High Prevalence of Pneumocystis Pneumonia in Interstitial Lung Disease: a Retrospective Study

Overview

Journal Infection

Date 2023 Dec 26

PMID 38147199

Authors

Ling Liu

Tong Ji

Ranxun Chen

Li Fan

Jinghong Dai

Yuying Qiu

Affiliations

Soon will be listed here.

Abstract

Background: Interstitial lung disease (ILD) is a new risk category for pneumocystis pneumonia (PCP) with a high mortality rate. The definite diagnostic criteria of PCP in ILD patients have not been established until now. The aims of this study were to identify potential risk factors of PCP in patients with ILD, and to evaluate the performance of metagenomic next-generation sequencing (mNGS), CD4 + T cell count, (1-3)-β-D-Glucan (BG) and lactate dehydrogenase (LDH) in the diagnosis of PCP in ILD patients.

Methods: This is a retrospective, single-center, case-control study. ILD patients who underwent mNGS from December 2018 to December 2022 were included in the study. Based on the diagnosis criteria of PCP, these patients were divided into PCP-ILD and non-PCP-ILD groups. The potential risk factors for PCP occurrence in ILD patients were analysed via logistic regression. The diagnostic efficacy of mNGS was compared with serological biomarkers.

Results: 92 patients with ILD were enrolled, 31 of which had a definite PCP and were assigned to the PCP-ILD group while 61 were to the non-PCP-ILD group. The infection rate of PJ in ILD patients was 33.7% (31/92). The history of glucocorticoid therapy, CD4 + T cell count, BG level and traction bronchiectasis on HRCT were associated with PCP occurrence in ILD patients. LDH level did not reach statistical significance in the logistic regression analysis. mNGS was confirmed as the most accurate test for PCP diagnosis in ILD patients.

Conclusion: ILD is a new risk group of PCP with high PCP prevalence. Clinicians should pay close attention to the occurrence of PCP in ILD patients who possess the risk factors of previous glucocorticoid therapy, decreased CD4 + T cell count, increased BG level and absence of traction bronchiectasis on HRCT. mNGS showed the most excellent performance for PCP diagnosis in ILD patients. Peripheral blood CD4 + T cell count and BG level are alternative diagnostic methods for PCP in ILD patients. However, the diagnostic value of serum LDH level was limited in ILD patients.

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References

Cooley L, Dendle C, Wolf J, Teh B, Chen S, Boutlis C . Consensus guidelines for diagnosis, prophylaxis and management of Pneumocystis jirovecii pneumonia in patients with haematological and solid malignancies, 2014. Intern Med J. 2014; 44(12b):1350-63. DOI: 10.1111/imj.12599. View

Alanio A, Hauser P, Lagrou K, Melchers W, Helweg-Larsen J, Matos O . ECIL guidelines for the diagnosis of Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother. 2016; 71(9):2386-96. DOI: 10.1093/jac/dkw156. View

Festic E, Gajic O, Limper A, Aksamit T . Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection: outcome and associated features. Chest. 2005; 128(2):573-9. DOI: 10.1378/chest.128.2.573. View

Maini R, Henderson K, Sheridan E, Lamagni T, Nichols G, Delpech V . Increasing Pneumocystis pneumonia, England, UK, 2000-2010. Emerg Infect Dis. 2013; 19(3):386-92. PMC: 3647665. DOI: 10.3201/eid1903.121151. View

Vidal S, de la Horra C, Martin J, Montes-Cano M, Rodriguez E, Respaldiza N . Pneumocystis jirovecii colonisation in patients with interstitial lung disease. Clin Microbiol Infect. 2006; 12(3):231-5. DOI: 10.1111/j.1469-0691.2005.01337.x. View

Hamada S, Ichiyasu H, Inaba M, Takahashi H, Sadamatsu T, Akaike K . Prognostic impact of pre-existing interstitial lung disease in non-HIV patients with pneumonia. ERJ Open Res. 2020; 6(2). PMC: 7196667. DOI: 10.1183/23120541.00306-2019. View

Montesi S, Fisher J, Martinez F, Selman M, Pardo A, Johannson K . Update in Interstitial Lung Disease 2019. Am J Respir Crit Care Med. 2020; 202(4):500-507. PMC: 7427378. DOI: 10.1164/rccm.202002-0360UP. View

Rego de Figueiredo I, Vieira Alves R, Drummond Borges D, Torres M, Lourenco F, Antunes A . Pneumocystosis pneumonia: A comparison study between HIV and non-HIV immunocompromised patients. Pulmonology. 2019; 25(5):271-274. DOI: 10.1016/j.pulmoe.2019.04.003. View

Sokulska M, Kicia M, Wesolowska M, Hendrich A . Pneumocystis jirovecii--from a commensal to pathogen: clinical and diagnostic review. Parasitol Res. 2015; 114(10):3577-85. PMC: 4562001. DOI: 10.1007/s00436-015-4678-6. View

10.

Wang J, Han Y, Feng J . Metagenomic next-generation sequencing for mixed pulmonary infection diagnosis. BMC Pulm Med. 2019; 19(1):252. PMC: 6921575. DOI: 10.1186/s12890-019-1022-4. View

11.

Xie Y, Du J, Jin W, Teng X, Cheng R, Huang P . Next generation sequencing for diagnosis of severe pneumonia: China, 2010-2018. J Infect. 2018; 78(2):158-169. DOI: 10.1016/j.jinf.2018.09.004. View

12.

Liu N, Kan J, Yu N, Cao W, Cao J, Jiang E . Application of metagenomic next-generation sequencing technology for difficult lung lesions in patients with haematological diseases. Transl Cancer Res. 2022; 9(9):5245-5254. PMC: 8798119. DOI: 10.21037/tcr-20-604. View

13.

Chen J, He T, Li X, Wang X, Peng L, Ma L . Metagenomic Next-Generation Sequencing in Diagnosis of a Case of Pneumonia in a Kidney Transplant Recipient and Literature Review. Infect Drug Resist. 2020; 13:2829-2836. PMC: 7431457. DOI: 10.2147/IDR.S257587. View

14.

Anan K, Oshima Y, Ogura T, Tanabe Y, Higashi A, Iwashita Y . Safety and harms of bronchoalveolar lavage for acute respiratory failure: A systematic review and meta-analysis. Respir Investig. 2021; 60(1):68-81. DOI: 10.1016/j.resinv.2021.07.008. View

15.

Shimizu Y, Sunaga N, Dobashi K, Fueki M, Fueki N, Makino S . Serum markers in interstitial pneumonia with and without Pneumocystis jirovecii colonization: a prospective study. BMC Infect Dis. 2009; 9:47. PMC: 2676289. DOI: 10.1186/1471-2334-9-47. View

16.

Damiani C, Gal S, Da Costa C, Virmaux M, Nevez G, Totet A . Combined quantification of pulmonary Pneumocystis jirovecii DNA and serum (1->3)-β-D-glucan for differential diagnosis of pneumocystis pneumonia and Pneumocystis colonization. J Clin Microbiol. 2013; 51(10):3380-8. PMC: 3811637. DOI: 10.1128/JCM.01554-13. View

17.

White P, Backx M, Barnes R . Diagnosis and management of Pneumocystis jirovecii infection. Expert Rev Anti Infect Ther. 2017; 15(5):435-447. DOI: 10.1080/14787210.2017.1305887. View

18.

Raghu G, Collard H, Egan J, Martinez F, Behr J, Brown K . An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011; 183(6):788-824. PMC: 5450933. DOI: 10.1164/rccm.2009-040GL. View

19.

Wissmann G, Morilla R, Friaza V, Calderon E, Varela J . [Human reservoirs of Pneumocystis]. Enferm Infecc Microbiol Clin. 2009; 28(1):38-43. DOI: 10.1016/j.eimc.2008.07.008. View

20.

Tasaka S, Tokuda H . Pneumocystis jirovecii pneumonia in non-HIV-infected patients in the era of novel immunosuppressive therapies. J Infect Chemother. 2012; 18(6):793-806. DOI: 10.1007/s10156-012-0453-0. View