the diagnosis of PCP was 0.902 (95% confidence interval, 0.849-0.955). The analysis rendered an optimum cut-off value of 0.715 corresponding to 89.2% sensitivity and 80.4% specificity. Using a multivariate logistic regression model, three parameters were identified as significantly associated with mortality: LDH level, mechanical ventilation and co-infection.
  
  
  CONCLUSIONS
  The outcome of PCP in non-HIV children remains poor. A critical stage for PCP development is administration of follow-up glucocorticoid without prophylaxis. CD4/CD8 ratio is a suitable biomarker for predicting PCP and diagnostic of PCP in non-HIV children. Poor prognostic factors include LDH level, need for mechanical ventilation and co-infection.
authors.affiliation: Pediatric Intensive Care Unit, Beijing Children's Hospital affiliated to Capital Medical University, Beijing, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Ling
authors.affiliation: Pediatric Intensive Care Unit, Beijing Children's Hospital affiliated to Capital Medical University, Beijing, China.
authors.forename: Suyun
authors.initials: S
authors.lastname: Qian
authors.affiliation: Pediatric Intensive Care Unit, Beijing Children's Hospital affiliated to Capital Medical University, Beijing, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Pediatric Intensive Care Unit, Beijing Children's Hospital affiliated to Capital Medical University, Beijing, China.
authors.forename: Jiansheng
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Pediatric Intensive Care Unit, Beijing Children's Hospital affiliated to Capital Medical University, Beijing, China.
authors.forename: Xinlei
authors.initials: X
authors.lastname: Jia
authors.affiliation: Pediatric Intensive Care Unit, Beijing Children's Hospital affiliated to Capital Medical University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Pediatric Intensive Care Unit, Beijing Children's Hospital affiliated to Capital Medical University, Beijing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D001999:Bronchoscopy; D002648:Child; D002681:China / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006678:HIV; D006801:Humans; D015994:Incidence; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D013902:Radiography, Thoracic; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: CD4/CD8 ratio; non-HIV; pediatric patients; pneumocystis pneumonia