https://doi.org/10.4081/monaldi.2024.2810
Pneumocystis pneumonia in HIV-positive and non-HIV patients: a retrospective comparative study from a lower-middle income country
Submitted: October 10, 2023
Accepted: March 15, 2024
Published: April 3, 2024
Accepted: March 15, 2024
Abstract Views: 541
PDF_EARLY VIEW: 218
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
In this study, we compared the predisposing factors, key demographic and clinical characteristics, clinical outcomes, and factors associated with poor prognosis in pneumocystis pneumonia (PCP) infection among the human immunodeficiency virus (HIV)-positive and non-HIV patient populations. This retrospective analysis was conducted at the Aga Khan University Hospital, Karachi, via the collection and analysis of patient records with a diagnosis of "pneumocystosis" between January 2015 and October 2020. Additionally, the laboratory database was evaluated, and patients with a laboratory-confirmed diagnosis of PCP were included. During the study period, 52 laboratory-confirmed hospitalized PCP patients were identified. Of these, 23 and 29 patients were diagnosed using microscopy and polymerase chain reaction, respectively. 34.6% of our patients were HIV positive, with a median CD4 count of 20.5 cells/mm3 (range: 10.7-50.5). Other conditions identified were corticosteroid use, autoimmune diseases, malignancy, radiation, and chemotherapy. On chest imaging, consolidation was found in 30%, ground-glass opacities in 24%, and nodular infiltrates in 20% of the cases. HIV-positive patients had a lower hemoglobin level and a higher level of β-D-glucan at the time of admission, whereas non-HIV patients were found to have more co-morbid conditions than HIV patients. We observed no difference in clinical outcomes between the two populations. Factors associated with a poor prognosis among our patients included concomitant infections at the time of diagnosis, the need for invasive mechanical ventilation, and a longer duration of stay in the hospital as well as the intensive care unit.
Huang YS, Yang JJ, Lee NY, et al. Treatment of Pneumocystis jirovecii pneumonia in HIV-infected patients: a review. Expert Rev Anti Infect Ther 2017;15:873-92.
DOI: https://doi.org/10.1080/14787210.2017.1364991
Song Y, Ren Y, Wang X, Li R. Recent advances in the diagnosis of pneumocystis pneumonia. Med Mycol J 2016;57:E111-6.
DOI: https://doi.org/10.3314/mmj.16-00019
Sarwar Zubairi AB, Shahzad H, Zafar A. Clinical outcomes of pneumocystis pneumonia from a tertiary care centre in Pakistan. J Pak Med Assoc 2016;66:1367-71.
White PL, Backx M, Barnes RA. Diagnosis and management of Pneumocystis jirovecii infection. Expert Rev Anti Infect Ther 2017;15:435-47.
DOI: https://doi.org/10.1080/14787210.2017.1305887
Salzer HJF, Schäfer G, Hoenigl M, et al. Clinical, diagnostic, and treatment disparities between HIV-infected and non-HIV-infected immunocompromised patients with Pneumocystis jirovecii pneumonia. Respiration 2018;96:52-65.
DOI: https://doi.org/10.1159/000487713
Thomas CF, Limper AH. Pneumocystis Pneumonia. N Engl J Med 2004;350:2487-98.
DOI: https://doi.org/10.1056/NEJMra032588
Kaur R, Wadhwa A, Bhalla P, Dhakad MS. Pneumocystis pneumonia in HIV patients: a diagnostic challenge till date. Med Mycol 2015;53:587-92.
DOI: https://doi.org/10.1093/mmy/myv023
Lowe DM, Rangaka MX, Gordon F, et al. Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systematic review and meta-regression. PLoS One 2013;8:e69969.
DOI: https://doi.org/10.1371/journal.pone.0069969
Jabeen K, Farooqi J, Mirza S, et al. Serious fungal infections in Pakistan. Eur J Clin Microbiol Infect Dis 2017;36:949-56.
DOI: https://doi.org/10.1007/s10096-017-2919-6
Rabold EM, Ali H, Fernandez D, et al. Systematic review of reported HIV outbreaks, Pakistan, 2000-2019. Emerg Infect Dis 2021;27:1039-47.
DOI: https://doi.org/10.3201/eid2704.204205
Ahmed A, Hashmi FK, Khan GM. HIV outbreaks in Pakistan. Lancet HIV 2019;6:e418.
DOI: https://doi.org/10.1016/S2352-3018(19)30179-1
Fan LC, Lu HW, Cheng KB, Li HP, Xu JF. Evaluation of PCR in bronchoalveolar lavage fluid for diagnosis of Pneumocystis jirovecii pneumonia: a bivariate meta-analysis and systematic review. PLoS One 2013;8:e73099.
DOI: https://doi.org/10.1371/journal.pone.0073099
Alshahrani MY, Alfaifi M, Ahmad I, et al. Pneumocystis Jirovecii detection and comparison of multiple diagnostic methods with quantitative real-time PCR in patients with respiratory symptoms. Saudi J Biol Sci 2020;27:1423-7.
DOI: https://doi.org/10.1016/j.sjbs.2020.04.032
Bienvenu AL, Traore K, Plekhanova I, et al. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients. Int J Infect Dis 2016;46:11-7.
DOI: https://doi.org/10.1016/j.ijid.2016.03.018
Liu CJ, Lee TF, Ruan SY, et al. Clinical characteristics, treatment outcomes, and prognostic factors of Pneumocystis pneumonia in non-HIV-infected patients. Infect Drug Resist 2019;12:1457-67.
DOI: https://doi.org/10.2147/IDR.S199761
Rego de Figueiredo I, Vieira Alves R, Drummond Borges D, et al. Pneumocystosis pneumonia: a comparison study between HIV and non-HIV immunocompromised patients. Pulmonology 2019;25:271-4.
DOI: https://doi.org/10.1016/j.pulmoe.2019.04.003
Lu PX, Deng YY, Liu ST, et al. Correlation between imaging features of Pneumocystis Jiroveci pneumonitis (PCP), CD(4) (+) T lymphocyte count, and plasma HIV viral load: a study in 50 consecutive AIDS patients. Quant Imaging Med Surg 2012;2:124-9.
Qin X, Li S, Zhao Y, Li P. Radiological features of AIDS-related pneumocystis jiroveci infection. Radiol Infect Dis 2019;6:38-40.
DOI: https://doi.org/10.1016/j.jrid.2018.05.001
Asai N, Motojima S, Ohkuni Y, et al. Pathophysiological mechanism of non-HIV Pneumocystis jirovecii pneumonia. Respir Investig 2022;60:522-30.
DOI: https://doi.org/10.1016/j.resinv.2022.04.002
Ewald H, Raatz H, Boscacci R, et al. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection. Cochrane Database Syst Rev 2015;2015:CD006150.
DOI: https://doi.org/10.1002/14651858.CD006150.pub2
Wieruszewski PM, Barreto JN, Frazee E, et al. Early corticosteroids for pneumocystis pneumonia in adults without HIV are not associated with better outcome. Chest 2018;154:636-44.
DOI: https://doi.org/10.1016/j.chest.2018.04.026
Ding L, Huang H, Wang H, He H. Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies. Ann Intensive Care 2020;10:34.
DOI: https://doi.org/10.1186/s13613-020-00649-9
Liu Y, Su L, Jiang SJ, Qu H. Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis. Oncotarget 2017;8:59729-39.
DOI: https://doi.org/10.18632/oncotarget.19927
Confalonieri M, Calderini E, Terraciano S, et al. Noninvasive ventilation for treating acute respiratory failure in AIDS patients with pneumocystis carinii pneumonia. Intensive Care Med 2002;28:1233-8.
DOI: https://doi.org/10.1007/s00134-002-1395-2
Amado-Rodríguez L, Bernal T, López-Alonso I, et al. Impact of initial ventilatory strategy in hematological patients with acute respiratory failure: a systematic review and meta-analysis. Crit Care Med 2016;44:1406-13.
DOI: https://doi.org/10.1097/CCM.0000000000001613
Ethics Approval
The study protocol was exempted from review by the Ethical Review Committee at the Aga Khan University as the data did not contain any individual patient identifiers (ERC Number: 2019-2116-5758).How to Cite
Ayub, Maaha, Mustafa Bin Ali Zubairi, Najia Ghanchi, Safia Awan, Kauser Jabeen, and Ali Zubairi. 2024. “Pneumocystis Pneumonia in HIV-Positive and Non-HIV Patients: A Retrospective Comparative Study from a Lower-Middle Income Country”. Monaldi Archives for Chest Disease, April. https://doi.org/10.4081/monaldi.2024.2810.
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Nabila Kanwal, Humza Thobani, Ainan Arshad, Priya Ashok Kumar, Fatima Amjad, Safia Awan, Muhammad Irfan, Factors predicting mortality among patients with COVID-19 associated hospital acquired pneumonia: insights from a tertiary care center , Monaldi Archives for Chest Disease: Vol. 93 No. 4 (2023)
- Teresa Cascella, Francesco Giallauria, Domenico Tafuri, Gaetano Lombardi, Annamaria Colao, Carlo Vigorito, Francesco Orio, Cardiovascular complications of obesity , Monaldi Archives for Chest Disease: Vol. 66 No. 4 (2006): Cardiac series
- Mauro Di Bari, Alessandra Pratesi, Francesca M. Nigro, Irene Marozzi, Stefano Fumagalli, DAPT plus anticoagulant therapy: The difficult coexistence post-ACS in older patients with atrial fibrillation , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- M. Messina, N. Scichilone, F. Guddo, V. Bellia, Rapidly progressive organising pneumonia associated with cytomegalovirus infection in a patient with psoriasis , Monaldi Archives for Chest Disease: Vol. 67 No. 3 (2007): Pulmonary series
- A. Srinivasan, R. Agarwal, Cardiovocal syndrome , Monaldi Archives for Chest Disease: Vol. 75 No. 4 (2011): Pulmonary series
- Francesco Fattirolli, Elisabetta Angelino, The bare minimum of information at discharge after acute coronary syndrome. Part 2: the quality improvement project , Monaldi Archives for Chest Disease: Vol. 78 No. 3 (2012): Cardiac series
- Renzo Rozzini, Aging clinical problems: a difficult balance between age and frailty , Monaldi Archives for Chest Disease: Vol. 84 No. 1-2 (2015): Cardiac series
- Samuele Baldasseroni, Alessandra Pratesi, Francesco Orso, Claudia Di Serio, Alice Foschini, Andrea Giosafat Marella, Nadia Bartoli, Mauro Di Bari, Stefano Fumagalli, Niccolò Marchionni, Francesca Tarantini, Epicardial adipose tissue and insulin resistance in patients with coronary artery disease with or without left ventricular dysfunction , Monaldi Archives for Chest Disease: Vol. 80 No. 4 (2013): Cardiac Series
- Francesco Vetta, Gabriella Locorotondo, Giampaolo Vetta, Maria Mignano, Sonia Bracchitta, Prognostic impact of frailty in elderly cardiac surgery patients , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- R.M. Jones, A. Dawson, E.N. Evans, N.K. Harrison, Co-existence of organising pneumonia in a patient with Mycobacterium Avium Intracellulare pulmonary infection , Monaldi Archives for Chest Disease: Vol. 71 No. 2 (2009): Pulmonary series
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
