Pneumocystis jirovecii Pneumonia (PCP) at Major Risk of Death in Chronic Obstructive Pulmonary Disease: a Retrospective Analysis on 116 Cases

Alessandra Ricciardi

Introduction. Pneumocystis jirovecii (PJ) is an opportunistic fungus causing PJ pneumonia (PJP), a severe lung infection mostly affecting immunocompromised patients. PJP may have an adverse outcome and previous studies reported that non-HIV with PJP has a more acute and severe course than HIV with PJP.
Methods. Data on 116 PJP inpatients were retrospectively collected during the period from 2011-2015 in “Tor Vergata” University Hospital of Rome. Demographic, clinical, radiological and genotype characteristics were considered. Statistical analysis was performed using IBM SPSS.
Results. Seventy out of 116 patients (60.3%) were male aged >50 years old (mean 54.4 years old, range 20-87); 44 (37.9%) were onco-hematologic patients (receiving chemotherapy or haematological stem cell transplantation); 19 (16.4%) had COPD; 26 (22.4%) were HIV-positive; 9 (7.8%) had solid cancer; 4 ( 3.4%) underwent a solid organ transplant; 14 (12.1%) patients had other clinical. The outcome was available in 114 out of 116 (98.3%) patients: 29 out of 114 (25.4%) died due to PCP related respiratory failure. Of these, 9 (31%) were affected by COPD, while 8 (27.6%) had onco-hematologic neoplasms, 4 (13.8%) had solid cancer, 3 (10.3%) had HIV and 5 (17.2%) had other immunodeficiency illness. At univariate analysis, a negative PJP outcome statistically correlated with age>50 (p=0.04) and type of pathology (p=0.04). A significant higher number of patients with COPD died respect to the other groups (p=0.01).
Conclusion. The higher risk of death for PJP in COPD, demonstrated by our retrospective study, leads to carefully consider PJP in the differential diagnosis of worsening lung function in these patients.

Simone Agnello
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