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Pneumocystis carinii pneumonia in HIV-negative patients

Abstract number: 1734_177

Kofteridis D., Velegraki M., Antoniou M., Papazoglou G., Anastasopoulos T., Alegakis D., Samonis G.

Purpose:Pneumocystis carinii (renamed jirovecii) pneumonia (PCP), is a life-threatening opportunistic infection occurring in immunocompromised hosts. The aim of this study was to investigate the predisposing factors, clinical features and outcome of PCP in HIV-negative patients.

Materials and Methods: The medical records of 18 hospitalised adult patients with PCP during a 3 year period (2004 to 2006) were retrospectively reviewed using a standardised questionnaire.

Results: Twelve men (67%) and 6 women (33%) were identified suffering of PCP.

Their median age was 65 (range 25–80 years). Eight patients had haematologic malignancies, 5 solid tumours, 2 rheumatoid arthritis, 1 systemic lupus erythematosus and 2 patients had type 2 diabetes, as underlying diseases. Cytotoxic and/or immunosuppressive drugs including steroids were used in 14 (78%). One patient did not have any known immunosuppression. Only ten patients (55%) had absolute lymphopenia at the time of PCP onset, ranging from 100–700 lymphocytes/mm3 (median 300/mm3). In 7 (70%) out of 10 patients having a high-resolution computed tomography the ground-glass pattern was a characteristic finding suggestive of PCP. All 18 cases were confirmed microbiologically by direct immunofluorescence technique. On admission only 3 patients (17%) was receiving trimethoprim-sulfamethoxazole prophylactically. Six patients (33%) developed severe symptoms, required mechanical ventilation and were admitted to the intensive care unit. All patients received appropriate therapy consisting of trimethoprim-sulfamethoxazole (sulfamethoxazole 100 mg/kg/day) and corticosteroids. Improvement occurred only in 9 (50%) who survived, whereas the remaining 9 patients died. PCP was the clear cause of death in 5 (26%).

Conclusions: PCP is a life-threatening disease with poor prognosis in patients treated appropriately. The infection occurs mainly in patients treated with immunosuppressives, especially corticosteroids. However it can also occur in patients with no apparent immunosuppression. PCP prophylaxis should be considered in patients treated with corticosteroids and those with malignancies receiving antineoplastic chemotherapy.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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