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Original ArticleOpen Access
Pneumocystis carinii Pneumonia in Patients without HIV Infection
SAW ARA SAKSASITHON, MD*,
SOMNUEK SUNGKANUPARPH, MD*,
SITTHEP THANAKITCHARU, MD*
Background
:
Pneumocystis
carinii pneumonia (PCP) can occur in immunocompromised
patients without HIV infection. Risk factors, clinical features, treatment outcomes, and factors related
to mortality in these patients may be useful clinical data for physicians who care for these patients.
Method
: A retrospective study of PCP patients without HIV infection at Ramathibodi Hos-
pital. from 1994 to 200 I. was conducted. Only cases with microbiological and/or pathological proven
were included.
Results
: There were 19 patients with 42.1 per cent males and a mean age of 44.6 years. All
patients had underlying immunocompromised diseases. 94.7 per cent of the cases received immuno-
suppressive drugs. PCP occurred at a mean duration of 26.4 months after the diagnosis and treatment
of underlying diseases. Common clinical presentations of PCP were progressive dyspnea, fever, and
non-productive cough. All patients had abnormal chest radiography with a majority of bilateral inter-
stitial infiltration (63.2% ). Diagnosis of PCP was confirmed with microbiological examination from
bronchoalveolar larvage (84.2%) and pathological diagnosis from transbronchial biopsy (15.8%).
Almost all of the cases (94.7%) were treated with co-trimoxazole. Ten patients (52.6%) had concomi-
tant bacterial pneumonia or fungal pneumonitis. Overall mortality rate was 36.8 per cent. Mortality was
significantly higher in patients who needed mechanical ventilation (p
=
0.006). There was a trend toward
a higher mortality rate in patients with concomitant pulmonary diseases (p
=
0.09).
Conclusions
: PCP may complicate a variety of immunocompromised states especially auto-
immune diseases and hematologic malignancy. Patients who receive corticosteroids and/or cytotoxic
drugs should receive primary PCP prophylaxis. The mortality rate is high especially in severe cases that
need mechanical ventilation. Intensive care and close monitoring are needed for these patients.
Key word
:
Pneumocystis carinii
Pneumonia, PCP, Non-HIV, Mortality Rate
SOMNUEK SUNGKANUPARPH, MD*,
SITTHEP THANAKITCHARU, MD*
Background
:
Pneumocystis
carinii pneumonia (PCP) can occur in immunocompromised
patients without HIV infection. Risk factors, clinical features, treatment outcomes, and factors related
to mortality in these patients may be useful clinical data for physicians who care for these patients.
Method
: A retrospective study of PCP patients without HIV infection at Ramathibodi Hos-
pital. from 1994 to 200 I. was conducted. Only cases with microbiological and/or pathological proven
were included.
Results
: There were 19 patients with 42.1 per cent males and a mean age of 44.6 years. All
patients had underlying immunocompromised diseases. 94.7 per cent of the cases received immuno-
suppressive drugs. PCP occurred at a mean duration of 26.4 months after the diagnosis and treatment
of underlying diseases. Common clinical presentations of PCP were progressive dyspnea, fever, and
non-productive cough. All patients had abnormal chest radiography with a majority of bilateral inter-
stitial infiltration (63.2% ). Diagnosis of PCP was confirmed with microbiological examination from
bronchoalveolar larvage (84.2%) and pathological diagnosis from transbronchial biopsy (15.8%).
Almost all of the cases (94.7%) were treated with co-trimoxazole. Ten patients (52.6%) had concomi-
tant bacterial pneumonia or fungal pneumonitis. Overall mortality rate was 36.8 per cent. Mortality was
significantly higher in patients who needed mechanical ventilation (p
=
0.006). There was a trend toward
a higher mortality rate in patients with concomitant pulmonary diseases (p
=
0.09).
Conclusions
: PCP may complicate a variety of immunocompromised states especially auto-
immune diseases and hematologic malignancy. Patients who receive corticosteroids and/or cytotoxic
drugs should receive primary PCP prophylaxis. The mortality rate is high especially in severe cases that
need mechanical ventilation. Intensive care and close monitoring are needed for these patients.
Key word
:
Pneumocystis carinii
Pneumonia, PCP, Non-HIV, Mortality Rate
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