Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Microbiol Immunol Infect. 2021 Aug;54(4):701-709. doi: 10.1016/j.jmii.2020.06.007. Epub 2020 Jun 26.
Pneumocystis pneumonia (PCP) is a common opportunistic infection with high mortality in individuals with decreased immunity. Pulmonary coinfections with PCP are associated with poor prognosis. The study aims to identify radiological predictors for pulmonary coinfections in patients with PCP and risk factors for mortality.
This is a retrospective, five-year study was conducted in a medical center, enrolling patients diagnosed with PCP, who received a chest computed tomography (CT) scan. The radiological findings and medical records of all participants were reviewed carefully by 2 independent doctors. Univariable and multivariable analysis was performed to identify radiological predictors for pulmonary coinfection and clinical risk factors for poor prognosis.
A total of 101 participants were included, of which 39 were HIV-infected and 62 were non-HIV-infected. In multivariable analysis, radiologic predictors on chest CT for coinfection with bacteria pneumonia included lack of ground glass opacity (adjusted odds ratio [aOR], 6.33; 95% confidence interval [CI], 2.03-19.77; p = 0.001) and presence of pleural effusion (aOR, 3.74; 95% CI, 1.27-10.99; p = 0.017). Predictors for fungal pneumonia included diffuse consolidation (adjusted OR, 6.27; 95% CI, 1.72-22.86; p = 0.005) and presence of pleural effusion (adjusted OR, 5.26; 95% CI, 1.44-19.17; p = 0.012). A significantly higher in-hospital mortality was associated with older age, recent corticosteroid exposure, cytomegalovirus coinfection, and acute respiratory failure.
Early identification of pulmonary coinfections in PCP using radiological features on the CT scans, will enable appropriate treatment which is crucial to improve the prognosis.
肺囊虫肺炎（PCP）是一种常见的机会性感染，在免疫力下降的个体中死亡率较高。PCP 的肺部合并感染与预后不良相关。本研究旨在确定 PCP 患者肺部合并感染的放射学预测因素和死亡率的危险因素。
这是一项在医疗中心进行的回顾性五年研究，纳入了诊断为 PCP 并接受胸部计算机断层扫描（CT）检查的患者。由 2 位独立医生仔细审查所有参与者的放射学发现和病历。进行单变量和多变量分析，以确定肺部合并感染的放射学预测因素和预后不良的临床危险因素。
共纳入 101 名参与者，其中 39 名 HIV 感染者和 62 名非 HIV 感染者。多变量分析显示，细菌性肺炎合并感染的胸部 CT 放射学预测因素包括缺乏磨玻璃影（调整优势比[aOR]，6.33；95%置信区间[CI]，2.03-19.77；p=0.001）和胸腔积液存在（aOR，3.74；95% CI，1.27-10.99；p=0.017）。真菌性肺炎的预测因素包括弥漫性实变（调整 OR，6.27；95% CI，1.72-22.86；p=0.005）和胸腔积液存在（调整 OR，5.26；95% CI，1.44-19.17；p=0.012）。住院期间死亡率较高与年龄较大、近期皮质类固醇暴露、巨细胞病毒合并感染和急性呼吸衰竭有关。
通过 CT 扫描上的放射学特征早期识别 PCP 中的肺部合并感染，将能够进行适当的治疗，这对改善预后至关重要。
