Pneumocystis jirovecii pneumonia in non-HIV infected patients: A study of 41 cases

Background. - The increasing use of immunosuppressive and cytotoxic therapies leads to a growing number of opportunistic infections especially Pneumocystis jirovecii pneumonia (PCP). The purpose of our study was to describe the population involved, and to assess clinical, biological, and mortality data. Methods. - We collected retrospectively the whole medical file of all PCP cases diagnosed in non-HIV infected patients, in two French University Hospitals in the last decade (1999-2009). Diagnosis was made on standard coloration and/or immunofluorescence analysis of bronchoalveolar lavage fluid (BAL). Results. - Forty-one patients were included in the study, mean age 56 (+/- 12.5) years, sex ratio 0.71 men/woman. Underlying diseases were as follow: 12 patients (29%) were renal transplant recipients, 13 (32%) were treated for solid cancers, and 16 (39%) suffered from various diseases (three allogenic bone-marrow transplantation, 11 hematological malignancies, one pulmonary transplantation, one vasculitis). Twelve patients died (i.e. 29%). Median lymphocyte count was 542/mm(3). More than 85% patients received corticosteroids at a median cumulative 6-month dose of 2700 mg. Seven patients (17%) had a PCP prophylaxis. Clinical worsening at day 5 (P < 0.003), poor control of the underlying disease (P < 0.015), WHO performans status superior than 2 (P < 0.025), high temperature (P < 0.04), and high oxygen flow (P < 0.042) were linked to a poor prognosis. Discussion/Conclusion. - The prognosis factors found are mostly linked to the patients' clinical severity. We would like to highlight: first, near to 30% mortality rate, secondly, a lack of prophylaxis in 34 patients, reflecting the difficulty to define PCP's risk in non HIV-infected patients. (C) 2011 Elsevier Masson SAS. All rights reserved.