Clinical Manifestations and Prognostic Factors of Pneumocystis jirovecii Pneumonia without HIV.
INTRODUCTION
Pneumocystis jirovecii pneumonia (PCP) can occur in HIV patients but also in those without HIV (non-HIV PCP) but with other causes of immunodeficiency including malignancy or rheumatic diseases.


OBJECTIVE AND METHODS
To evaluate the clinical presentation and prognostic factors of non-HIV PCP, we retrospectively reviewed all patients diagnosed as having PCP without HIV at Kameda Medical Center, Chiba, Japan, from January 2005 until June 2012. For the purpose of examining a prognostic factor for non-HIV PCP with 30-day mortality, we compared the characteristics of patients, clinical symptoms, radiological images, Eastern Cooperative Oncology Group performance status (PS), and the time from the onset of respiratory symptoms to the start of therapy, in both survival and fatality groups.


RESULTS
A total of 38 patients were eligible in this study. Twenty-five survived and 13 had died. The non-HIV PCP patients in the survivor group had a better PS and received anti-PCP therapy earlier than those in the nonsurvivor group. Rales upon auscultation and respiratory failure at initial visits were seen more frequently in the nonsurvivor group than in the survivor group. Lactate dehydrogenase and C-reactive protein values tended to be higher in the nonsurvivor group, but this was not statistically significant. Multivariate analyses using 5 variables showed that a poor PS of 2-4 was an independent risk factor for non-HIV PCP patients and resulted in death (odds ratio 15.24; 95% confidence interval 1.72-135.21).


CONCLUSION
We suggest that poor PS is an independent risk factor in non-HIV PCP, and a patient's PS and disease activity may correlate with outcome.
['Asai|Nobuhiro|N|', 'Motojima|Shinji|S|', 'Ohkuni|Yoshihiro|Y|', 'Matsunuma|Ryo|R|', 'Iwasaki|Takuya|T|', 'Nakashima|Kei|K|', 'Sogawa|Keiji|K|', 'Nakashita|Tamao|T|', 'Kaneko|Norihiro|N|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002097:C-Reactive Protein D005260:Female D015658:HIV Infections D006801:Humans D007770:L-Lactate Dehydrogenase D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D016017:Odds Ratio D045363:Pneumocystis carinii D011014:Pneumonia D011379:Prognosis D012189:Retrospective Studies D012307:Risk Factors D013909:Thorax
Pneumocystis jirovecii pneumonia Malignancy Human immunodeficiency virus Non-HIV P. jirovecii pneumonia Rheumatoid arthritis β-<span style="font-variant:small-caps text-transform:lowercase">D</span>-glucan