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首页> 外文期刊>Italian Journal of Medicine >Pneumocystis pneumonia in HIV-negative immunocompromised patients in Internal Medicine ward
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Pneumocystis pneumonia in HIV-negative immunocompromised patients in Internal Medicine ward

机译：内科病房艾滋病毒阴性免疫因素患者的肺炎肺炎

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Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection typically observed in AIDS patients, for whom it represents a leading cause of death. However, its incidence among HIV-negative immunocompromised patients is progressively increasing, with a significantly higher mortality compared to that of AIDS-patients. We performed a retrospective observational study on HIV-negative patients with PJP. We aimed to determine their epidemiological features and their biohumoral and therapeutic variables, searching for a correlation between them and our patients’ outcome. We included all patients admitted to our Internal Medicine ward from January 2010 to June 2015, who were immunocompromised at the time of admission and had microbiologically confirmed PJP (association between compatible clinical-radiological findings and qualitative polymerase chain reaction positivity on bronchoalveolar lavage). Their immune impairment was assessed considering both their medical history and their complete white blood cells (WBC), differential WBC and their CD4 cell count. Transfer to Intensive Care Unit (ICU) or death was considered as an unfavorable clinical outcome, while hospital discharge or transfer to a non-ICU ward was considered as a favorable outcome. We included a total of 18 patients in our statistical analysis. We used Student’s t-test and Fischer’s χ-square test to compare, respectively, normally distributed continuous variables and non-continuous variables. Our patients’ mean age was 65±13.9 years. All of them had cancer, mostly hematological malignancies (13/18), notably non-Hodgkin lymphoma (NHL; 8/13). They were all being or had been recently treated with chemotherapy (10/18) and/or high-dose glucocorticoids, with full dose or during tapering (13/18). Statistical analysis of blood tests results showed a significant difference between mean serum lactate dehydrogenase (LDH) concentration in the group of patients with favorable vs unfavorable outcome. Also, mean serum immunoglobulins G (IgG) concentration and certain arterial blood gas findings (mean arterial paO2/FiO2, mean blood Ph and mean paCO2) at the time of admission were significantly different in the two groups of patients. 12/18 patient’s outcome turned out unfavorable. Trimethoprim + sulfamethoxazole (TMP+SMX) treatment was given to all our patients, with a mean duration of 13.39±9.36 days. Patients with a favorable outcome had received TMP+SMX treatment significantly earlier than those with an unfavorable outcome. Hematological malignancies, according to literature, confer the strongest predisposition to PJP. Both chemotherapy and high-dose Glucocorticoid treatment are well known predisposing factors. A remarkable elevation of serum LDH represents both a typical clinical feature and a well-known negative prognostic factor in PJP. Low IgG levels have never been reported as a negative prognostic factor, but their role in enhancing macrophage killing of pneumocystis may account for the worst observed prognosis in the group of patients with lower mean levels. Therefore, in order to reduce the heavy mortality rate associated with PJP, an early beginning of specific treatment is of utmost importance, and even if this is certainly true for many infectious diseases, the time gap is particularly limited in the setting of this type of pneumonia. Hence, PJP should be ruled out as soon as possible and, in case of a strong clinical- radiological suspicion, therapy should be started immediately, even while waiting for microbiological confirmation (especially in critically-ill patients).
机译：Pneumocystis jirovecii肺炎（PJP）是艾滋病患者通常观察到的机会主义感染，其代表着死亡的主要原因。然而，其在HIV阴性免疫造型患者之间的发病率逐渐增加，与艾滋病患者相比具有显着提高的死亡率。我们对HIV阴性PJP患者进行了回顾性观察研究。我们旨在确定其流行病学特征及其生物漏斗和治疗变量，寻找它们与患者结果之间的相关性。我们包括2010年1月至2015年6月入院的所有患者，他在入院时受到免疫功能，并在患有微生物学证实的PJP（兼容的临床放射发现与支气管肺泡灌洗上的兼容临床放射发现和定性聚合酶链反应阳性之间的关联）。考虑到其病史及其完全白细胞（WBC），差异WBC及其CD4细胞计数评估其免疫损伤。转移到重症监护病房（ICU）或死亡被认为是不利的临床结果，而医院排放或转移到非ICU病房被认为是一个有利的结果。我们在我们的统计分析中占总患者。我们使用学生的T-Test和Fischer的χ方形测试分别进行比较，通常分布连续变量和非连续变量。我们的患者的平均年龄为65±13.9岁。所有这些都有癌症，主要是血液恶性肿瘤（13/18），特别是非霍奇金淋巴瘤（NHL; 8/13）。它们最近曾经是或最近用化疗（10/18）和/或高剂量糖皮质激素治疗，具有全剂量或锥度（13/18）。血液试验的统计分析结果表明，在有利的结果的患者中，平均血清乳酸脱氢酶（LDH）浓度之间存在显着差异。此外，在两组患者中，平均血清免疫球蛋白G（IgG）浓度和某些动脉血液发现（平均动脉PaO2 / FiO 2，平均动脉PaO2 / FiO 2，平均血液pH和平均PACO2）显着不同。 12/18患者的结果结果不可利益。对所有患者给予三甲基丙醇+磺胺甲恶唑（TMP + SMX）处理，平均持续时间为13.39±9.36天。患有有利的结果的患者比具有不利结果的人显着提前获得TMP + SMX治疗。据文学称，血液恶性肿瘤赋予了最强的倾向于PJP。化疗和高剂量糖皮质激素治疗都是众所周知的易感因素。血清LDH的显着升高表示典型的临床特征和PJP中的众所周知的负预后因子。低IgG水平从未被报告为阴性预后因素，但它们在增强巨噬细胞杀伤肺炎的作用可能会占该组平均水平患者组中最糟糕的预后。因此，为了降低与PJP相关的沉重死亡率，特定治疗的早期开始是至关重要的，即使这对于许多传染病肯定是真的，即使这对于许多传染病而言，在这种类型的设置中特别限制了时间差异肺炎。因此，应该尽快排除PJP，如果有强烈的临床放射性怀疑，均应立即开始治疗，即使在等待微生物学确认（特别是在危重患者中）。

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