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
ARTICLE HIGHLIGHTS
Research background

Incidence of non-human immunodeficiency virus (HIV)-infected Pneumocystis jirovecii pneumonia (PJP) patients has been increasing annually owing to increased use of immunosuppressants and organ transplantation. In addition, management of non-HIV-infected PJP patients is not standardized as it is the case for HIV-infected PJP patients, and the clinical attention is poor compared with that of HIV-infected PJP patients.

Research motivation

The aim of this retrospective study was to explore the characteristics of non-HIV-infected PJP treated with trimethoprim–sulfamethoxazole (TMP-SMX) and caspofungin.

Research objectives

The findings of the current study will improve understanding of PJP in non-HIV-infected patients, and reduce misdiagnosis rate and mortality rate of non-HIV-infected PJP patients.

Research methods

A retrospective case review of 22 non-HIV-infected PJP patients admitted to Dongyang Hospital Affiliated to Wenzhou Medical University was conducted between October 2019 and April 2021. Patient data on symptoms, laboratory results, dynamic and comprehensive computed tomography, and clinical course of the disease were extracted from electronic medical records. Additional data on treatment, response to treatment, outcomes, and any relevant follow-up data were also collected.

Research results

A total of 22 cases of non-HIV-infected PJP were included in the current study. Clinical manifestations of patients mainly included fever, dry cough, and progressive dyspnea. All patients presented with an acute onset and respiratory failure. The most common imaging manifestation was ground glass opacity around the hilar, mainly located in the upper lobe. All patients underwent diagnosis using next-generation sequencing, and were all treated with TMP-SMX and caspofungin. Seventeen patients received short-term adjuvant glucocorticoid therapy. All patients recovered and were discharged from hospital.

Research conclusions

Non-HIV-infected PJP patients are characterized by rapid disease progression, high risk of respiratory failure, and high mortality. The findings of the current study showed that a combination of TMP-SMX and caspofungin is an effective treatment option for severe non-HIV-infected PJP patients with respiratory failure.

Research perspectives

The timing and duration of adjunctive treatment using glucocorticoids and identification of patients susceptible to Pneumocystis jirovecii infection at an early stage to start effective prophylaxis drugs.