The Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
J Infect Chemother. 2012 Dec;18(6):898-905. doi: 10.1007/s10156-012-0441-4. Epub 2012 Jun 13.
The mortality of Pneumocystis pneumonia (PCP) patients without human immunodeficiency virus (HIV) infection ranges from 0 to 70 %, whereas that of HIV-infected PCP patients ranges from 10 to 20 %. The reasons for these differences are not known. We retrospectively analyzed factors contributing to the survival of 23 patients with PCP and without HIV infection, in whom PCP developed as community-acquired pneumonia (CAP). The interval from admission to the start of PCP-specific treatment was significantly shorter for survivors (2.71 ± 3.64 days; n = 14) than for non-survivors (8.67 ± 5.5 days; n = 9; p = 0.003). Moreover, although the severity scores/classes assessed by A-DROP, CURB-65, and PSI were no different on admission, scores/classes at the start of PCP-specific treatment were significantly higher for non-survivors. Overall mortality was 39 %, but mortality was approximately 70-100 % for patients classified as severe grade by A-DROP, CURB-65, or PSI scores/classes at the time when PCP-specific treatment was started, which was far higher than expected for these guidelines. In conclusion, early diagnosis and treatment within 3 days are crucial for the survival of PCP patients without HIV infection. We emphasize the limitations of application of guidelines for CAP to patients with PCP.
无 HIV 感染的卡氏肺孢子菌肺炎（PCP）患者的死亡率为 0 至 70%，而 HIV 感染的 PCP 患者的死亡率为 10 至 20%。造成这些差异的原因尚不清楚。我们回顾性分析了 23 例无 HIV 感染的社区获得性肺炎（CAP）患者发生 PCP 的生存相关因素。与非幸存者（n=9）相比，幸存者（n=14）从入院到开始针对 PCP 的治疗的间隔时间明显更短（2.71±3.64 天；p=0.003）。此外，尽管入院时通过 A-DROP、CURB-65 和 PSI 评估的严重程度评分/等级没有差异，但开始针对 PCP 的治疗时，非幸存者的评分/等级明显更高。总死亡率为 39%，但在开始针对 PCP 的治疗时，根据 A-DROP、CURB-65 或 PSI 评分/等级被分类为严重等级的患者死亡率约为 70-100%，远高于这些指南所预期的死亡率。总之，对于无 HIV 感染的 PCP 患者，早期诊断和 3 天内治疗至关重要。我们强调将 CAP 指南应用于 PCP 患者存在局限性。
