title: Intermittent Courses of Corticosteroids Also Present a Risk forPneumocystisPneumonia in Non-HIV Patients.
abstract: Introduction.Pneumocystispneumonia (PCP) is rising in the non-HIV population and associates with higher morbidity and mortality. The aggressive immunosuppressive regimens, as well as the lack of stablished guidelines for chemoprophylaxis, are likely contributors to this increased incidence. Herein, we have explored the underlying conditions, immunosuppressive therapies, and clinical outcomes of PCP in HIV-negative patients.Methods. Retrospective analysis of PCP in HIV-negative patients at Mayo Clinic from 2006-2010. The underlying condition, immunosuppressive therapies, coinfection, and clinical course were determined. PCP diagnosis required symptoms of pneumonia and identification of the organisms by visualization or by a real-time polymerase chain reaction.Results. A total of 128 cases of PCP were identified during the study period. Hematological malignancies were the predisposing condition for 50% of the patients. While 87% had received corticosteroids or other immunosuppressive therapies for >4 weeks prior to the diagnosis, only 7 were receiving PCP prophylaxis. Up to 43% of patients were not on daily steroids. Sixty-seven patients needed Intensive Care Unit (ICU) and 53 received mechanical ventilation. The mortality for those patients requiring ICU was 40%.Conclusions. PCP diagnosis in the HIV-negative population requires a high level of suspicion even if patients are not receiving daily corticosteroids. Mortality remains high despite adequate treatment.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Seville, Spain.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Calero-Bernal
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Servicio de Medicina Interna, Hospital Quirón San Camilo, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Martin-Garrido
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: Donazar-Ezcurra
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Limper
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eva M
authors.identifier: 0000-0001-9852-8396
authors.initials: EM
authors.lastname: Carmona
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011020:Pneumonia, Pneumocystis / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination