Human herpes virus co-infection is associated with mortality in HIV-negative patients with Pneumocystis jirovecii pneumonia

• Published in: European journal of clinical microbiology & infectious diseases 2013-02, Vol.32 (2), p.189-194
• Main Authors: Fillatre, P., Chevrier, S., Revest, M., Gacouin, A., Jouneau, S., Leroy, H., Robert-Gangneux, F., Minjolle, S., Le Tulzo, Y., Tattevin, P.
• Format: Article
• Language: English
• Subjects: Age; Aged; Alveoli; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Bronchoalveolar Lavage Fluid; Bronchoalveolar Lavage Fluid - virology; Bronchus; Cohort Studies; Coinfection; Coinfection - mortality; Corticoids; Cytomegalovirus; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - mortality; Cytotoxicity; Disease prevention; Drugs; Female; Herpes Simplex; Herpes Simplex - complications; Herpes Simplex - mortality; Herpes simplex virus; Herpes viruses; Herpesvirus; HIV; Human health and pathology; Human immunodeficiency virus; Human viral diseases; Humans; Immune system; Immunofluorescence; Infections; Infectious diseases; Intensive care; Intensive care units; Internal Medicine; Intubation; Lavage; Life Sciences; Lung; Male; Malignancy; Medical Microbiology; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Observational studies; Physiology; Pneumocystis; Pneumology; Pneumonia; Pneumonia, Pneumocystis; Pneumonia, Pneumocystis - complications; Pneumonia, Pneumocystis - mortality; Prognosis; Prophylaxis; Respiratory distress syndrome; Respiratory failure; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Shock; Simplexvirus; Simplexvirus - isolation & purification; Solid tumors; Steroids; trimethoprim-sulfamethoxazole; Vasculitis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1730-7

The purpose of this investigation was to characterize the management and prognosis of severe Pneumocystis jirovecii pneumonia (PJP) in human immunodeficiency virus (HIV)-negative patients. An observational cohort study of HIV-negative adults with PJP documented by bronchoalveolar lavage (BAL) through Gomori–Grocott staining or immunofluorescence, admitted to one intensive care unit (ICU) for acute respiratory failure, was undertaken. From 1990 to 2010, 70 patients (24 females, 46 males) were included, with a mean age of 58.6 ± 18.3 years. The mean Simplified Acute Physiology Score (SAPS)-II was 36.9 ± 20.4. Underlying conditions included hematologic malignancies ( n  = 21), vasculitis ( n  = 13), and solid tumors ( n  = 13). Most patients were receiving systemic corticosteroids ( n  = 63) and cytotoxic drugs ( n  = 51). Not a single patient received trimethoprim–sulfamethoxazole as PJP prophylaxis. Endotracheal intubation (ETI) was required in 42 patients (60.0 %), including 38 with acute respiratory distress syndrome (ARDS). In-ICU mortality was 52.9 % overall, reaching 80.9 % and 86.8 %, respectively, for patients who required ETI and for patients with ARDS. In the univariate analysis, in-ICU mortality was associated with SAPS-II ( p  = 0.0131), ARDS ( p