Clinical Usefulness of HRCT in Assessing the Severity of Pneumocystis jirovecii Pneumonia
نویسندگان
چکیده
The aim of this study was to investigate the clinical relevance of thoracic high-resolution computed tomography (HRCT) in evaluating the severity and outcome of Pneumocystis jirovecii pneumonia (PJP) in non-AIDS immunocompromised patients.We measured mean lung attenuation (MLA) and extent of increased attenuation (EIA) of PJP lesions on thoracic HRCT in 40 non-AIDS immunocompromised patients with PJP diagnosed by demonstration of the pathogens in cytological smears of bronchoalveolar lavage fluid. The MLA and EIA of PJP lesions on thoracic HRCT were used to investigate the severity of PJP. Clinically, the severity of PJP was determined by arterial oxygen tension/fraction of inspired oxygen concentration (PaO2/FiO2) ratio, acute physiology and chronic health evaluation (APACHE) II scores, the need of mechanical ventilation, and death.MLA highly correlated with EIA of PJP lesions (ρ = 0.906, P < 0.001). MLA and EIA of PJP lesions significantly correlated with PaO2/FiO2 (ρ = -0.481 and -0.370, respectively and P = 0.007 and 0.044, respectively). When intensive care unit (ICU) admission and HRCT performed were within 2 days, MLA and EIA of PJP lesions were significantly correlated with APACHE II score (ρ = 0.791 and 0.670, respectively and P = 0.001 and 0.009, respectively). There were significant differences in the values of MLA and EIA of PJP lesions between patients with and without assisted mechanical ventilator (MLA, median and [interquartile range, IQR, 25%, 75%] -516.44 [-572.10, -375.34] vs -649.27 [-715.62, -594.01], P < 0.001 and EIA, median and [IQR 25%, 75%] 0.75 [0.66, 0.82] vs 0.53 [0.45, 0.68], P = 0.003, respectively). The data of MLA and EIA of PJP lesions had limited value in identifying survivors and non-survivors.The MLA and EIA values of PJP lesions measured on thoracic HRCT might be valuable in assessing the severity of PJP in non-AIDS immunocompromised patients, but might have limited value in predicting the mortality of the patients.
منابع مشابه
Pneumocystis jirovecii colonization in Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is associated with a chronic inflammatory response in airways and lung parenchyma that results in significant morbidity and mortality worldwide. Cigarette smoking considered as an important risk factor plays a role in pathogenesis of disease. Pneumocystis jirovecii is an atypical opportunistic fungus that causes pneumonia in immunosuppressed host, al...
متن کاملآیا شیوع کلونیزاسیون با پنوموسیستیس جیرووسی در مبتلایان به بیماری انسدادی مزمن ریوی با شرایط اکولوژیک و اقلیمی ارتباط دارد؟
Background : Chronic obstructive pulmonary disease (COPD) causes significant mortality and morbidity. The role of infectious agents has been determined in pathogenesis of the disease. Pneumocystis jirovecii is a fungus that causes pneumonia in immune deficient patients. The organism has been detected in the respiratory tracts of asymptomatic patients in low levels, which is called colonizatio...
متن کاملPneumothorax and Acute Kidney Injury in the Early Phase of Acute Lymphoblastic Leukemia Induction Therapy due to Aspergillus Fumigatus and Pneumocystis Jirovecii Co-Infection: A Case Report
Leukemia is the most common malignancy in children which leads to immunosuppression and predisposes patients to opportunistic infections. We report a 12-year-old girl with acute lymphoblastic leukemia (ALL) who developed simultaneous infection with pneumocystis Jirovecii pneumonia and aspergillosis in the induction phase of chemotherapy. The patient developed pulmonary cavitation and pneumothor...
متن کاملNewly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia
BACKGROUND Pneumocystis jirovecii, formerly named Pneumocystis carinii, is one of the most common opportunistic infections in human immunodeficiency virus (HIV)-infected patients. CASE PRESENTATIONS We encountered two cases of spontaneous pneumomediastinum with subcutaneous emphysema in HIV-infected patients being treated for Pneumocystis jirovecii pneumonia with trimethoprim/sulfamethoxazole...
متن کاملMolecular detection of Pneumocystis jirovecii using polymerase chain reaction in immunocompromised patients with pulmonary disorders in northeast of Iran
Background and Purpose: Pneumocystis pneumonia, caused by Pneumocystis jirovecii, is a fatal disease threatening patients with AIDS or immunosuppression. Assessment of colonization in these patients is of great significance, since it can lead to severe pulmonary disorders. Considering the scarcity of published reports on Pneumocystis jirovecii isolates from patients in Mashhad, Iran, we aimed t...
متن کامل