Diagnostic characteristics of pneumocystis carinii pneumonia with non-human immunodeficiency virus infection and literature review
Pei Xiaohua1, Zhang Tao1, Jin Ke2, Bai Yun1, Gao Fei1, Zhu Bei1, Zhao Weihong1
1Department of Geriatric Nephrology, 2Department of Infectious Diseases, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Abstract：ObjectiveTo investigate the clinical characteristics of pneumocystis carinii pneumonia (PCP) in non-human immunodeficiency virus (HIV) infected patients. MethodsTake the clinical materials of one PCP patient as the breakthrough point, who was admitted to the Geriatric Nephrology Department of the First Affiliated Hospital of Nanjing Medical University on March 15, 2022 to summarize the key points and review literatures on progress in diagnosis and treatment of PCP in non-HIV infected patients. ResultsA 44-year-old female patient was treated with glucocorticoids combined with leflunomide for IgA nephropathy. The patient had fever onset, cough, no sputum, and HIV was negative. Routine examination (including chest CT) showed no special exception, and the patient failed to respond to broadspectrum antibiotic treatment. After the patient was transferred to our hospital, the pathogen was confirmed to be Pneumocystis by metagenomic nextgeneration sequencing (mNGS), and the patient was treated with compound sulfamethoxazole, echinocandin, and gamma globulin. During the treatment, the patient developed type I respiratory failure, granulocytosis, intestinal fungal infection, abnormal liver function, drug eruption and other phenomena, which were cured after corresponding treatment. ConclusionsPCP progresses rapidly. The mNGS of pathogen can reduce the rate of missed diagnosis and misdiagnosis of PCP. Compound sulfamethoxazole is still the first choice in the treatment of PCP, but the side effects are obvious, which needs timely detection and reasonable intervention.
