Torres H A, Chemaly R F, Storey R, Aguilera E A, Nogueras G M, Safdar A, Rolston K V I, Raad I I, Kontoyiannis D P
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Eur J Clin Microbiol Infect Dis. 2006 Jun;25(6):382-8. doi: 10.1007/s10096-006-0149-4.
Pneumocystis jiroveci pneumonia is a common infection in patients with AIDS but an infrequent cause of pneumonia in cancer patients. Little is known about the impact of cancer type and hematopoietic stem cell transplantation on the presentation and outcome of P. jiroveci pneumonia in cancer patients. A retrospective cohort study of all patients with cancer and P. jiroveci pneumonia cared for at The M.D. Anderson Cancer Center during 1990-2003 was conducted. Eighty episodes of P. jiroveci pneumonia in 79 patients were identified. In most (67%) episodes, patients had a hematologic malignancy. In 23 (29%) episodes, patients had undergone hematopoietic stem cell transplantation. Twenty-seven percent of patients with histopathologically confirmed P. jiroveci pneumonia had nodular infiltrates on the radiographic study. Pleural effusion and pneumothorax were more common in patients with hematopoietic stem cell transplantation than in those with solid tumors. Clinical suspicion of P. jiroveci pneumonia was less common in patients with nodular infiltrates than in those without such a radiographic finding (7 vs. 39%; p=0.002). Twenty-six of 76 (34%) patients with data available died of P. jiroveci pneumonia. Predictors of death by univariate analysis included older age, tachypnea, high APACHE II score, use of mechanical ventilation or vasopressors, lower arterial pH level, absence of interstitial component, pneumothorax, and comorbid conditions (all p<0.05). Multivariate analysis identified the use of mechanical ventilation as an independent predictor of death. Death attributable to P. jiroveci pneumonia appeared to be higher in patients with hematopoietic stem cell transplantation. The clinical presentation of P. jiroveci pneumonia in cancer patients may be affected by the category of cancer and the history of hematopoietic stem cell transplantation. P. jiroveci pneumonia remains a rare yet severe infection in cancer patients.
耶氏肺孢子菌肺炎是艾滋病患者常见的感染，但在癌症患者中是肺炎的少见病因。关于癌症类型和造血干细胞移植对癌症患者耶氏肺孢子菌肺炎的表现及预后的影响，人们所知甚少。对1990年至2003年期间在MD安德森癌症中心接受治疗的所有癌症合并耶氏肺孢子菌肺炎患者进行了一项回顾性队列研究。共确定了79例患者的80次耶氏肺孢子菌肺炎发作。在大多数（67%）发作中，患者患有血液系统恶性肿瘤。在23次（29%）发作中，患者接受了造血干细胞移植。经组织病理学确诊的耶氏肺孢子菌肺炎患者中，27%在影像学检查中有结节状浸润。胸腔积液和气胸在造血干细胞移植患者中比实体瘤患者更常见。有结节状浸润的患者临床怀疑耶氏肺孢子菌肺炎的情况比无此类影像学表现的患者少见（7%对39%；p=0.002）。76例有可用数据的患者中有26例（34%）死于耶氏肺孢子菌肺炎。单因素分析显示，死亡的预测因素包括年龄较大、呼吸急促、APACHE II评分高、使用机械通气或血管活性药物、动脉血pH值较低缺乏间质成分、气胸和合并症（所有p<0.05）。多因素分析确定使用机械通气是死亡的独立预测因素。造血干细胞移植患者中因耶氏肺孢子菌肺炎导致的死亡似乎更高。癌症患者耶氏肺孢子菌肺炎的临床表现可能受癌症类型和造血干细胞移植史的影响。耶氏肺孢子菌肺炎在癌症患者中仍然是一种罕见但严重的感染。
