Background

Pneumocystis pneumonia (PCP) is a common opportunistic infection with high mortality in individuals with decreased immunity. Pulmonary coinfections with PCP are associated with poor prognosis. The study aims to identify radiological predictors for pulmonary coinfections in patients with PCP and risk factors for mortality.

Methods

This is a retrospective, five-year study was conducted in a medical center, enrolling patients diagnosed with PCP, who received a chest computed tomography (CT) scan. The radiological findings and medical records of all participants were reviewed carefully by 2 independent doctors. Univariable and multivariable analysis was performed to identify radiological predictors for pulmonary coinfection and clinical risk factors for poor prognosis.

Results

A total of 101 participants were included, of which 39 were HIV-infected and 62 were non-HIV-infected. In multivariable analysis, radiologic predictors on chest CT for coinfection with bacteria pneumonia included lack of ground glass opacity (adjusted odds ratio [aOR], 6.33; 95% confidence interval [CI], 2.03–19.77; p = 0.001) and presence of pleural effusion (aOR, 3.74; 95% CI, 1.27–10.99; p = 0.017). Predictors for fungal pneumonia included diffuse consolidation (adjusted OR, 6.27; 95% CI, 1.72–22.86; p = 0.005) and presence of pleural effusion (adjusted OR, 5.26; 95% CI, 1.44–19.17; p = 0.012). A significantly higher in-hospital mortality was associated with older age, recent corticosteroid exposure, cytomegalovirus coinfection, and acute respiratory failure.

Conclusion

Early identification of pulmonary coinfections in PCP using radiological features on the CT scans, will enable appropriate treatment which is crucial to improve the prognosis.

中文翻译：

---

肺囊虫肺炎患者胸部计算机断层扫描中细菌和真菌合并感染的预测因子

背景

肺孢子菌肺炎 (PCP) 是一种常见的机会性感染，在免疫力下降的个体中死亡率很高。PCP 的肺部合并感染与预后不良有关。该研究旨在确定 PCP 患者肺部合并感染的放射学预测因素和死亡率的危险因素。

方法

这是一项为期五年的回顾性研究，在一家医疗中心进行，招募了被诊断患有 PCP 的患者，这些患者接受了胸部计算机断层扫描 (CT) 扫描。所有参与者的放射学发现和医疗记录均由 2 位独立医生仔细审查。进行单变量和多变量分析以确定肺部合并感染的放射学预测因素和预后不良的临床危险因素。

结果

总共包括101名参与者，其中39人感染了HIV，62人未感染HIV。在多变量分析中，胸部 CT 对细菌性肺炎合并感染的放射学预测因素包括没有磨玻璃影（调整后的比值比 [aOR]，6.33；95% 置信区间 [CI]，2.03-19.77；p = 0.001）和存在胸膜积液（aOR，3.74；95% CI，1.27–10.99；p = 0.017）。真菌性肺炎的预测因素包括弥漫性实变（调整后的 OR，6.27；95% CI，1.72-22.86；p = 0.005）和存在胸腔积液（调整后的 OR，5.26；95% CI，1.44-19.17；p = 0.012）。显着较高的院内死亡率与年龄较大、最近接触皮质类固醇、巨细胞病毒合并感染和急性呼吸衰竭有关。

结论

使用 CT 扫描的放射学特征及早识别 PCP 中的肺部合并感染，将能够进行适当的治疗，这对于改善预后至关重要。