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[Pneumocystis jiroveci pneumonia in immunocompromised patients without AIDS -- a case series]

T Blum1, A Roth, H Mauch

  • 1Klinik für Pneumologie und Infektiologie, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring. tblum@berlin-behring.helios-kliniken.de

Deutsche Medizinische Wochenschrift (1946)
|July 4, 2006
PubMed
Abstract

Insights

Pneumocystis pneumonia (PcP) without AIDS is a significant concern in immunocompromised patients. Polymerase chain reaction (PCR) testing of broncho-alveolar lavage (BAL) is superior for diagnosing PcP compared to immunofluorescence testing (IFT).

Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Immunology

Background:

  • Pneumonia resistant to treatment is a common challenge in chest hospitals.
  • Pneumocystis jiroveci (Pc) is an opportunistic pathogen associated with T cell immunodeficiency, even without obvious AIDS.
  • This study focuses on cases of Pneumocystis jiroveci pneumonia (PcP) in patients without associated AIDS.

Purpose of the Study:

  • To report on cases of Pneumocystis jiroveci pneumonia (PcP) in patients without associated AIDS.
  • To highlight the diagnostic challenges and outcomes of PcP in this patient population.
  • To evaluate diagnostic methods for PcP in immunocompromised individuals.

Main Methods:

  • Assessed 1921 inpatients with pneumonia between 1996 and 2005.
  • Identified PcP cases using discharge diagnoses and microbiological databases (detection of Pc by immunofluorescence-test (IFT) and/or PCR).
  • Analyzed patient data including CD4 cell counts, diagnostic test results (Pc-PCR, Pc-IFT), ventilation requirements, and mortality rates.

Main Results:

  • PcP was diagnosed in 14 patients (11 males, 3 females) without associated AIDS, all on immunosuppressive medication.
  • 11 patients had significantly decreased CD4 cell counts (<200/microl).
  • Pneumocystis jiroveci pneumonia (PcP) diagnosis required Pc-PCR in 8 patients, as Pc-IFT was positive in only 6; mortality rate was 14.3% (2/14).

Conclusions:

  • Pneumocystis jiroveci pneumonia (PcP) is a critical differential diagnosis for pneumonia and a severe complication in immunodeficient patients.
  • Suspected immunodeficiency warrants CD4 cell count and bronchoscopy with broncho-alveolar lavage (BAL) for PcP diagnosis.
  • Pneumocystis jiroveci pneumonia (PcP) diagnosis: Pc-PCR is superior to Pc-IFT and should be routine.

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