Human herpes virus co-infection is associated with mortality in HIV-negative patients with Pneumocystis jirovecii pneumonia.

P. Fillatre 1 Sylviane Chevrier 2 Matthieu Revest 3 Arnaud Gacouin 1, 4 Stéphane Jouneau 5 Hélène Leroy 1, 4 Florence Robert-Gangneux 6 S. Minjolle 7 Yves Le Tulzo 1, 4 Pierre Tattevin 8, *
* Auteur correspondant
3 Unité de maladies infectieuses
CIC - Centre d'Investigation Clinique [Rennes], Service des maladies infectieuses et réanimation médicale
5 Contaminants Chimiques, immunité et Inflammation
Irset - Institut de recherche, santé, environnement et travail
8 Fonction structure et inactivation d'ARN bactérien
CIC - Centre d'Investigation Clinique [Rennes], Service des maladies infectieuses et réanimation médicale, Fonction, structure et inactivation d'ARN bactériens
Abstract : The purpose of this investigation was to characterize the management and prognosis of severe Pneumocystis jirovecii pneumonia (PJP) in human immunodeficiency virus (HIV)-negative patients. An observational cohort study of HIV-negative adults with PJP documented by bronchoalveolar lavage (BAL) through Gomori-Grocott staining or immunofluorescence, admitted to one intensive care unit (ICU) for acute respiratory failure, was undertaken. From 1990 to 2010, 70 patients (24 females, 46 males) were included, with a mean age of 58.6 ± 18.3 years. The mean Simplified Acute Physiology Score (SAPS)-II was 36.9 ± 20.4. Underlying conditions included hematologic malignancies (n = 21), vasculitis (n = 13), and solid tumors (n = 13). Most patients were receiving systemic corticosteroids (n = 63) and cytotoxic drugs (n = 51). Not a single patient received trimethoprim-sulfamethoxazole as PJP prophylaxis. Endotracheal intubation (ETI) was required in 42 patients (60.0 %), including 38 with acute respiratory distress syndrome (ARDS). In-ICU mortality was 52.9 % overall, reaching 80.9 % and 86.8 %, respectively, for patients who required ETI and for patients with ARDS. In the univariate analysis, in-ICU mortality was associated with SAPS-II (p = 0.0131), ARDS (p < 0.0001), shock (p < 0.0001), and herpes simplex virus (HSV) or cytomegalovirus (CMV) on BAL (p = 0.0031). In the multivariate analysis, only ARDS was associated with in-ICU mortality (odds ratio [OR] 23.4 [4.5-121.9], p < 0.0001). PJP in non-HIV patients remains a serious disease with high in-hospital mortality. Pulmonary co-infection with HSV or CMV may contribute to fatal outcome.
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European Journal of Clinical Microbiology and Infectious Diseases, Springer Verlag, 2013, 32 (2), pp.189-94. 〈10.1007/s10096-012-1730-7〉
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Soumis le : lundi 14 octobre 2013 - 14:22:03
Dernière modification le : mercredi 18 juillet 2018 - 20:02:03

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P. Fillatre, Sylviane Chevrier, Matthieu Revest, Arnaud Gacouin, Stéphane Jouneau, et al.. Human herpes virus co-infection is associated with mortality in HIV-negative patients with Pneumocystis jirovecii pneumonia.. European Journal of Clinical Microbiology and Infectious Diseases, Springer Verlag, 2013, 32 (2), pp.189-94. 〈10.1007/s10096-012-1730-7〉. 〈inserm-00872789〉

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