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Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features

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Journal of Infection and Chemotherapy

Abstract

Pneumocystis pneumonia (PCP) remains the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). Familiarity with the clinical features of PCP is crucial for prompt diagnosis, even if the patient is unaware of their HIV serostatus. We describe herein the clinical features of 34 episodes in 32 patients with AIDS-associated PCP and review the existing literature. As for symptoms, the frequency of fever, cough, and dyspnea was 74%, 74%, and 65%, respectively, and the complete triad was present in only 14 of the 34 episodes on first examination. Median duration from onset of symptoms until diagnosis was 3 weeks, and AIDS-associated PCP tended to take an insidious clinical course. Although laboratory findings were generally nonspecific, measurement of β-D-glucan levels in the serum or plasma was highly useful in the diagnosis of PCP. All but 1 of the patients showed β-D-glucan levels higher than the cutoff value (median, 147 pg/ml; range, 5–6920 pg/ml). Typical radiographic features of PCP are bilateral, symmetrical ground-glass opacities, but a wide variety of radiographic findings were observed. In our patients, high-resolution computed tomography (HRCT) of the lung showed ground-glass opacities sparing the lung periphery (41% of episodes) or displaying a mosaic pattern (29%), or being nearly homogeneous (24%), ground-glass opacities associated with air-space consolidation (21%), associated with cystic formation (21%), associated with linear-reticular opacities (18%), patchily and irregularly distributed (15%), associated with solitary or multiple nodules (9%), and associated with parenchymal cavity lesions (6%).

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Authors and Affiliations

  1. Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan

    Takeshi Fujii & Aikichi Iwamoto

  2. Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    Tetsuya Nakamura & Aikichi Iwamoto

  3. China-Japan Joint Laboratory of Structural Virology and Immunology, Institute of Biophysics, Chinese Academy of Sciences, and Institute of Medical Science, University of Tokyo, Tokyo, Japan

    Aikichi Iwamoto

  4. China-Japan Joint Laboratory of Molecular Immunology and Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences and Institute of Medical Science, University of Tokyo, Tokyo, Japan

    Aikichi Iwamoto

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  1. Takeshi Fujii
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  2. Tetsuya Nakamura
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  3. Aikichi Iwamoto
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Correspondence to Takeshi Fujii.

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Fujii, T., Nakamura, T. & Iwamoto, A. Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features. J Infect Chemother 13, 1–7 (2007). https://doi.org/10.1007/s10156-006-0484-5

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