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Pneumocystis jirovecii pneumonia in AIDS and non-AIDS immunocompromised patients - an update
Yuan-Ti Lee1, Ming-Lung Chuang2
1Chung Shan Medical University, Taichung, Taiwan. leey521@yahoo.com.tw.
Introduction:
Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients.
Methodology:
We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017.
Results:
The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial.
Conclusions:
Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.
Insights
Pneumocystis pneumonia (PJP) affects immunocompromised patients, with non-AIDS patients potentially facing a more severe course. Early diagnosis and treatment are crucial for improving survival rates in all PJP patients.
Area of Science:
- Infectious Diseases
- Mycology
- Immunocompromised Hosts
Background:
- Pneumocystis jirovecii pneumonia (PJP) is a significant opportunistic infection in immunocompromised individuals.
- PJP presents a growing concern, particularly with potentially higher mortality in non-AIDS patients.
- Understanding PJP characteristics, diagnosis, and outcomes in both AIDS and non-AIDS populations is critical.
Purpose of the Study:
- To compare the characteristics, diagnosis, and treatment outcomes of PJP in patients with and without AIDS.
- To identify key differences and similarities in clinical presentation and disease course.
- To evaluate diagnostic markers and treatment strategies for PJP.
Main Methods:
- A comprehensive literature review of studies on PJP in AIDS and non-AIDS patients was conducted.
- PubMed database was searched for relevant studies published up to December 2017.
- Data on incidence, clinical features, radiological findings, diagnostic methods, and outcomes were analyzed.
Main Results:
- While AIDS-PJP incidence decreased, non-AIDS-PJP incidence varied. Both groups shared similar clinical and radiological features, but non-AIDS-PJP cases showed a more fulminant course.
- Mortality rates remained high in both groups despite treatment advances. Laboratory diagnosis was often nonspecific, though CD4+ T-cell counts and serum 1,3-β-D-glucan (BDG) aided diagnosis.
- Combining BDG with lactic dehydrogenase improved AIDS-PJP diagnosis; histopathology and PCR could not distinguish infection from colonization.
Conclusions:
- Vigilance in early diagnosis and prompt treatment are essential for improving PJP survival rates in immunocompromised patients.
- Further research into optimal diagnostic and therapeutic strategies for non-AIDS PJP is warranted.
- Distinguishing PJP infection from colonization requires careful interpretation of diagnostic tests.
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