Clinical characteristics and medication analysis of patients with non-HIV Pneumocystis jirovecii severe pneumonia confirmed by metagenomic next-generation sequencing
OBJECTIVE To investigate clinical characteristics of patients with non-HIV Pneumocystis jirovecii(PJ)severe pneumonia confirmed by metagenomic next-generation sequencing,and to analyze the rationality of the drugs used for treatment.METHOD We retrospectively analyzed the clinical data of 16 patients with non-HIV Pneumocystis jirovecii severe pneumonia who were hospitalized in the intensive care unit of Zhongda Hospital Af-filiated to Southeast University and diagnosed by metagenomic next-generation sequencing on bronchoalveolar lav-age fluid and/or blood in combination with clinically confirmed diagnosis from Jan.2021 to Dec.2023,and the un-derlying diseases,clinical data,laboratory test indices,imaging manifestations,drug treatment and regression were also analyzed.RESULTS Among the 16 PJP patients,there were seven men and nine women,aged 29-77 years.Mean APACHE Ⅱ score was(19.90±8.40),and median SOFA score was 6.50(4.80)points.Most of them started with symptoms such as coughing,coughing up sputum,chest tightness and shortness of breath,and fever.Totally 10 patients had autoimmune underlying diseases,4 patients had tumors and 1 patient was post kid-ney transplantation.Totally 11 patients had a history of hormone use prior to hospitalization,and 9 patients had chemotherapy or use of immunosuppressants.After ICU admission(first results),median total lymphocyte count was 0.38(0.54)X 109/L,mean C-reactive protein value was(111.51±81.40)mg/L,percentage of CD4+cell count＜200 cells/μl was 60.00％,median CD4+cell count was 112.30(230.52)cells/μl,percentage of(1,3)-β-D glucan＞200 pg/ml and lactate dehydrogenase＞250 U/L were both 62.50％(10 cases),and the mean value of al-bumin was(27.08±4.04)g/L.Cytomegalovirus and/or EBV were detected by metagenomic next-generation se-quencing in 9 of 16 patients(56.25％).Eigth of 13 cases were positive for cytomegalovirus DNA and/or EBV DNA in plasma.On the basis of treatment with compounded sulfamethoxazole in combination or not with echino-candins,75.00％(12/16)of patients used antiviral drugs,93.75％(15/16)used hormones,56.25％(9/16)used gammaglobulin,62.50％(10/16)used thymidine,and 93.75％(15/16)used other antimicrobials empirically or on target.Nine(56.25％)patients improved after treatment.CONCLUSIONS Patients with non-HIV Pneumocys-tis jirovecii pneumonia had more autoimmune underlying disease,predominately mixed infections,with higher morbidity and mortality,metagenomic next-generation sequencing technology could provide better pathogenetic evidence for this type of infection.In addition to compounded sulfamethoxazole and echinocandins for anti-Pneumo-cystis jirovecii therapy,the use of hormones,gammaglobulins,thymosin,and other antimicrobials should be in-dividualized and require more clinical data.
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