ORIGINAL ARTICLE

Evaluation of Pneumocystis pneumonia infection risk factors in patients with connective tissue disease

Authors

Noriko Iikuni¹, Mariko Kitahama¹, Shuji Ohta², Hiroshi Okamoto¹, Naoyuki Kamatani¹ and Makoto Nishinarita²

Received:

14 March 2006

Accepted:

05 June 2006

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Abstract

We conducted a retrospective, clinical evaluation of connective tissue disease (CTD) patients who were tested for either sputum or bronchoalveolar lavage fluid Pneumocystis polymerase chain reaction (PC-PCR) and analyzed the risk factors that cause Pneumocystis pneumonia (PCP) susceptibility and fatality. PC-PCR was performed on 66 CTD patients who presented with symptoms, data, or radiological findings strongly suggesting respiratory infection. Patients with higher oral corticosteroid doses, use of oral methotrexate (MTX), bilateral lung findings, positive β-d-glucan, and no prophylaxis use were more susceptible to PCP. They had significantly low immunoglobulin G and significantly high β-d-glucan and lactate dehydrogenase. Survivors and nonsurvivors of PCP were also evaluated. Poor prognoses were observed with older age, elevated β-d-glucan, rheumatoid arthritis (RA) patients using MTX, hypoxemia, bilateral lung findings, and mechanical ventilation use. Nonsurvivors had significantly lower lymphocytes, oxygen saturation, and significantly higher β-d-glucan. In RA, poor prognoses were seen with those taking MTX. Disease duration, underlying pulmonary complications, and oral corticosteroid doses did not lead to poor prognoses in RA. Because PCP in CTD leads to abrupt onset of symptoms with poor survival rates, early diagnosis and initiation of treatment are critical, and it is essential for clinicians to recognize risk factors that predispose patients to PCP and its mortality.

Key words

Connective tissue disease (CTD) - Opportunistic infection - Pneumocystis infection - Rheumatic disease