Korean J Intern Med.  2017 May;32(3):478-485. 10.3904/kjim.2015.340.

Clinical significance of positive Pneumocystis jirovecii polymerase chain reaction in non-human immunodeficiency virus immunocompromised patients in a real practice

• Lee HY
• Kang HS
• Lee HY
• Rhee CK
• Lee SY
• Kim SC
• Kim SJ
• Park YJ
• Kim YK
• Kang JY

• KMID: 2379478
• DOI: http://doi.org/10.3904/kjim.2015.340

Abstract

BACKGROUND/AIMS
Pneumocystis jirovecii polymerase chain reaction (PCR) can be helpful in diagnosing Pneumocystis pneumonia (PCP); however it has limitations. We evaluated the prevalence of positive P. jirovecii PCR from non-human immunodeficiency virus (HIV) immunocompromised patients and tried to determine the risk of PCP development.
METHODS
Between May 2009 and September 2012, P. jirovecii PCR was performed in bronchoscopic specimens from 1,231 adult non-HIV immunocompromised patients suspected of respiratory infection. Only 169 patients (13.7%) who were tested positive for P. jirovecii PCR were enrolled. Retrospective chart review was performed. PCP was defined in patients with positive P. jirovecii PCR who were treated for PCP based on the clinical decision.
RESULTS
From 169 P. jirovecii PCR-positive patients, 90 patients were in the PCP group (53.3%) and 79 patients were in the non-PCP group (46.7%). In the PCP group, 38% of patients expired or aggravated after therapy, whereas the majority of patients (84%) in the non-PCP group recovered without treatment for PCP. Independent risk factors for PCP by binary logistic regression analysis were underlying conditions- hematological malignancies, solid tumors or solid organ transplantation, dyspnea, age < 60 years, and albumin < 2.9 g/dL.
CONCLUSIONS
This study suggests that not all P. jirovecii PCR-positive patients need to be treated for PCP. Among P. jirovecii PCR-positive patients, those who are less than 60 years old, with hematological malignancies, solid tumors or solid organ transplantation, low albumin, and with symptoms of dyspnea, the possibility of PCP might be higher. Treatment should also be selected to these patients.

Keyword

Immunocompromised; Polymerase chain reaction; Pneumocystis; Pneumonia

MeSH Terms

Adult
Dyspnea
Hematologic Neoplasms
Humans
Immunocompromised Host*
Logistic Models
Organ Transplantation
Pneumocystis jirovecii*
Pneumocystis*
Pneumonia
Pneumonia, Pneumocystis
Polymerase Chain Reaction*
Prevalence
Retrospective Studies
Risk Factors
Transplants