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Canadian Respiratory Journal
Volume 2016, Article ID 2464791, 7 pages
http://dx.doi.org/10.1155/2016/2464791
Research Article

Intermittent Courses of Corticosteroids Also Present a Risk for Pneumocystis Pneumonia in Non-HIV Patients

1Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA
2Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Seville, Spain
3Servicio de Medicina Interna, Hospital Quirón San Camilo, Madrid, Spain
4Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain

Received 22 June 2016; Accepted 18 August 2016

Academic Editor: Jörg D. Leuppi

Copyright © 2016 Maria L. Calero-Bernal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Pneumocystis pneumonia (PCP) is rising in the non-HIV population and associates with higher morbidity and mortality. The aggressive immunosuppressive regimens, as well as the lack of stablished guidelines for chemoprophylaxis, are likely contributors to this increased incidence. Herein, we have explored the underlying conditions, immunosuppressive therapies, and clinical outcomes of PCP in HIV-negative patients. Methods. Retrospective analysis of PCP in HIV-negative patients at Mayo Clinic from 2006–2010. The underlying condition, immunosuppressive therapies, coinfection, and clinical course were determined. PCP diagnosis required symptoms of pneumonia and identification of the organisms by visualization or by a real-time polymerase chain reaction. Results. A total of 128 cases of PCP were identified during the study period. Hematological malignancies were the predisposing condition for 50% of the patients. While 87% had received corticosteroids or other immunosuppressive therapies for >4 weeks prior to the diagnosis, only 7 were receiving PCP prophylaxis. Up to 43% of patients were not on daily steroids. Sixty-seven patients needed Intensive Care Unit (ICU) and 53 received mechanical ventilation. The mortality for those patients requiring ICU was 40%. Conclusions. PCP diagnosis in the HIV-negative population requires a high level of suspicion even if patients are not receiving daily corticosteroids. Mortality remains high despite adequate treatment.