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High prevalence of pneumocystis pneumonia in interstitial lung disease: a retrospective study

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Abstract

Background

Interstitial lung disease (ILD) is a new risk category for pneumocystis pneumonia (PCP) with a high mortality rate. The definite diagnostic criteria of PCP in ILD patients have not been established until now. The aims of this study were to identify potential risk factors of PCP in patients with ILD, and to evaluate the performance of metagenomic next-generation sequencing (mNGS), CD4 + T cell count, (1–3)-β-d-Glucan (BG) and lactate dehydrogenase (LDH) in the diagnosis of PCP in ILD patients.

Methods

This is a retrospective, single-center, case–control study. ILD patients who underwent mNGS from December 2018 to December 2022 were included in the study. Based on the diagnosis criteria of PCP, these patients were divided into PCP-ILD and non-PCP-ILD groups. The potential risk factors for PCP occurrence in ILD patients were analysed via logistic regression. The diagnostic efficacy of mNGS was compared with serological biomarkers.

Results

92 patients with ILD were enrolled, 31 of which had a definite PCP and were assigned to the PCP-ILD group while 61 were to the non-PCP-ILD group. The infection rate of PJ in ILD patients was 33.7% (31/92). The history of glucocorticoid therapy, CD4 + T cell count, BG level and traction bronchiectasis on HRCT were associated with PCP occurrence in ILD patients. LDH level did not reach statistical significance in the logistic regression analysis. mNGS was confirmed as the most accurate test for PCP diagnosis in ILD patients.

Conclusion

ILD is a new risk group of PCP with high PCP prevalence. Clinicians should pay close attention to the occurrence of PCP in ILD patients who possess the risk factors of previous glucocorticoid therapy, decreased CD4 + T cell count, increased BG level and absence of traction bronchiectasis on HRCT. mNGS showed the most excellent performance for PCP diagnosis in ILD patients. Peripheral blood CD4 + T cell count and BG level are alternative diagnostic methods for PCP in ILD patients. However, the diagnostic value of serum LDH level was limited in ILD patients.

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Data availability

The datasets used in the present study are not publicly available but are available from the corresponding author upon reasonable request.

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Funding

This research received no external funding.

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Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China

    Ling Liu, Tong Ji, Ranxun Chen, Li Fan, Jinghong Dai & Yuying Qiu

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  1. Ling Liu
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  2. Tong Ji
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  3. Ranxun Chen
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  4. Li Fan
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  5. Jinghong Dai
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  6. Yuying Qiu
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Contributions

LL collected and analyzed the data and drafted the manuscript. YQ designed and supervised the project and edited the manuscript. JD substantively revised and edited the manuscript. LF, TJ and RC helped with data collection and analysis. All authors have read and agreed to the submitted manuscript.

Corresponding authors

Correspondence to Jinghong Dai or Yuying Qiu.

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Conflict of interest

The authors declare no conflict of interest.

Institutional review board statement

This study was approved by the Ethics Committee of Nanjing University Medical School Affiliated Drum Tower Hospital according to the policy (protocol number 2022- 067- 02, March 28, 2022).

Informed consent statement

The consent is waived because it is a retrospective review study.

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Liu, L., Ji, T., Chen, R. et al. High prevalence of pneumocystis pneumonia in interstitial lung disease: a retrospective study. Infection (2023). https://doi.org/10.1007/s15010-023-02148-y

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