General Report

Clinical features of severe Pneumocystis pneumonia in non-HIV-infected children

  • Qinqiang GONG ,
  • Yuping HUANG ,
  • Xueping LI ,
  • Cairong WU ,
  • Qin XIAO ,
  • Qiongqiong WANG ,
  • Dongyan CHEN ,
  • Jie HONG ,
  • Jianping TAO ,
  • Yufeng LIANG
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  • 1. Department of Respiration, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510000, Guangdong, China
    2. School of Pediatrics, Guangzhou Medical University, Guangzhou 510000, Guangdong, China
    3. Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510000, Guangdong, China
    4. Department of Pediatrics, Nyingchi People's Hospital, Tibet Autonomous Region, Nyingchi 860000, Tibet

Received date: 2022-04-26

  Online published: 2023-10-08

Abstract

Objective To investigate the clinical characteristics of severe Pneumocystis pneumonia (PCP) in non-HIV-infected children, and to improve the understanding of such disease among pediatricians. Methods The clinical data of non-HIV-infected children with severe pneumonia hospitalized from March 2018 to March 2021 were retrospectively analyzed. The patients diagnosed with PCP by metagenomic next-generation sequencing (mNGS) were classified into the case group and the patients with severe pneumonia infected by other respiratory pathogens were included in the control group. The clinical characteristics, prognosis and complications were compared between the two groups. Results A total of 60 patients (38 boys and 22 girls) were enrolled in the study, and the median age was 1.6 (0.7-4.3) years. There were 20 patients in the case group and 40 in the control group. Compared with the control group, the proportions of primary immunodeficiency, renal connective tissue disease, use of immunosuppressive agents, and glucocorticoids use ≥1 month in the case group were higher, and the differences were statistically significant (P<0.05). Compared with the control group, the proportion of lung rales, the arterial oxygen pressure/ inhaled oxygen concentration value within 24 hours, CD4+ T cell count and CD4+ /CD8+ in the case group were lower, the oxygenation index within 24 hours was higher, and the proportion of cytomegalovirus (CMV), Epstein-Barr virus (EBV) and other fungal infections were higher in the case group, and the differences were statistically significant (P<0.05). The proportion of ground glass shadow, strip shadow, incidence of air leakage and mortality in the case group were higher than those in the control group, the proportion of patchy consolidation and pleural effusion were lower than those in the control group, and the invasive ventilation time was longer than that in the control group, and the differences were statistically significant (P<0.05). Conclusions Most non-HIV infected children with severe PCP had a history of glucocorticoid and immunosuppressant use or primary immunodeficiency before the onset of the disease. The hypoxemia was severe and long lasting, and the fatality rate was high. The main manifestations of chest CT were diffuse ground glass shadow and strip shadow. Laboratory tests suggested a low cellular immune function.

Cite this article

Qinqiang GONG , Yuping HUANG , Xueping LI , Cairong WU , Qin XIAO , Qiongqiong WANG , Dongyan CHEN , Jie HONG , Jianping TAO , Yufeng LIANG . Clinical features of severe Pneumocystis pneumonia in non-HIV-infected children[J]. Journal of Clinical Pediatrics, 2023 , 41(10) : 697 -702 . DOI: 10.12372/jcp.2023.22e0566

References

[1] Li MC, Lee NY, Lee CC, et al. Pneumocystis jiroveci pneumonia in immunocompromised patients: delayed diagnosis and poor outcomes in non-HIV-infected individuals[J]. J Microbiol Immunol Infect, 2014, 47(1): 42-47.
[2] Chen M, Tian X, Qin F, et al. Pneumocystis pneumonia in patients with autoimmune diseases: a retrospective study focused on clinical characteristics and prognostic factors related to death[J]. PLoS One, 2015, 10(9): e0139144.
[3] 中华人民共和国国家健康委员会, 国家中医药局. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12(1): 6-13.
[4] Jiang J, Bai L, Yang W, et al. Metagenomic next-generation sequencing for the diagnosis of Pneumocystis jirovecii pneumonia in non-HIV-infected patients: a retrospective study[J]. Infect Dis Ther, 2021, 10(3): 1733-1745.
[5] Zhang F, Chen J, Huang H, et al. Application of metagenomic next-generation sequencing in the diagnosis and treatment guidance of Pneumocystis jirovecii pneumonia in renal transplant recipients[J]. Eur J Clin Microbiol Infect Dis, 2021, 40(9): 1933-1942.
[6] 钱素云, 曾健生, 杨明. 关于肺孢子菌肺炎的诊断和治疗——如何运用《儿童侵袭性肺部真菌感染诊治指南(2009版)》[J]. 中华儿科杂志, 2009, 47(7): 548-549.
[7] 代艳, 李新叶, 唐慧荷, 等. 非HIV感染的免疫低下者肺孢子菌肺炎防治进展[J]. 中国临床新医学, 2021, 14(2): 134-138.
[8] Ling C, Qian S, Wang Q, et al. Pneumocystis pneumonia in non-HIV children: a 10-year retrospective study[J]. Clin Respir J, 2018, 12(1): 16-22.
[9] Liu Y, Zheng K, Liu Y, et al. Pneumocystis jirovecii pneumonia in patients with nephrotic syndrome: application of lymphocyte subset analysis in predicting clinical outcomes[J]. Can J Infect Dis Med Microbiol, 2020: 4631297.
[10] 黄絮, 翁利, 易丽, 等. 非HIV免疫抑制患者肺孢子菌肺炎合并急性呼吸衰竭的临床特征[J]. 中华医学杂志, 2016, 96(38): 3057-3061.
[11] 丘金铭, 吴仁华. 肺孢子菌肺炎的影像学表现[J]. 新发传染病电子杂志, 2019, 4(4): 235-239.
[12] 史婧奕, 王斐, 徐婷婷, 等. 儿童重症监护病房重症腺病毒肺炎特点和救治方法探讨[J]. 中国小儿急救医学, 2019, 26(3): 190-194.
[13] 袁新宇. 儿童细菌性肺炎影像特点及其临床价值[J]. 中国实用儿科杂志, 2018, 33(9): 679-682.
[14] 闫宇娇, 王德莉, 石对先. 儿童细菌性重症肺炎病原菌分布、耐药性分析及临床用药指导[J]. 中国药物滥用防治杂志, 2021, 27(3): 398-401.
[15] Miao Q, Ma Y, Wang Q, et al. Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical practice[J]. Clin Infect Dis, 2018, 67(suppl_2): S231-S240.
[16] 顾鹏, 许书添, 姜雪, 等. 外周血宏基因组二代测序对肺孢子菌肺炎的诊断价值[J]. 肾脏病与透析肾移植杂志, 2020, 29(1): 8-13.
[17] Xu J, Yu Y, Lv J, et al. Application of metagenomic next-generation sequencing to diagnose Pneumocystis jirovecii pneumonia in kidney transplantation recipients[J]. Ann Transplant, 2021, 26: e931059.
[18] Messiaen PE, Cuyx S, Dejagere T, et al. The role of CD4 cell count as discriminatory measure to guide chemoprophylaxis against Pneumocystis jirovecii pneumonia in human immunodeficiency virus-negative immunocompromised patients: a systematic review[J]. Transpl Infect Dis, 2017, 19(2). doi: 10.1111/tid.12651.
[19] Jin F, Liu XH, Chen WC, et al. High initial (1, 3) beta-d-glucan concentration may be a predictor of satisfactory response of c aspofungin combined with TMP/SMZ for HIV-negative patients with moderate to severe Pneumocystis jirovecii pneumonia[J]. Int J Infect Dis, 2019, 88: 141-148.
[20] Kim SJ, Lee J, Cho YJ, et al. Prognostic factors of Pneumocystis jirovecii pneumonia in patients without HIV infection[J]. J Infect, 2014, 69(1): 88-95.
[21] Huang SH, Meng XY, Bai ZJ, et al. X-linked hyper IgM syndrome manifesting as recurrent Pneumocystis jirovecii pneumonia: a case report[J]. J Trop Pediatr, 2020, 66(6): 648-654.
[22] 李侗曾, 梁连春. 肺孢子菌肺炎的治疗进展[J]. 国际呼吸杂志, 2020, 40(2): 151-155.
[23] García-Moreno J, Melendo-Pérez S, Martín-Gómez MT, et al. Pneumocystis jirovecii pneumonia in children. A retrospective study in a single center over three decades[J]. Enferm Infecc Microbiol Clin (Engl Ed), 2020, 38(3): 111-118.
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