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Characteristics and outcome according to underlying disease in non-AIDS patients with acute respiratory failure due to Pneumocystis pneumonia

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Abstract

In the non-AIDS group, several underlying conditions and immune defects could lead to different PCP presentations. This study compared PCP presentation and outcome according to the underlying disease. A secondary analysis of a previously published prospective observational study including 544 PCP patients was done. Only non-AIDS patients were included. Underlying disease was defined as chronic lymphocytic leukemia (CLL), organ transplantation, solid cancer, allogeneic hematopoietic stem cell transplant (AHSCT), other hematological diseases, and immunosuppressive treatment. Clinical characteristics and outcomes were compared between groups. Multiple correspondent analyses compared clinical characteristics at diagnosis. Day 30 mortality was analyzed. Three hundred and twenty-one patients were included in the study. The underlying diseases were hematological malignancy (n = 75), AHSCT (n = 14), CLL (n = 19), solid organ transplant (n = 94), solid tumor (n = 39), and immunosuppressive treatment (n = 57). Compared with other underlying diseases, PCP related to CLL was closer to PCP related to AIDS presentation (long duration of symptoms before diagnosis, high level of dyspnea, and low oxygen saturation at diagnosis). Day 30 mortality was associated with underlying disease, oxygen flow, and shock at ICU admission. PCP presentations may vary according to the underlying reason for immunosuppression. Response to treatment and adjuvant steroid therapy should be analyzed regarding this result.

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Data availability

Data are available on reasonable request required because of observational study.

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Funding

The initial cohort was supported by a grant from the French ministry of health.

Author information

Authors and Affiliations

  1. AP-HP, Hôpital Saint-Louis, Medical ICU, Paris, France

    Gaston Burghi, Sandrine Valade, Samia Hamane, Elie Azoulay & Virginie Lemiale

  2. UFR de Médecine, University Paris-7 Paris-Diderot, 1 Avenue Claude Vellefaux, 75010, Paris, France

    Gaston Burghi, Lucie Biard, Samia Hamane, Elie Azoulay & Virginie Lemiale

  3. AP-HP, Hôpital Saint-Louis, SBIM, Paris, France

    Lucie Biard

  4. Centre Medico-Chirurgical FOCH, Suresnes, France

    Antoine Roux

  5. Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, 35000, Rennes, France

    Florence Robert-Gangneux

  6. CHU de Grenoble, Grenoble, France

    Daniéle Maubon

  7. Université de Lorraine, CHRU-Nancy, laboratoire de Microbiologie, F-54000, Nancy, France

    Anne Debourgogne

  8. Centre Hospitalier Régional et Universitaire de Brest, Brest, France

    Soléne Le Gal

  9. Centre Hospitalier Universitaire de Dijon, Laboratoire de Parasitologie-Mycologie, Dijon, France

    Fréderic Dalle

  10. UMR PAM, Agrosup, Université de Bourgogne-Franche Comté, Dijon, France

    Fréderic Dalle

  11. CHU de Nantes, Nantes, France

    Marion Leterrier

  12. CHU de Reims, Reims, France

    Dominique Toubas

  13. Service de Parasitologie, Mycologie CHU Nice, UCA, INSERM 1065 C3M, Nice, France

    Christelle Pomares

  14. CHU Jean Minjoz, Besançon, France

    Anne Pauline Bellanger

  15. CHU Côte de Nacre, Normandie University, UNICAEN, Caen, France

    Julie Bonhomme

  16. CHU de Toulouse, Toulouse, France

    Antoine Berry & Xavier Iriart

  17. Centre de Physiopathologie Toulouse Purpan (CPTP), Université de Toulouse, INSERM, CNRS, UPS, Toulouse, France

    Antoine Berry & Xavier Iriart

  18. CHU de Lille, Lille France and CH de Dunkerque, Dunkerque, France

    Isabelle Durand-Joly

  19. AP-HP, Hôpital St Antoine, Université de Paris, Paris, France

    Denis Magne & Eric Maury

  20. CHU Gabriel Montpied, Clermont-Ferrand, France

    Denis Pons

  21. Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, 75012, Paris, France

    Christophe Hennequin

Authors
  1. Gaston Burghi
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  2. Lucie Biard
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  3. Antoine Roux
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  4. Sandrine Valade
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  5. Florence Robert-Gangneux
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  6. Samia Hamane
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  7. Daniéle Maubon
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  8. Anne Debourgogne
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  9. Soléne Le Gal
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  10. Fréderic Dalle
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  11. Marion Leterrier
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  12. Dominique Toubas
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  13. Christelle Pomares
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  14. Anne Pauline Bellanger
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  15. Julie Bonhomme
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  16. Antoine Berry
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  17. Xavier Iriart
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  18. Isabelle Durand-Joly
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  19. Denis Magne
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  20. Denis Pons
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  21. Christophe Hennequin
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  22. Eric Maury
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  23. Elie Azoulay
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  24. Virginie Lemiale
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Contributions

GB, LB, EA, and VL designed the study, performed analysis, and wrote the manuscript. AR, SV, FRG, SH, DM, AD, SLG, FD, ML, DT, CP, APB, JB, AB, XI, IDJ, DM, DP, CH, and EM included patients, and reviewed and approved the manuscript.

Corresponding author

Correspondence to Virginie Lemiale.

Ethics declarations

Ethical approval

The appropriate ethics committee approved the first study.

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Non-applicable

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Non-applicable

Informed consent

It was not required because of observational study.

Competing interests

Antoine Roux, MD,; Sandrine Valade, MD; Florence Gangneux-Robert, PharmD, PhD; Samia Hamane, MD; Daniele Maubon, MD, PhD; Anne Debourgogne, PhD, MPH; Solène Le Gal, DVM, PhD; Frederic Dalle, PharmD, PhD; Marion Leterrier, PharmD; Dominique Toubas, MD, PhD; Christelle Pomares, MD, PhD; Anne Pauline Bellanger, PharmD, PhD; Julie Bonhomme, MD, PhD; Xavier Iriart, PhD; Isabelle Durand-Joly, PhD; Denis Magne, PhD; Denis Pons, Pharmacien Biologiste; and Eric Maury, MD, PhD, have disclosed no relevant financial relationships. Christophe Hennequin, MD, PhD, has disclosed the following relevant financial relationships: served as an advisor or consultant for Gilead Sciences, Inc., Merck Sharp & Dohme Corp; Pfizer Inc. Elie Azoulay, MD, PhD, has disclosed the following relevant financial relationships: Gilead Sciences, Pfizer, Astellas, Alexion, Fisher-Paykel. Dr. Lemiale has disclosed being memeber of a research group which received grant from Pfizer, Fisher-Paykel, Gilead, Alexion, Astellas.

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Burghi, G., Biard, L., Roux, A. et al. Characteristics and outcome according to underlying disease in non-AIDS patients with acute respiratory failure due to Pneumocystis pneumonia. Eur J Clin Microbiol Infect Dis 40, 1191–1198 (2021). https://doi.org/10.1007/s10096-020-04118-w

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  • DOI: https://doi.org/10.1007/s10096-020-04118-w

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