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Open Access Highly Accessed Research article

Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes

Yasufumi Matsumura1, Yuichiro Shindo2, Yoshitsugu Iinuma3, Masaki Yamamoto1, Michinori Shirano4, Aki Matsushima1, Miki Nagao1, Yutaka Ito5, Shunji Takakura1, Yoshinori Hasegawa2 and Satoshi Ichiyama1*

Author Affiliations

1 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

2 Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan

3 Department of Infectious Diseases, Kanazawa Medical University, Kanazawa, Japan

4 Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan

5 Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

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BMC Infectious Diseases 2011, 11:76  doi:10.1186/1471-2334-11-76

Published: 25 March 2011

Abstract

Background

The number of patients with non-HIV Pneumocystis pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We investigated the clinical characteristics of non-HIV PCP and its association with microbiological genotypes.

Methods

Between January 2005 and March 2010, all patients in 2 university hospitals who had been diagnosed with PCP by PCR were enrolled in this study. Retrospective chart review of patients, microbiological genotypes, and association with 30-day mortality were examined.

Results

Of the 82 adult patients investigated, 50 patients (61%) had inflammatory diseases, 17 (21%) had solid malignancies, 12 (15%) had hematological malignancies, and 6 (7%) had received transplantations. All patients received immunosuppressive agents or antitumor chemotherapeutic drugs. Plasma (1→3) β-D-glucan levels were elevated in 80% of patients, and were significantly reduced after treatment in both survivors and non-survivors. However, β-D-glucan increased in 18% of survivors and was normal in only 33% after treatment. Concomitant invasive pulmonary aspergillosis was detected in 5 patients. Fifty-six respiratory samples were stored for genotyping. A dihydropteroate synthase mutation associated with trimethoprim-sulfamethoxazole resistance was found in only 1 of the 53 patients. The most prevalent genotype of mitochondrial large-subunit rRNA was genotype 1, followed by genotype 4. The most prevalent genotype of internal transcribed spacers of the nuclear rRNA operon was Eb, followed by Eg and Bi. Thirty-day mortality was 24%, in which logistic regression analysis revealed association with serum albumin and mechanical ventilation, but no association with genotypes.

Conclusions

In non-HIV PCP, poorer general and respiratory conditions at diagnosis were independent predictors of mortality. β-D-glucan may not be useful for monitoring the response to treatment, and genotypes were not associated with mortality.