Asai Nobuhiro, Motojima Shinji, Ohkuni Yoshihiro, Matsunuma Ryo, Nakasima Kei, Iwasaki Takuya, Nakashita Tamao, Otsuka Yoshihito, Kaneko Norihiro
Department of Pulmonology, Kameda Medical Center, 296-8602, 929 higashi-cho, Kamogawa-city, Chiba, Japan.
Multidiscip Respir Med. 2012 Jun 11;7(1):2. doi: 10.1186/2049-6958-7-2.
Non-HIV Pneumocystis pneumonia (PCP) can occur in immunosuppressed patients having malignancy or on immunosuppressive agents. To classify severity, the A-DROP scale proposed by the Japanese Respiratory Society (JRS), the CURB-65 score of the British Respiratory Society (BTS) and the Pneumonia Severity Index (PSI) of the Infectious Diseases Society of America (IDSA) are widely used in patients with community-acquired pneumonia (CAP) in Japan. To evaluate how correctly these conventional prognostic guidelines for CAP reflect the severity of non-HIV PCP, we retrospectively analyzed 21 patients with non-HIV PCP.
A total of 21 patients were diagnosed by conventional staining and polymerase chain reaction (PCR) for respiratory samples with chest x-ray and computed tomography (CT) findings. We compared the severity of 21 patients with PCP classified by A-DROP, CURB-65, and PSI. Also, patients' characteristics, clinical pictures, laboratory results at first visit or admission and intervals from diagnosis to start of specific-PCP therapy were evaluated in both survivor and non-survivor groups.
Based on A-DROP, 18 patients were classified as mild or moderate; respiratory failure developed in 15 of these 18 (83.3%), and 7/15 (46.7%) died. Based on CURB-65, 19 patients were classified as mild or moderate; respiratory failure developed in 16/19 (84.2%), and 8 of the 16 (50%) died. In contrast, PSI classified 14 as severe or extremely severe; all of the 14 (100%) developed respiratory failure and 8/14 (57.1%) died. There were no significant differences in laboratory results in these groups. The time between the initial visit and diagnosis, and the time between the initial visit and starting of specific-PCP therapy were statistically shorter in the survivor group than in the non-survivor group.
Conventional prognostic guidelines for CAP could underestimate the severity of non-HIV PCP, resulting in a therapeutic delay resulting in high mortality. The most important factor to improve the mortality of non-HIV PCP is early diagnosis and starting of specific-PCP therapy as soon as possible.
非HIV卡氏肺孢子虫肺炎（PCP）可发生于患有恶性肿瘤或正在使用免疫抑制剂的免疫抑制患者中。为了对病情严重程度进行分类，日本呼吸学会（JRS）提出的A-DROP量表、英国胸科学会（BTS）的CURB-65评分以及美国传染病学会（IDSA）的肺炎严重程度指数（PSI）在日本社区获得性肺炎（CAP）患者中被广泛应用。为了评估这些传统的CAP预后指南对非HIV PCP严重程度的反映准确程度，我们对21例非HIV PCP患者进行了回顾性分析。
通过对21例患者的呼吸道样本进行传统染色和聚合酶链反应（PCR），并结合胸部X线和计算机断层扫描（CT）结果进行诊断。我们比较了根据A-DROP、CURB-65和PSI对21例PCP患者进行分类的严重程度。此外，还评估了幸存者和非幸存者组患者的特征、临床表现、首次就诊或入院时的实验室检查结果以及从诊断到开始特异性PCP治疗的间隔时间。
根据A-DROP，18例患者被分类为轻度或中度；这18例患者中有15例（83.3%）发生呼吸衰竭，其中7/15（46.7%）死亡。根据CURB-65，19例患者被分类为轻度或中度；16/19（84.2%）发生呼吸衰竭，其中16例中的8例（50%）死亡。相比之下，PSI将14例分类为重度或极重度；这14例患者全部（100%）发生呼吸衰竭，8/14（57.1%）死亡。这些组间实验室检查结果无显著差异。幸存者组从初次就诊到诊断的时间以及从初次就诊到开始特异性PCP治疗的时间在统计学上比非幸存者组短。
传统的CAP预后指南可能低估了非HIV PCP的严重程度，导致治疗延迟，从而导致高死亡率。提高非HIV PCP死亡率的最重要因素是尽早诊断并尽快开始特异性PCP治疗。
