Pneumocystis carinii Pneumonia in Patients Without AIDS, 1980 Through 1993: An Analysis of 78 Cases

doi:10.1001/archinte.1995.00430220094010

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Vol. 155 No. 22, 11 DECEMBER 1995

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Pneumocystis carinii Pneumonia in Patients Without AIDS, 1980 Through 1993

An Analysis of 78 Cases

Sandra M. Arend, MD; Frank P. Kroon, MD; Jan W. van't Wout, MD, PhD

Arch Intern Med. 1995;155(22):2436-2441.

Abstract

Background
Pneumocystis carinii pneumonia (PCP) occurs in immunocompromisedpatients without the acquired immunodeficiency syndrome (AIDS).There has been an increasing yearly number of cases of PCP inour patients without AIDS.

Objective
To determine the nature of the underlying disorder and previousimmunosuppressive treatment in patients with PCP without AIDS.

Method
A study of the charts of 78 such patients admitted to our hospitalfrom 1980 through 1993.

Results
The number of PCP cases per year increased during the periodstudied. All patients had an underlying disorder, either hematologicmalignancy (49%), solid organ tumor (4%), vasculitis or otherimmunologic disorder (22%), or they had undergone renal transplantation(17%) or bone marrow transplantation (9%). Previous immunosuppressivemedication consisted of prednisone or other corticosteroidsin 72 (92%) of 78 patients, cytotoxic drugs in 55 (71%) of 78patients, both in 50 (64%) of 78 patients, and none in one patient.Quantification of previous corticosteroid treatment showed alarge variability among patients. The overall mortality ratefor patients was 35% (27/78). Mortality was significantly higherin patients with a concomitant pulmonary infection (P=.01),an underlying disorder other than that which resulted in renaltransplantation (P=.03), mechanical ventilation (P<.001),previous chemotherapy (P=.04), as well as previous cyclophosphamidetreatment (P=.01). A trend toward a higher mortality in patientswith previous corticosteroid use was detected (P=.06).

Conclusion
Pneumocystis carinii pneumonia may complicate a variety of immunocompromisedstates, with considerable mortality. Pneumocystis carinii pneumoniaoccurred at all levels of immunosuppression; no threshold levelcould be defined.

(Arch Intern Med. 1995;155:2436-2441)

Author Affiliations

From the Department of Infectious Diseases, University Hospital, Leiden, the Netherlands.

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