Clinical Characteristics and Prognosis of Pneumocystis Pneumonia in Lymphoma Patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZhengJing ¹ , YuanXin ¹ , LiuYonghui ¹ , NiuWenkai ¹ , LiFengjiang ¹ , LiuHuiying ¹ , HengZhizhi ¹ , JinXin ² , XiaoXiubin ³ ,  BaiChangqing ¹

1. Department of Respiratory and Critical Care Medicine, The PLA 307 Hospital, Beijing, 100071, China;
2. ;
3. ;

Corresponding author：

BaiChangqing, Email: baicq307@163.com

Keywords：

Pneumocystis pneumonia; Lymphoma; Prognosis

DOI：

10.7507/1671-6205.2016128

Video：

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Objective To investigate the clinical characteristics and prognosis of pneumocystis pneumonia (PCP) in patients with lymphoma. Methods Twenty inpatients who were diagnosed as lymphoma with PCP in PLA 307 Hospital from March 2012 to December 2014 were retrospectively analyzed. Results All patients got non-Hodgkin's lymphoma. Specific genes for Pneumocystis jirovecii were found in the sputum of 5 patients and the bronchoalveolar lavage fluid of the other 15 patients. The major clinical presentations were fever (18/20) and dyspnea (13/20). Arterial blood gas analysis showed that all patients had hypoxaemia. There were 10 patients with respiratory failure (10/20), in which 7 patients needed mechanical ventilation (7/20). Four patients died (4/20). All patients were treated by multiple chemotherapy. Fifteen patients (75%) had leukocytopenia, with an average white blood cell (WBC) count of (3.2±2.8)×10⁹/L. The mean lactate dehydrogenase (LDH) level was (374.6±197.2) U/L. The mean APACHEⅡ score was 12.6±4.4. PCP had no significant manifestations under the bronchoscope. Imaging manifestations were ground-glass opacities expanding to periphery from the hila, but the pleura was less involved. Univariate analysis revealed that there were no significant differences in chemotherapy cycle, WBC count or G test between the survival group and the death group. However, serum LDH, APACHEⅡ score, delay diagnosis, and co-infection were statistically significant between the two groups. Conclusions The main clinical presentations of PCP patients with lymphoma are fever and progressive exertional dyspnea. High LDH, high APACHEⅡ score, diagnosis delay and co-infection indicate poor prognosis.

Citation： ZhengJing, YuanXin, LiuYonghui, NiuWenkai, LiFengjiang, LiuHuiying, HengZhizhi, JinXin, XiaoXiubin, BaiChangqing. Clinical Characteristics and Prognosis of Pneumocystis Pneumonia in Lymphoma Patients. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(6): 557-561. doi: 10.7507/1671-6205.2016128 Copy

1.	孙岚, 黄敏君, 安亦军, 等.非艾滋病病毒感染临床病例肺孢子菌肺炎的流行病学研究.中华流行病学杂志, 2009, 30:348-351.
2.	Monnet X, Vidal-Petiot E, Osman D, et al. Critical care management and outcome of severe pneumocystis pneumonia in patients with and without HIV infection. Crit Care, 2008, 12:R28.
3.	Fillatre P, Decaux O, Jouneau S, et al. Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients. Am J Med, 2014, 127:1242.e11-e17.
4.	中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则.中华内科杂志, 2006, 45:697-700.
5.	Thomas CJ, Limper AH. Pneumocystis pneumonia. N Engl J Med, 2004, 350:2487-2498.
6.	Obeid KM, Aguilar J, Szpunar S, et al. Risk factors for pneumocystis jirovecii pneumonia in patients with lymphoproliferative disorders. Clin Lymphoma Myeloma Leuk, 2012, 12:66-69.
7.	Chang H, Yeh HC, Su YC, et al. Pneumocystis jiroveci pneumonia in patients with non-Hodgkin's lymphoma receiving chemotherapy containing rituximab. Chin Med Assoc, 2008, 71:579-582.
8.	Tsimberidou AM, Younes A, Romaguera J, et al. Immunosuppression and infectious complications in patients with stage Ⅳ indolent lymphoma treated with a fludarabine, mitoxantrone, and dexamethasone regimen. Cancer, 2005, 104:345-353.
9.	Martin-Garrido I, Carmona EM, Specks U, et al. Pneumocystis pneumonia in patients treated with rituximab. Chest, 2013, 144:258-265.
10.	Jiang X, Mei X, Feng D, et al. Prophylaxis and treatment of pneumocystis jiroveci pneumonia in lymphoma patients subjected to rituximab-contained therapy:a systemic review and meta-analysis. PLoS One, 2015, 10:e0122171.
11.	Lund FE, Hollifield M, Schuer K, et al. B cells are required for generation of protective effector and memory CD4 cells in response to Pneumocystis lung infection. J Immunol, 2006, 176:6147-6154.
12.	Church DL, Ambasta A, Wilmer A, et al. Development and validation of a Pneumocystis jirovecii real-time polymerase chain reaction assay for diagnosis of Pneumocystis pneumonia.Can J Infect Dis Med Microbiol, 2015, 26:263-267.
13.	Azoulay E, Berqeron A, Chevret S, et al. Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. Chest, 2009, 135:655-661.
14.	Matsumura Y, Shindo Y, Linuma Y, et al. Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes. BMC infect Dis, 2011, 11:76.
15.	William BM, Bonqu NR, Bast M, et al. The utility of lactate dehydrogenase in the follow up of patients with diffuse large B-cell lymphoma. Rev Bras Hematol Hemotre, 2013, 35:189-191.
16.	Vogel M, Weissgerber P, Goeppert B, et al. Accuracy of serum LDH elevation for the diagnosis of Pneumocystis jiroveci pneumonia. Swiss Med Wkly, 2011, 141:w13184.
17.	吴海涵, 梁林, 于农, 等.血清乳酸脱氢酶在耶氏肺孢子虫肺炎诊断、治疗及预后评估中的价值.检验医学与临床, 2014, 11:106-107.
18.	Limper AH, Knox KS, Sarosi GA, et al. An official American Thoracic Society statement:treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med, 2011, 183:96-128.
19.	Carmona EM, Limper AH. Update on the diagnosis and treatment of Pneumocystis pneumonia. Ther Adv Respir Dis, 2011, 5:41-59.
20.	Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome:associated illness and prior corticosteroid therapy. Mayo Clin Proc, 1996, 71:5-13.
21.	Belhz K, Kramm CM, Laws HJ, et al. Combined trimethoprim and caspofungin treatment for severe Pneumocystis jiroveci pneumonia in a five year old boy with acute lymphoblastic leukemia. Klin Padiatr, 2006, 218:177-179.
22.	Festic E, Gajic O, Limper AH, et al. Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection:outcome and associated features. Chest, 2005, 128:573-579.
23.	Bienvenu AL, Traore K, Plekhanova I, et al. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients. Int J Infect Dis, 2016, 46:11-17.

1. 孙岚, 黄敏君, 安亦军, 等.非艾滋病病毒感染临床病例肺孢子菌肺炎的流行病学研究.中华流行病学杂志, 2009, 30:348-351.
2. Monnet X, Vidal-Petiot E, Osman D, et al. Critical care management and outcome of severe pneumocystis pneumonia in patients with and without HIV infection. Crit Care, 2008, 12:R28.
3. Fillatre P, Decaux O, Jouneau S, et al. Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients. Am J Med, 2014, 127:1242.e11-e17.
4. 中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则.中华内科杂志, 2006, 45:697-700.
5. Thomas CJ, Limper AH. Pneumocystis pneumonia. N Engl J Med, 2004, 350:2487-2498.
6. Obeid KM, Aguilar J, Szpunar S, et al. Risk factors for pneumocystis jirovecii pneumonia in patients with lymphoproliferative disorders. Clin Lymphoma Myeloma Leuk, 2012, 12:66-69.
7. Chang H, Yeh HC, Su YC, et al. Pneumocystis jiroveci pneumonia in patients with non-Hodgkin's lymphoma receiving chemotherapy containing rituximab. Chin Med Assoc, 2008, 71:579-582.
8. Tsimberidou AM, Younes A, Romaguera J, et al. Immunosuppression and infectious complications in patients with stage Ⅳ indolent lymphoma treated with a fludarabine, mitoxantrone, and dexamethasone regimen. Cancer, 2005, 104:345-353.
9. Martin-Garrido I, Carmona EM, Specks U, et al. Pneumocystis pneumonia in patients treated with rituximab. Chest, 2013, 144:258-265.
10. Jiang X, Mei X, Feng D, et al. Prophylaxis and treatment of pneumocystis jiroveci pneumonia in lymphoma patients subjected to rituximab-contained therapy:a systemic review and meta-analysis. PLoS One, 2015, 10:e0122171.
11. Lund FE, Hollifield M, Schuer K, et al. B cells are required for generation of protective effector and memory CD4 cells in response to Pneumocystis lung infection. J Immunol, 2006, 176:6147-6154.
12. Church DL, Ambasta A, Wilmer A, et al. Development and validation of a Pneumocystis jirovecii real-time polymerase chain reaction assay for diagnosis of Pneumocystis pneumonia.Can J Infect Dis Med Microbiol, 2015, 26:263-267.
13. Azoulay E, Berqeron A, Chevret S, et al. Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. Chest, 2009, 135:655-661.
14. Matsumura Y, Shindo Y, Linuma Y, et al. Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes. BMC infect Dis, 2011, 11:76.
15. William BM, Bonqu NR, Bast M, et al. The utility of lactate dehydrogenase in the follow up of patients with diffuse large B-cell lymphoma. Rev Bras Hematol Hemotre, 2013, 35:189-191.
16. Vogel M, Weissgerber P, Goeppert B, et al. Accuracy of serum LDH elevation for the diagnosis of Pneumocystis jiroveci pneumonia. Swiss Med Wkly, 2011, 141:w13184.
17. 吴海涵, 梁林, 于农, 等.血清乳酸脱氢酶在耶氏肺孢子虫肺炎诊断、治疗及预后评估中的价值.检验医学与临床, 2014, 11:106-107.
18. Limper AH, Knox KS, Sarosi GA, et al. An official American Thoracic Society statement:treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med, 2011, 183:96-128.
19. Carmona EM, Limper AH. Update on the diagnosis and treatment of Pneumocystis pneumonia. Ther Adv Respir Dis, 2011, 5:41-59.
20. Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome:associated illness and prior corticosteroid therapy. Mayo Clin Proc, 1996, 71:5-13.
21. Belhz K, Kramm CM, Laws HJ, et al. Combined trimethoprim and caspofungin treatment for severe Pneumocystis jiroveci pneumonia in a five year old boy with acute lymphoblastic leukemia. Klin Padiatr, 2006, 218:177-179.
22. Festic E, Gajic O, Limper AH, et al. Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection:outcome and associated features. Chest, 2005, 128:573-579.
23. Bienvenu AL, Traore K, Plekhanova I, et al. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients. Int J Infect Dis, 2016, 46:11-17.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical Characteristics and Prognosis of Pneumocystis Pneumonia in Lymphoma Patients

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