Pneumocystis carinii Pneumonia in Patients without HIV Infection
SAW ARA SAKSASITHON, MD*, SOMNUEK SUNGKANUPARPH, MD*, SITTHEP THANAKITCHARU, MD*
Affiliation : *Department of Medicine, Fnculty of Medicine Ramathibodi Hospital. Mahidol University, Bangkok 10400, Thailand.
Method : A retrospective study of PCP patients without HIV infection at Ramathibodi Hos pital. from 1994 to 200 I. was conducted. Only cases with microbiological and/or pathological proven were included.
Results : There were 19 patients with 42.1 per cent males and a mean age of 44.6 years. All patients had underlying immunocompromised diseases. 94.7 per cent of the cases received immuno suppressive drugs. PCP occurred at a mean duration of 26.4 months after the diagnosis and treatment of underlying diseases. Common clinical presentations of PCP were progressive dyspnea, fever, and non-productive cough. All patients had abnormal chest radiography with a majority of bilateral inter stitial infiltration (63.2% ). Diagnosis of PCP was confirmed with microbiological examination from bronchoalveolar larvage (84.2%) and pathological diagnosis from transbronchial biopsy (15.8%). Almost all of the cases (94.7%) were treated with co-trimoxazole. Ten patients (52.6%) had concomi tant bacterial pneumonia or fungal pneumonitis. Overall mortality rate was 36.8 per cent. Mortality was = significantly higher in patients who needed mechanical ventilation (p 0.006). There was a trend toward = a higher mortality rate in patients with concomitant pulmonary diseases (p 0.09).
Conclusions : PCP may complicate a variety of immunocompromised states especially auto immune diseases and hematologic malignancy. Patients who receive corticosteroids and/or cytotoxic drugs should receive primary PCP prophylaxis. The mortality rate is high especially in severe cases that need mechanical ventilation. Intensive care and close monitoring are needed for these patients.
Keywords : Pneumocystis carinii Pneumonia, PCP, Non-HIV, Mortality Rate
