HIV ile Enfekte Hastalarda Pneumocystis Jirovecii Pnömonisi: Tek Merkez Deneyimi

Year 2021, Volume: 12 Issue: 43, 131 - 135, 19.08.2021

Heval Can Bilek Aydın Deveci Esra Tanyel

https://doi.org/10.17944/mkutfd.911354

Abstract

Amaç: Pneumocystis jirovecii pnömonisi (PCP), insan immünyetmezlik virüsü (HIV) ile enfekte ileri evre hastalarda ve antiretroviral tedavilerine uymayan kişilerde hala kritik bir fırsatçı enfeksiyondur. Bu çalışma, HIV ile enfekte hastalarda gelişen PCP enfeksiyonlarının klinik ve tanısal özelliklerini değerlendirmeyi amaçlamaktadır.Yöntem: Ocak 2005 ile Mart 2020 arasında üniversite hastanesinde izlenen 18 yaş ve üstü HIV ile enfekte hastaların tıbbi kayıtları geriye dönük olarak incelendi.Bulgular: Çalışma kapsamında; 62'si (%15,6) kadın, 335’i (%84,4) erkek ve yaş ortalaması 39,2 ± 11,6 yıl olan 397 HIV ile enfekte hasta değerlendirildi. Yaş, PCP'yi gelişimi açısından bir risk faktörü olarak bulunmasa da erkek cinsiyet risk faktörü olarak saptandı. PCP'li hastalar, PCP'si olmayan hastalara göre önemli ölçüde daha düşük CD4 lenfosit sayılarına sahipti ve CD4 lenfosit sayısının <200/mm3 olması, hastalık riskini önemli ölçüde arttırmaktaydı. Hastaların başvuru anında en yaygın sistemik şikâyeti ateş, en sık görülen solunum yolu şikâyeti ise öksürüktü. Hastaların %57,1'inde immünofloresan antikor (IFA) testi pozitifti. Tüm hastaların göğüs tomografisinde PCP'yi destekleyen görünümler saptandı.Sonuç: İleri düzeyde immün yetmezliği olan HIV ile enfekte erkek hastalar, PCP gelişimi için yüksek riskli olarak değerlendirildi. Tipik klinik bulguların varlığında, göğüs tomografisi ve mikrobiyolojik tanı testlerinin birlikte değerlendirilmesinin doğru klinik tanı için yararlı olduğu saptandı.

Keywords

HIV, Edinilmiş İmmün Yetmezlik Sendromu, Pnömosistis

Supporting Institution

yok.

Project Number

yok.

Pneumocystis Jirovecii Pneumonia In HIV-Infected Patients: A Single Center Experience

Abstract

Objective: Pneumocystis jirovecii pneumonia (PCP) is still a critical opportunistic infection in patients diagnosed with the human immunodeficiency (HIV) infection in the advanced stages and patients who do not adhere to antiretroviral therapy. This study aimed to evaluate the clinical and diagnostic features of PCP infections developed in HIV-infected patients.Methods: HIV-infected patients aged 18 years and older, followed between January 2005 and March 2020 at the university hospital, were retrospectively reviewed from medical records. Results: Within the study's scope, 397 HIV-infected patients, 62 (15.6%) females and 335 (84.4%) males, with a mean age of 39.2 ± 11.6 years, were evaluated. While age was not a risk factor for developing PCP, the male gender was a risk factor. Patients with PCP had significantly lower CD4 lymphocytes counts than patients without PCP, and a CD4 lymphocyte count <200/mm3 significantly increased the disease's risk. The patients' most common systemic complaint was fever at the time of presentation, and the most common respiratory complaint was cough. The immunofluorescent antibody (IFA) test was positive in 57.1% of the patients. All patients had appearances that might be supportive for PCP in chest tomography.Conclusion: HIV infected male patients with advanced immunodeficiency constituted a high-risk group for developing PCP. In the presence of typical clinical findings, the evaluation of chest tomography and microbiological diagnostic tests together were found to be useful for accurate clinical diagnosis.

Keywords

HIV, Acquired Immunodeficiency Syndrome, Pneumocytis

Project Number

yok.

References

• Ma L, Cissé OH, Kovacs JA. A Molecular Window into the Biology and Epidemiology of Pneumocystis spp. Clin Microbiol Rev. 2018;31(3):e00009-18. https://doi.org/10.1128/CMR.00009-18.
• Otieno-Odhiambo P, Wasserman S, Hoving JC. The Contribution of Host Cells to Pneumocystis Immunity: An Update. Pathogens. 2019;8(2): 52. https://doi.org/10.3390/pathogens8020052.
• Salzer HJF, Schäfer G, Hoenigl M, Günther G, Hoffmann C, Kalsdorf B, Alanio A, Lange C. Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia. Respiration. 2018;96(1): 52-65. https://doi.org/10.1159/000487713.
• Pereira-Díaz E, Moreno-Verdejo F, de la Horra C, Guerrero JA, Calderón EJ, Medrano FJ. Changing Trends in the Epidemiology and Risk Factors of Pneumocystis Pneumonia in Spain. Front Public Health. 2019;7: 275. https://doi.org/10.3389/fpubh.2019.00275.
• Lapadula G, Cozzi-Lepri A, Marchetti G, Antinori A, Chiodera A, Nicastri E, Parruti G, Galli M, Gori A, Monforte Ad; ICONA Foundation Study. Risk of clinical progression among patients with immunological nonresponse despite virological suppression after combination antiretroviral treatment. AIDS. 2013;27(5): 769-79. https://doi.org/10.1097/QAD.0b013e32835cb747.
• Chow JY, Alsan M, Armstrong W, del Rio C, Marconi VC. Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia. AIDS Care. 2015;27(7): 844-8. https://doi.org/10.1080/09540121.2015.1007114.
• Lee YT, Chuang ML. Pneumocystis jirovecii pneumonia in AIDS and non-AIDS immunocompromised patients - an update. J Infect Dev Ctries. 2018;12(10): 824-834. https://doi.org/10.3855/jidc.10357.
• Turkey, Ministry of Health. [cited 2021 Jun 02]. Statistics of HIV-AIDS. Available from: https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar/hiv-aids/hiv-aids-liste/hıv-aids-istatislik.html.
• Dunbar A, Schauwvlieghe A, Algoe S, van Hellemond JJ, Reynders M, Vandecasteele S, Boelens J, Depuydt P, Rijnders B. Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis. Front Cell Infect Microbiol. 2020;10:224. https://doi.org/10.3389/fcimb.2020.00224.
• Kovacs JA, Masur H. Evolving health effects of Pneumocystis: one hundred years of progress in diagnosis and treatment. JAMA. 2009;301(24): 2578-85. https://doi.org/10.1001/jama.2009.880.
• Shibata S, Kikuchi T. Pneumocystis pneumonia in HIV-1-infected patients. Respir Investig. 2019;57(3): 213-219. https://doi.org/10.1016/j.resinv.2019.01.009.
• Siegel M, Masur H, Kovacs J. Pneumocystis jirovecii Pneumonia in Human Immunodeficiency Virus Infection. Semin Respir Crit Care Med. 2016;37(2): 243-56. https://doi.org/10.1055/s-0036-1579556.
• Liu CJ, Lee TF, Ruan SY, Yu CJ, Chien JY, Hsueh PR. Clinical characteristics, treatment outcomes, and prognostic factors of Pneumocystis pneumonia in non-HIV-infected patients. Infect Drug Resist. 2019;12: 1457-1467. https://doi.org/10.2147/IDR.S199761.
• Roux A, Canet E, Valade S, Gangneux-Robert F, Hamane S, Lafabrie A, Maubon D, Debourgogne A, Le Gal S, Dalle F, Leterrier M, Toubas D, Pomares C, Bellanger AP, Bonhomme J, Berry A, Durand-Joly I, Magne D, Pons D, Hennequin C, Maury E, Roux P, Azoulay É. Pneumocystis jirovecii pneumonia in patients with or without AIDS, France. Emerg Infect Dis. 2014;20(9): 1490-7. https://doi.org/10.3201/eid2009.131668.
• Esteves F, Medrano FJ, de Armas Y, Wissmann G, Calderón EJ, Matos O. Pneumocystis and Pneumocystosis: first meeting of experts from Latin-American and Portuguese-speaking countries - a mini-review. Expert Rev Anti Infect Ther. 2014;12(5): 545-8. https://doi.org/10.1586/14787210.2014.894883.
• Calderón EJ, Gutiérrez-Rivero S, Durand-Joly I, Dei-Cas E. Pneumocystis infection in humans: diagnosis and treatment. Expert Rev Anti Infect Ther. 2010;8(6): 683-701. https://doi.org/10.1586/eri.10.42.
• Pennington K, Wilson J, Limper AH, Escalante P. Positive Pneumocystis jirovecii Sputum PCR Results with Negative Bronchoscopic PCR Results in Suspected Pneumocystis Pneumonia. Can Respir J. 2018; 2018:6283935. https://doi.org/10.1155/2018/6283935.
• Yanık K, Karadağ A, Usta E, Ünal N, Yılmaz H, Hökelek. Evaluation of Respiratory Samples Results of the Direct Fluorescent Antibody Test Sending with Suspicion of Pneumocystis jirovecii Pneumonia to the Parasitology Laboratory of Ondokuz Mayıs University Medical School Between the Years 2003-2011. Türk Mikrobiyol Cem Derg 2012;42(4): 132-136. DOI:10.5222/TMCD.2012.132
• Wang D, Hu Y, Li T, Rong HM, Tong ZH. Diagnosis of Pneumocystis jirovecii pneumonia with serum cell-free DNA in non-HIV-infected immunocompromised patients. Oncotarget. 2017;8(42):71946-71953. https://doi.org/10.18632/oncotarget.18037.
• Choo R, Naser NSH, Nadkarni NV, Anantham D. Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates. BMC Pulm Med. 2019;19(1):51. https://doi.org/10.1186/s12890-019-0801-2.
• Prebil SE, Andrews J, Cribbs SK, Martin GS, Esper A. Safety of research bronchoscopy in critically ill patients. J Crit Care. 2014;29(6): 961-4. https://doi.org/10.1016/j.jcrc.2014.06.006.
• Mu XD, Jia P, Gao L, Su L, Zhang C, Wang RG, Wang GF. Relationship between Radiological Stages and Prognoses of Pneumocystis Pneumonia in Non-AIDS Immunocompromised Patients. Chin Med J (Engl). 2016;129(17): 2020-5. https://doi.org/10.4103/0366-6999.189068.
• Christe A, Walti L, Charimo J, Rauch A, Furrer H, Meyer A, Huynh-Do U, Heverhagen JT, Mueller NJ, Cavassini M, Mombelli M, van Delden C, Frauenfelder T, Montet X, Beigelman-Aubry C, Arampatzis S, Ebner L. Imaging patterns of Pneumocystis jirovecii pneumonia in HIV-positive and renal transplant patients - a multicentre study. Swiss Med Wkly. 2019;149: w20130. https://doi.org/10.4414/smw.2019.20130.
• White PL, Backx M, Barnes RA. Diagnosis and management of Pneumocystis jirovecii infection. Expert Rev Anti Infect Ther. 2017;15(5): 435-447. https://doi.org/10.1080/14787210.2017.1305887.
• She WH, Chok KSH, Li IWS, Ma KW, Sin SL, Dai WC, Fung JYY, Lo CM. Pneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report. BMC Infect Dis. 2019;19(1):66. https://doi.org/10.1186/s12879-019-3723-y.