Overgaard Ulrik M, Helweg-Larsen Jannik
Department of Internal Medicine, Nykøbing Falster Sygehus, Rigshospitalet, Copenhagen, Denmark.
Scand J Infect Dis. 2007;39(6-7):589-95. doi: 10.1080/00365540601150497.
A retrospective study was conducted to describe risk factors associated with Pneumocystis jiroveci pneumonia (PCP) among HIV-negative patients. During 2002-2004, 50 cases of PCP were identified at Rigshospitalet University Hospital on the basis of histology, PCR and clinical symptoms of PCP. Predisposing conditions included haematological malignancy (72%), inflammatory diseases (14%), solid organ transplantation (6%) and other conditions associated with immunodeficiency (8%). The most common treatment related risk factors were steroid usage (76%) and chemotherapy (72%). In 88% of patients who received steroids, dosage was either lowered or given as pulse-therapy in the 2 weeks preceding the onset of symptoms. Only 1 patient was on PCP prophylaxis at diagnosis and only 8 (16%) patients had previously been given PCP prophylaxis. At diagnosis, 78% of patients were lymphopenic. CD4 counts were available in 17 patients. Only 9 patients (52%) had CD4 count values below 300 cells/microl. The overall mortality attributable to PCP was 14% and was significantly associated with delayed diagnosis and treatment. Among immunocompromized HIV-negative patients, PCP should be particularly suspected in the context of steroid treatment and lymphopenia. Although low CD4 count is associated with a higher risk of PCP, the use of CD4 count as guidance for risk identification or prophylaxis among HIV-negative patients appears insufficient.
开展了一项回顾性研究，以描述HIV阴性患者中与耶氏肺孢子菌肺炎（PCP）相关的危险因素。在2002年至2004年期间，里格霍斯帕勒特大学医院根据PCP的组织学、聚合酶链反应（PCR）和临床症状确定了50例PCP病例。诱发因素包括血液系统恶性肿瘤（72%）、炎症性疾病（14%）、实体器官移植（6%）以及其他与免疫缺陷相关的疾病（8%）。最常见的与治疗相关的危险因素是使用类固醇（76%）和化疗（72%）。在接受类固醇治疗的患者中，88%在症状出现前2周降低了剂量或采用了脉冲疗法。诊断时只有1例患者正在接受PCP预防，之前只有8例（16%）患者接受过PCP预防。诊断时，78%的患者淋巴细胞减少。17例患者有CD4细胞计数数据。只有9例患者（52%）的CD4细胞计数低于300个/微升。PCP导致的总死亡率为14%，且与诊断和治疗延迟显著相关。在免疫功能低下的HIV阴性患者中，在使用类固醇治疗和淋巴细胞减少的情况下应特别怀疑PCP。虽然低CD4细胞计数与PCP风险较高相关，但将CD4细胞计数用作HIV阴性患者风险识别或预防的指导似乎并不充分。
