Pneumocystis pneumonia in critically ill patients

Abstract

Pneumocystis pneumonia is one of the common pulmonary infections in immunocompromised patients. Due to an increasing number of patients with drug-induced immunosuppression or underlying disease such as solid organ transplantation or hematological malignancy, Pneumocystis pneumonia is more frequently diagnosed in non-HIV patients. The diagnosis should therefore be widely discussed, particularly in the lack of prophylaxis in patients with T-cell deficiency. The diagnostic remains difficult. In addition to CT scan patterns, often very suggestive, the diagnosis is currently confirmed by indirect techniques (serum Beta-D glucan, qPCR in bronchoalveolar lavage or in induced sputum). The interpretations of these tests is based on the diagnostic probability, which must be assessed a priori.

Anti-fungal treatment includes, in the absence of contraindication, trimethoprim associated with sulfamethoxazole for 21 days. This treatment must be followed by prophylaxis. Due to immunosuppression, the risk of co-infection is high and should be assessed on admission.

The mortality of HIV patients with pneumocystis has decreased drastically in the past years but remains high in non-HIV immunocompromised patients.

This manuscript should help the clinician during the diagnostic approach.