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Early diagnosis and treatment are crucial for the survival of Pneumocystis pneumonia patients without human immunodeficiency virus infection

  • Original Article
  • Published:
Journal of Infection and Chemotherapy

Abstract

The mortality of Pneumocystis pneumonia (PCP) patients without human immunodeficiency virus (HIV) infection ranges from 0 to 70 %, whereas that of HIV-infected PCP patients ranges from 10 to 20 %. The reasons for these differences are not known. We retrospectively analyzed factors contributing to the survival of 23 patients with PCP and without HIV infection, in whom PCP developed as community-acquired pneumonia (CAP). The interval from admission to the start of PCP-specific treatment was significantly shorter for survivors (2.71 ± 3.64 days; n = 14) than for non-survivors (8.67 ± 5.5 days; n = 9; p = 0.003). Moreover, although the severity scores/classes assessed by A-DROP, CURB-65, and PSI were no different on admission, scores/classes at the start of PCP-specific treatment were significantly higher for non-survivors. Overall mortality was 39 %, but mortality was approximately 70–100 % for patients classified as severe grade by A-DROP, CURB-65, or PSI scores/classes at the time when PCP-specific treatment was started, which was far higher than expected for these guidelines. In conclusion, early diagnosis and treatment within 3 days are crucial for the survival of PCP patients without HIV infection. We emphasize the limitations of application of guidelines for CAP to patients with PCP.

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Acknowledgments

We are grateful for the diligent and thorough critical reading of our manuscript by Mr John Wocher, Executive Vice President and Director, International Affairs/International Patient Services, Kameda Medical Center (Japan).

Conflict of interest

The authors have no conflicting interests.

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Authors and Affiliations

  1. The Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan

    Nobuhiro Asai, Shinji Motojima, Yoshihiro Ohkuni, Ryo Matsunuma, Kei Nakashima, Takuya Iwasaki, Tamao Nakashita & Norihiro Kaneko

  2. Department of Laboratory Medicine, Kameda Medical Center, Chiba, Japan

    Yoshihito Otsuka

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  1. Nobuhiro Asai
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  2. Shinji Motojima
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  9. Norihiro Kaneko
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Correspondence to Nobuhiro Asai.

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Asai, N., Motojima, S., Ohkuni, Y. et al. Early diagnosis and treatment are crucial for the survival of Pneumocystis pneumonia patients without human immunodeficiency virus infection. J Infect Chemother 18, 898–905 (2012). https://doi.org/10.1007/s10156-012-0441-4

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  • DOI: https://doi.org/10.1007/s10156-012-0441-4

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