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Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients
Anne-Lise Bienvenu1, Karim Traore2, Irina Plekhanova2
1Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France.
Background:
Pneumocystis pneumonia (PCP) is one of the most devastating fungal diseases in patients with impaired immunity. Effective antiviral therapies have reduced the burden of PCP among AIDS patients, but an increase in the prevalence of this disease among persons receiving immunosuppressive therapies has been reported.
Methods:
We retrospectively reviewed HIV and non-HIV PCP patients diagnosed in our department during a nine year period. Data were collected from the local database completed during the diagnosis procedure. For each patient, demographic, clinical, radiological, biological and therapeutic data were analyzed.
Results:
A total of 21,274 bronchoalveolar samples were received from patients suspected of pneumocystosis during the study period, leading to a discharge diagnosis of PCP for 604 patients (143 HIV-positive and 461 HIV-negative). The ratio of non-HIV versus HIV patients presenting PCP increased from 1.7 to 5.6 during the study period. The mortality rate at day 14 was 16%, occurring mostly in non-HIV patients (20.6% compared to 1.4%, P<0.0001), while non-HIV patients were less symptomatic at diagnosis than AIDS patients.
Conclusions:
This study presents one of the higher number of HIV and non-HIV patients presenting with PCP in a single center. Pneumocystosis is now a crucial health challenge for patients receiving immunosuppressive therapy, with a high mortality rate. This study highlights the need for international guidelines for prophylaxis of PCP in non-HIV patients.
Insights
Pneumocystis pneumonia (PCP) is increasingly affecting non-HIV patients, who also experience higher mortality rates. This highlights an urgent need for international guidelines for PCP prophylaxis in these vulnerable individuals.
Area of Science:
- Infectious Diseases
- Immunology
- Pulmonology
Background:
- Pneumocystis pneumonia (PCP) is a severe fungal infection primarily affecting immunocompromised individuals.
- While effective treatments have reduced PCP in AIDS patients, its incidence is rising in those on immunosuppressive therapies.
- This shift necessitates a re-evaluation of PCP's epidemiology and management strategies.
Purpose of the Study:
- To retrospectively analyze PCP cases in both HIV-positive and HIV-negative patients over a nine-year period.
- To compare demographic, clinical, radiological, and therapeutic data between HIV-positive and HIV-negative PCP patients.
- To assess trends in PCP prevalence and outcomes in different patient groups.
Main Methods:
- Retrospective review of 604 diagnosed PCP cases (143 HIV-positive, 461 HIV-negative) from bronchoalveolar lavage samples.
- Analysis of patient data including demographics, clinical presentation, diagnostic findings, and treatment regimens.
- Statistical comparison of outcomes between HIV-positive and HIV-negative patient cohorts.
Main Results:
- The ratio of non-HIV to HIV patients with PCP increased significantly from 1.7 to 5.6 during the study period.
- Overall 14-day mortality was 16%, with a substantially higher rate in non-HIV patients (20.6%) compared to HIV-positive patients (1.4%).
- Non-HIV patients presented with fewer symptoms at diagnosis than HIV-positive patients.
Conclusions:
- Pneumocystis pneumonia poses a significant and growing threat to non-HIV patients on immunosuppressive therapy.
- The high mortality rate observed in non-HIV PCP cases underscores the severity of this condition in this population.
- There is a critical need for the development and implementation of international guidelines for PCP prophylaxis in non-HIV patients.
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