Abstract
The aim of this study was to compare chest computerized tomography (CT) findings of Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients with and without acquired immune deficiency syndrome (AIDS). Chest CT findings and clinical parameters of 38 consecutive immunocompromised patients, nine with AIDS and 29 with other causes of immunosuppression, were characterized and compared. PCP in patients without AIDS was diagnosed after a significantly shorter time interval from symptom onset: 8 ± 6 vs. 18 ± 1.0 days (p = 0.024). From a radiographic point of view, non-AIDS patients had a significantly higher proportion of diffuse ground glass lesions, 86 vs. 44% (p = 0.02), and a lower proportion of cystic lesions, 3 vs. 56% (p = 0.015). The two subgroups did not differ in smoking status and the number of pack-years. On multivariant analysis, only the presence of AIDS was found to be a risk factor for the formation of pulmonary cystic lesions. Different immune reactions to the parasite P. jirovecii in immunocompromised patients with and without AIDS results in a different time lag between symptoms and a correspondingly different radiographic pattern: widespread ground glass opacities in the former and cystic lesions in the latter.
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Mansharamani NG, Garland R, Delaney D, Koziel H (2000) Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995, comparison of HIV-associated cases to other immune-compromised states. Chest 118:704–711
Varthalitis I, Aoun M, Daneau D, Meunier F (1993) Pneumocystis carinii pneumonia in patients with cancer. An increasing incidence. Cancer 71:481–485
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 155:2436–2441
Hidalgo A, Falco V, Mauleon S, Andreu J, Crespo E, Ribera M (2003) Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non-Pneumocystis carinii pneumonia in AIDS patients. Eur J Radiol 13:1179–1184
Crans CA Jr, Boiselle PM (1999) Imaging features of Pneumocystis carinii pneumonia. Crit Rev Diagn Imaging 40:251–284
Gruden JF, Huang L, Turner J, Webb WR, Merrifield C, Stansell JD (1997) High-resolution CT in the evaluation of clinically suspected Pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or nonspecific radiographic findings. AJR Am J Roentgenol 169:967–975
Kuhlman JE (1996) Pneumocystic infections: the radiologist’s perspective. Radiology 198:623–635
Fujii T, Nakamura T, Iwamoto I (2007) Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features. J Infect Chemother 13:1–7
Guinness MC (1997) Changing trends in the pulmonary manifestations of AIDs. Radiol Clin North Am 35:1029–1082
Aviram G, Fishman J, Boiselle P (2007) Thoracic infections in human immune-deficiency virus/acquired immune deficiency syndrome. Semin Roentgenol 42:23–36
Kovacs J, Hiemenz J, Macher A, Stover D, Murray HW, Shelhamer J, Lane HC, Urmacher C, Honig C, Longo DL et al (1984) Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and other immune-deficiencies. Ann Intern Med 100:663–671
Gilmartin GS, Koziel H (2002) Pneumocystis carinii pneumonia in adult non-HIV disorders. J Intensive Care Med 17:283–301
Bollée G, Sarfati C, Thiéry G, Bergeron A, de Miranda S, Menotti J, de Castro N, Tazi A, Schlemmer B, Azoulay E (2007) Clinical picture of Pneumocystis jiroveci pneumonia in cancer patients. Chest 132:1305–1310
Chen CS, Zheng SL, Fang ZX, Li YP, Ye M, Zhang DQ, Xing LL, Chen SX (2004) Alveolar damage of Pneumocystis carinii pneumonia in renal transplantation recipients. Zhonghua Jie He He Hu Xi Za Zhi 27:161–164
Schliep TC, Yarrish RL (1999) Pneumocystis carinii pneumonia. Semin Respir Infect 14:333–343
Limper AH, Offord KP, Smith TF, Martin WJ (1989) Differences in lung parasite number and inflammation in patients with and without AIDS. Am Rev Respir Dis 140:1204–1209
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Hardak, E., Brook, O. & Yigla, M. Radiological Features of Pneumocystis jirovecii Pneumonia in Immunocompromised Patients with and Without AIDS. Lung 188, 159–163 (2010). https://doi.org/10.1007/s00408-009-9214-y
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DOI: https://doi.org/10.1007/s00408-009-9214-y