Risk factors of Pneumocystis jeroveci pneumonia in patients with systemic lupus erythematosus

  • Ratchaya LertnawapanEmail author
  • Kitti Totemchokchyakarn
  • Kanokrat Nantiruj
  • Suchela Janwityanujit
Original Article


Pneumocystis jeroveci pneumonia (PCP) is an opportunistic infection which occurs mostly in the immune-deficiency host. Although PCP infected systemic lupus erythematosus (SLE) patient carries poor outcome, no standard guideline for prevention has been established. The aim of our study is to identify the risk factors which will indicate the PCP prophylaxis in SLE. This is a case control study. A search of Ramathibodi hospital’s medical records between January 1994 and March 2004, demonstrates 15 cases of SLE with PCP infection. Clinical and laboratory data of these patients were compared to those of 60 matched patients suffering from SLE but no PCP infection. Compared to SLE without PCP, those with PCP infection have significantly higher activity index by MEX-SLEDAI (13.6 ± 5.83 vs. 6.73 ± 3.22) or more renal involvement (86 vs. 11.6%, P < 0.01), higher mean cumulative dose of steroid (49 ± 29 vs. 20 ± 8 mg/d, P < 0.01), but lower lymphocyte count (520 ± 226 vs. 1420 ± 382 cells/mm3, P < 0.01). Interestingly, in all cases, a marked reduction in lymphocyte count (710 ± 377 cells/mm3) is observed before the onset of PCP infection. The estimated CD4+ count is also found to be lower in the PCP group (156 ± 5 vs. 276 ± 8 cells/mm3). Our study revealed that PCP infected SLE patients had higher disease activity, higher dose of prednisolone treatment, more likelihood of renal involvement, and lower lymphocyte count as well as lower CD4+ count than those with no PCP infection. These data should be helpful in selecting SLE patients who need PCP prophylaxis.


Systemic Lupus Erythematosus Systemic Lupus Erythematosus Patient Lymphocyte Count Acquire Immune Deficiency Syndrome Renal Involvement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Davis JL, Fei M, Haung L (2008) Respiratory infection complicating HIV infection. Curr Opin Infect Dis. 21(2):184–190PubMedGoogle Scholar
  2. 2.
    Porges AJ, Beattie SL, Ritchlin C, Kimberly RP, Christian CL (1992) Patients with systemic lupus erythematosus at risk for Pneumocystis carinii pneumonia. J Rheumatol 19:1191–1194PubMedGoogle Scholar
  3. 3.
    Limper AH, Offord KP, Smith TF, Martin WJ 2nd (1989) Pneumocystis carinii pneumonia. Differences in lung parasite number and inflammation in patients with and without AIDS. Am Rev Respir Dis 140:1204–1209PubMedGoogle Scholar
  4. 4.
    Lubis N, Baylis D, Short A et al (2003) Prospective cohort study showing changes in the monthly incidence of Pneumocystis carinii pneumonia. Postgrad Med J 79:164–166PubMedCrossRefGoogle Scholar
  5. 5.
    Ward MM, Donald F (1999) Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality. Arthritis Rheum 42:780–789PubMedCrossRefGoogle Scholar
  6. 6.
    Arend SM, Kroon FP, van’t Wout JW (1995) Pneumocystis carinii pneumonia in patients without AIDS, 1980 through 1993. An analysis of 78 cases. Arch Intern Med 155:2436–2441PubMedCrossRefGoogle Scholar
  7. 7.
    Yale SH, Limper AH (1996) Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc 71:5–13PubMedCrossRefGoogle Scholar
  8. 8.
    Gerrard JG (1995) Pneumocystis carinii pneumonia in HIV-negative immunocompromised adults. Med J Aust 162:233–235PubMedGoogle Scholar
  9. 9.
    Ognibene FP, Shelhamer JH, Hoffman GS et al (1995) Pneumocystis carinii pneumonia: a major complication of immunosuppressive therapy in patients with Wegener’s granulomatosis. Am J Respir Crit Care Med 151:795–799PubMedGoogle Scholar
  10. 10.
    LeMense GP, Sahn SA (1994) Opportunistic infection during treatment with low dose methotrexate. Am J Respir Crit Care Med 150:258–260PubMedGoogle Scholar
  11. 11.
    Jarrousse B, Guillevin L, Bindi P et al (1993) Increased risk of Pneumocystis carinii pneumonia in patients with Wegener’s granulomatosis. Clin Exp Rheumatol 11:615–621PubMedGoogle Scholar
  12. 12.
    Godeau B, Coutant-Perronne V, Le Thi Huong D et al (1994) Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases. J Rheumatol 21:246–251PubMedGoogle Scholar
  13. 13.
    Oien KA, Black A, Hunter JA, Madhok R (1995) Pneumocystis carinii pneumonia in a patient with rheumatoid arthritis, not on immunosuppressive therapy and in the absence of human immunodeficiency virus infection. Br J Rheumatol 34:677–679PubMedCrossRefGoogle Scholar
  14. 14.
    Kadoya A, Okada J, Iikuni Y, Kondo H (1996) Risk factors for Pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus. J Rheumatol 23:1186–1188PubMedGoogle Scholar
  15. 15.
    Katz MH, Hessol NA, Buchbinder SP, Hirozawa A, O’Malley P, Holmberg SD (1994) Temporal trends of opportunistic infections and malignancies in homosexual men with AIDS. J Infect Dis 170:198–202PubMedGoogle Scholar
  16. 16.
    Walzer PD, Perl DP, Krogstad DJ, Rawson PG, Schultz MG (1974) Pneumocystis carinii penumonia in the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med 80:83–93PubMedGoogle Scholar
  17. 17.
    Raychaudhuri SP, Siu S (1999) Pneumocystis carinii pneumonia in patients receiving immunosuppressive drugs for dermatological diseases. Br J Dermatol 141:528–530PubMedCrossRefGoogle Scholar
  18. 18.
    Rivero SJ, Diaz-Jouanen E, Alarcon-Segovia D (1978) Lymphopenia in systemic lupus erythematosus. Clinical, diagnostic, and prognostic significance. Arthritis Rheum 21:295–305PubMedCrossRefGoogle Scholar
  19. 19.
    Chechani V, Bridges A (1992) Pneumocystis carinii pneumonia in patients with connective tissue disease. Chest 101:375–378PubMedCrossRefGoogle Scholar
  20. 20.
    Jaime Guzman, Mario H Cardiel, Aleiandro Arce-Salinas et al (1992) Measurement of disease activity in systemic lupus erythematosus. Prospective validation of 3 clinical indices. J Rheumatol 19:1551–8Google Scholar
  21. 21.
    Ruskin J, Remington JS (1967) The compromised host and infection. I. Pneumocystis carinii pneumonia. JAMA 202:1070–1074PubMedCrossRefGoogle Scholar
  22. 22.
    Galeazzi M, Sebastiani GD, Marroni P (1993) Pneumocystis carinii pneumonia complicating selective CD4 T cell depletion induced by corticosteroid therapy in a patient with systemic lupus erythematosus. Clin Exp Rheumatol 11:96–97PubMedGoogle Scholar
  23. 23.
    Koletar SL, Heald AE, Finkelstein D et al (2001) A prospective study of discontinuing primary and secondary Pneumocystis carinii pneumonia prophylaxis after CD4 cell count increase to &gt; 200 x 106/l. Aids 15:1509–1515PubMedCrossRefGoogle Scholar
  24. 24.
    Bouza E, Moya JG, Munoz P. Infections in systemic lupus erythematosus and rheumatoid arthritis. Infect Dis Clin North Am 2001; 15:335–61, viiGoogle Scholar
  25. 25.
    Jian Li, Xiao-Ming Huang, Wei-Gang Fang, and Xue-Jun Zeng (2006) Pneumocystis carinii pneumonia in patients with connective tissue disease. J Clin Rheumatol 12:114–117Google Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ratchaya Lertnawapan
    • 1
    Email author
  • Kitti Totemchokchyakarn
    • 1
  • Kanokrat Nantiruj
    • 1
  • Suchela Janwityanujit
    • 1
  1. 1.Division of Allergy Immunology and Rheumatology, Department of Medicine, Faculty of Medicine at Ramathibodi HospitalMahidol UniversityBangkokThailand

Personalised recommendations