Pneumocystis jirovecii colonization in intensively cared patients with non-HIV infection

Abstract

Abstract: Objective To investigate the prevalence of Pneumocystis jirovecii（P.jirovecii）colonization in patients admitted into ICU with non-HIV infection, and to explore the correlationship between P.jirovecii colonization and occurrence of various diseases as well as CD4⁺T cell count. Methods A total of 33 non-HIV-positive patients with P.jirovecii positive identified in bronchoalveolar lavage fluid (BALF) specimen and confirmed as colonization in intensive care unit (ICU) in our hospital from April 2016 to March 2018 were chosen as the subjects of the P.jirovecii colonization group. Meanwhile,48 non-HIV-positive patients with P.jirovecii negative were selected as the control. The clinical data of the two groups were analyzed. Results The colonization rate of P.jirovecii was 40.7% in 81 patients. The incidence of shock in the P.jirovecii colonization group was significantly higher than that in the P.jirovecii negative group(P<0.05). The incidence of severe pneumonia in the P.jirovecii colonization group was significantly higher than that in the P. jirovecii negative group（P<0.05). No statistical differences were found concerning the incidences of pulmonary malignanttumor, interstitial lung disease (ILD), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and pulmonary tuberculosis between the P.jirovecii colonization group and the P. jirovecii negative group (P>0.05). The incidences of P.jirovecii colonization was 45.5%, 35.0% and 44.1% in the groups of CD4⁺>400 cells/μl, CD4⁺ 400~200 cells/μl and CD4⁺<200 cells/μl, respectively, with no statistical significance between the three groups (P>0.05). Conclusion The colonization rate of P.jirovecii is high in intensively cared non-HIV-positive patients. Shock and severe pneumonia more commonly occur in patients with P.jirovecii colonization. The occurrences of pulmonary malignant tumor, ILD, AECOPD, and pulmonary tuberculosis are not related to P.jirovecii colonization. And the occurrence of P.jirovecii colonization is not related to CD4⁺T cell count.

Key words: P.jirovecii, Colonization, Non-HIV positive, ICU

HU Shui-xiu, HUANG Kui, LAN Zheng, QIN Hai-yuan, TANG Xiu-wen. Pneumocystis jirovecii colonization in intensively cared patients with non-HIV infection[J]. Electronic Journal of Emerging Infectious Diseases, 2018, 3(3): 167-170.

References

[1] Sokulska M, Kicia M, Wesofowska M, et al.Genotyping of Pneumocystis jirovecii in colonized patients with various pulmonarydiseases[J]. Med Mycol, 2017, 10(8):1-7.
[2] Medrano FJ,Montes-Cano M,Conde M, et al.Pneumocystis jirovecii in General Population[J].Emerg InfectDis, 2005, 11(2): 245-250.
[3] Morrisb A,Norrise KA.Colonization by Pneumocystis jirovecii and its Role in Disease[J].Clin Microbiol Rev, 2012 ,25(2):297-317.
[4] Khalife S,Aliouat EM.,Aliouat-Denis C.M,et al.First data on Pneumocystis jirovecii colonization in patients with respiratory diseases in North Lebanon[J].New Microbe New Infect, 2015, 6(1): 11-14.
[5] Santos CR, Assis AM,Luz EA,et al.Detection of Pneumocystis jirovecii by nested PCR in HIV-negative patients with pulmonary disease[J]. Rev Iberoam Micol, 2017, 34(2): 83-88.
[6] 张楠,谭丽思,秦铮,等.肺孢子菌感染或定植与呼吸系统疾病的相关性探讨[J].中国人兽共患病学报,2014,30(3):310-314.
[7] 任珊珊,田小军,齐志群,等.非肺孢子菌肺炎患者支气管肺泡灌洗液肺孢子菌检出情况[J].中国热带医学杂志,2015,15(10):1172-1176.
[8] Le Gal S,Pougnet L,Damiani C, et al.Pneumocystis jirovecii in the air surrounding patients with Pneumocystis pulmonary colonization[J].Diagn Microbiol Infect Dis, 2015, 82(2): 137-142 .
[9] Damiani C,Choukri F,Solène Le Gal,et al.Possible Nosocomial transmission of Pneumocystis jirovecii[J]. Emerg Infect Dis, 2012, 18(5): 877-878.
[10] Mori H, Ohno Y,Ito F,et al.Polymerase Chain Reaction Positivity of Pneumocystis jirovecii During Primary Lung Cancer Treatment[J].Jpn J Clin Oncol, 2010, 40(7): 658-662.
[11] Khodavaisy S, Mortaz E, Mohammadi F, et al.Pneumocystis jirovecii colonization in Chronic Obstructive Pulmonary Disease (COPD)[J]. Curr Med Mycol, 2015, 1(1): 42-48.
[12] Vidal S, Horra C, Mart J, et al.Pneumocystis jirovecii colonisation in patients with interstitial lung disease[J]. Clin Microbiol Infect, 2006, 12(3): 231-235.
[13] Togashi Y, Masago K, Ito Y, et al.Pneumocystis jiroveci pneumonia and colonization in patients with advanced lung cancer[J].Oncology Letters, 2013, 5: 601-604.
[14] Jensen L, Jensen AV, Praygod G, et al.Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania[J]. BMC InfectDis, 2010, 10: 140.
[15] Calderon EJ, Rivero L, Respaldiza N, et al.Systemic inflamma- tion in patients with chronic obstructive pulmonary disease who are colonized with Pneumocystis jiroveci[J]. Clin Infect Dis, 2007,45(2): e17-e19.
[16] 张棉超,杨荣利.严重感染的免疫紊乱、免疫监测与免疫治疗进展[J].中华医学杂志,2016,96(7):1708-1712.
[17] Nevez G, Raccurt C, Vincent P, et al.Pulmonary Colonization with Pneumocystis carinii in Human Immunodeficiency Virus-Negative Patients: Assessing Risk with Blood CD4 + T Cell Counts[J]. Clin Infect Dis, 1999, 29:1331-1332.