Clinical analysis of 9 cases of Pneumocystis jirovecii pneumonia in adult haematology patients

Abstract

Abstract:

Objective To discuss the clinical characteristics,risk factors, treatment methods,prognosis and prevention measures of the Pneumocystis jirovecii pneumonia (PCP) in adult hematologic disorders. Methods The clinical manifestations, laboratory tests, imaging features, treatment and outcomes of adult patients with hematology diagnosed as PCP from January 2014 to July 2019 were collected. Results In all 9 patients with PCP, 8 patients were hematologic malignancies and 7 patients were with allogeneic hematopoietic stem cell transplantation. The median time of diagnosed as PCP after transplantation was 8 months. 8 patients were associated with cytomegalovirus, 4 of which were multiple infections in all 9 cases. All cases had fever during the infection, and 7 cases were accompanied by cough and sputum production. The serum 1-3-β-D glucan was ranging from 104.3 to 1377.1 pg/mL, the median was 293.3pg/mL, higher than the reference value. Diffuse plaques or ground-glass opacity were the primary manifestation in imaging findings. Nodules or pleural effusion were occurred in severe cases. All patients were treated with TMP/SMZ combined with voriconazole or caspofungin or with caspofungin alone, 8 patients were cured and one patient died. Conclusion The PCP in adult hematologic disease patients progresses rapidly,and which is usually with multiple infections. Fever and cough were the main clinical manifestation of adult hematologic disease complicated with PCP. Bilateral patchy areas in CT findings and serum 1-3-β-D glucan concentration increases both contribute to the diagnosis of PCP. Finding Pneumocystis in the bronchoalveolar lavage fluid (BALF) is the gold standard for diagnosis. Anti-PCP prophylaxis should be given for high-risk patients. Early treatment of PCP is the key to reduce death and improve the prognosis of PCP in adult hematologic disease patients.

Key words: hematology, Pneumocystis jirovecii pneumonia, clinical analysis

CLC Number:

R519
R563

GUO Kai, YUE Wen-qin, WANG Tie-gong, YANG Jian-min. Clinical analysis of 9 cases of Pneumocystis jirovecii pneumonia in adult haematology patients[J]. Chinese Journal of Mycology, 2020, 15(1): 26-30.

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