PURPOSE: To determine changes in the clinical characteristics of Pneumocystis pneumonia (PcP) affected patients in the XXI century as new immunosuppressive agents are available and population at risk has increased.
METHODS: Retrospective study of patients with PcP (March 2006-December 2009) Diagnosis required symptoms of pneumonia and identification of Pneumocystis organisms in respiratory samples (real-time polymerase chain reaction (PCR) or staining). Medical records were reviewed for the clinical data.
RESULTS: 109 patients were identified and classified depending on their active baseline condition: hematological malignancies (41%), inflammatory processes (18%), tumors (12%), transplant (10%), chronic diseases (10%) and HIV (8%). Sputum samples were positive in 42 occasions, BAL in 67 and biopsy in 4. Pneumocystis was identified by PCR in 70% of cases. 59% of the patients required intensive care unit and 53% of them needed ventilatory support. Hospital mortality was 32%. Ninety patients were on immunosuppressive agents but only 9 had received PcP prophylaxis. Steroids were found as part of the medication list in 73% of the patients, but only 50% were on a daily dose. The mean dose of daily steroids was higher if patient was only on steroids (30 mg/d) that if they were on steroids plus other immunosuppressives (20mg/d). A group of 10 patients that were on immunosuppressive therapy had not received steroids. Rituximab was found in 30% of these cases. Interestingly, in 17% of the patients no treatment was identified.
CONCLUSIONS: PcP has a high mortality despite treatment. The majority of patients had received steroids prior to the development of PcP but only half were on a daily dose. Patients on daily steroids received a higher dose than those on steroids plus other immunosuppressive therapy. Lack of PcP prophylaxis was found in most cases.
CLINICAL IMPLICATIONS: High level of suspicion for PcP is needed in immunocompromised individuals that present with dyspnea and pulmonary infiltrates even if not on daily steroids. PcP prophylaxis is still missed and could have prevented most of the cases.
DISCLOSURE: The following authors have nothing to disclose: Eva Carmona Porquera, Mikel Donazar Ezcurra, Andrew Limper
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