Yi Li1, Marc Ghannoum2, Chuntao Deng3, Yanxia Gao4, Huadong Zhu1, Xuezhong Yu1, Valery Lavergne5. 1. Emergency Department, Peking Union Medical College Hospital, Beijing, China. 2. Nephrology Department, Verdun Hospital, University of Montreal, Montreal, QC, Canada. 3. Emergency Department, Shenzhen Luohu People's Hospital, Shenzhen, China. 4. Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 5. Medical Microbiology and Infectious Diseases Department, Sacré-Cœur Hospital, University of Montreal, 5400 Boulevard Gouin Ouest, Montreal, QC, H2V 3A5, Canada. Electronic address: valerylavergne@gmail.com.
Abstract
OBJECTIVES: No consensus currently exists on the indications for Pneumocystis jirovecii prophylaxis in patients with inflammatory or autoimmune diseases. The main objective was to identify biomarkers associated with P. jirovecii pneumonia (PCP) in this population. METHODS: A retrospective study was carried out at Beijing Union Medical College Hospital (2003-2014). All patients with an inflammatory or autoimmune disease presenting with acute onset of fever and respiratory symptoms were included. RESULTS: A total of 123 patients were included, of whom 42% had confirmed PCP, 18% had possible PCP, and 40% were negative for PCP. Immunosuppressive conditions consisted mostly of diffuse connective tissue disease (50%) and primary nephropathy (20%). Immunosuppressive therapies consisted of corticosteroids (95%) with concomitant non-steroidal drugs (80%). Independent predictors of PCP were a CD3+ cell count <625×106/l, serum albumin <28g/l, and PaO2/FiO2 <210. Furthermore, 90% of patients with PCP had a CD3+ cell count <750×106/l. Independent predictors of mortality were a CD8+ cell count <160×106/l and a PaO2/FiO2 <160. CONCLUSIONS: In patients with inflammatory and autoimmune conditions receiving immunosuppressive therapy, low CD3+ and CD8+ cell counts were strongly associated with PCP and its mortality. These results suggest that lymphocyte subtyping is a very useful tool to optimize the selection of patients needing prophylaxis.
OBJECTIVES: No consensus currently exists on the indications for Pneumocystis jirovecii prophylaxis in patients with inflammatory or autoimmune diseases. The main objective was to identify biomarkers associated with P. jiroveciipneumonia (PCP) in this population. METHODS: A retrospective study was carried out at Beijing Union Medical College Hospital (2003-2014). All patients with an inflammatory or autoimmune disease presenting with acute onset of fever and respiratory symptoms were included. RESULTS: A total of 123 patients were included, of whom 42% had confirmed PCP, 18% had possible PCP, and 40% were negative for PCP. Immunosuppressive conditions consisted mostly of diffuse connective tissue disease (50%) and primary nephropathy (20%). Immunosuppressive therapies consisted of corticosteroids (95%) with concomitant non-steroidal drugs (80%). Independent predictors of PCP were a CD3+ cell count <625×106/l, serum albumin <28g/l, and PaO2/FiO2 <210. Furthermore, 90% of patients with PCP had a CD3+ cell count <750×106/l. Independent predictors of mortality were a CD8+ cell count <160×106/l and a PaO2/FiO2 <160. CONCLUSIONS: In patients with inflammatory and autoimmune conditions receiving immunosuppressive therapy, low CD3+ and CD8+ cell counts were strongly associated with PCP and its mortality. These results suggest that lymphocyte subtyping is a very useful tool to optimize the selection of patients needing prophylaxis.
Authors: Chiwook Chung; Chae Man Lim; Yeon-Mok Oh; Sang Bum Hong; Chang-Min Choi; Jin Won Huh; Sei Won Lee; Jae Seung Lee; Kyung-Wook Jo; Wonjun Ji; Chan-Jeoung Park; Mina Kim; Heungsup Sung; Young-Uk Cho; Hyo Sin Cho; Ho Cheol Kim Journal: BMC Pulm Med Date: 2022-06-26 Impact factor: 3.320
Authors: Christina L Kong; Nicole K Kelly; Miel Sundararajan; S R Rathinam; John A Gonzales; Radhika Thundikandy; Rajesh Vedhanayaki; Anuradha Kanakath; Bala Murugan; Thuy Doan; Debra Goldstein; Hassan A Al-Dhibi; Nisha R Acharya Journal: Ocul Immunol Inflamm Date: 2020-08-11 Impact factor: 3.070