Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2022; 10(9): 2743-2750
Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2743
Treatment of Pneumocystis jirovecii pneumonia in non-human immunodeficiency virus-infected patients using a combination of trimethoprim-sulfamethoxazole and caspofungin
Huan-Huan Wu, Shuang-Yan Fang, Yan-Xiao Chen, Lan-Fang Feng
Huan-Huan Wu, Shuang-Yan Fang, Yan-Xiao Chen, Lan-Fang Feng, Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
Author contributions: All authors contributed to the study conception and design; Material preparation and data analysis were performed by Feng LF and Chen YX; The first draft of the manuscript was written by Wu HH; Fang SY re-evaluated and added content on the computed tomography imaging outcomes; All authors were involved in the review of various previous versions of the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the Dongyang Hospital Affiliated to Wenzhou Medical University (No. 2021-YX-127).
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huan-Huan Wu, MD, Doctor, Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, No. 60 Wuning West Road, Dongyang 322100, Zhejiang Province, China. huanhuan871002@163.com
Received: August 24, 2021
Peer-review started: August 24, 2021
First decision: November 17, 2021
Revised: November 19, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: March 26, 2022
Processing time: 210 Days and 1.9 Hours
Abstract
BACKGROUND

Pneumocystis jirovecii pneumonia (PJP) is an infectious disease common in immunocompromised hosts. However, the currently, the clinical characteristics of non-HIV patients with PJP infection have not been fully elucidated.

AIM

To explore efficacy of trimethoprim–sulfamethoxazole (TMP-SMX) and caspofungin for treatment of non-human immunodeficiency virus (HIV)-infected PJP patients.

METHODS

A retrospective study enrolled 22 patients with non-HIV-infected PJP treated with TMP-SMX and caspofungin from 2019 to 2021. Clinical manifestations, treatment and prognosis of the patients were analyzed.

RESULTS

Five patients presented with comorbidity of autoimmune diseases, seven with lung cancer, four with lymphoma, two with organ transplantation and four with membranous nephropathy associated with use of immunosuppressive agents. The main clinical manifestations of patients were fever, dry cough, and progressive dyspnea. All patients presented with acute onset and respiratory failure. The most common imaging manifestation was ground glass opacity around the hilar, mainly in the upper lobe. All patients were diagnosed using next-generation sequencing, and were treated with a combination of TMP-SMX and caspofungin. Among them, 17 patients received short-term adjuvant glucocorticoid therapy. All patients recovered well and were discharged from hospital.

CONCLUSION

Non-HIV-infected PJP have rapid disease progression, high risk of respiratory failure, and high mortality. Combination of TMP-SMX and caspofungin can effectively treat severe non-HIV-infected PJP patients with respiratory failure.

Keywords: Acquired immunodeficiency syndrome; Non-human immunodeficiency virus-infected patients; Immunosuppression; caspofungin; Mortality; Pneumocystis jirovecii pneumonia

Core tip: Pneumocystis jirovecii pneumonia (PJP) is common in immunocompromised hosts. However, the clinical characteristics of non-human immunodeficiency virus (HIV) infected PJP patients have not been fully elucidated. This was a retrospective study of non-HIV-infected PJP treated with trimethoprim– sulfamethoxazole (TMP-SMX) and caspofungin. Clinical manifestations, treatment and prognosis of the patients were evaluated. Non-HIV-infected PJP patients are characterized by rapid disease progression, high risk of respiratory failure, and high mortality. Early diagnosis and treatment can improve survival in non-HIV-infected PJP patients. The findings of the current study showed that combination of TMP-SMX and caspofungin is effective for non-HIV-infected PJP patients with respiratory failure.