Purpose: To analyze the clinical characteristics of Pneumocystis pneumonia (PCP) in renal transplant recipients, identify early sensitivity indicators, and optimize clinical strategies.
Patients and methods: We retrospectively analyzed clinical data for 24 patients with confirmed PCP who underwent renal transplantation (RT) between 2010 and 2019, encompassing a mean follow-up of 29 (range, 11-49) d.
Results: A 71% incidence was observed for PCP during the first 6 months after RT. Progressive dyspnea (79%) was the most common symptom, followed by fever (75%) and dry cough (67%). In the initial phase of PCP, the most frequent computerized tomography (CT) finding was the presence of symmetric, apically distributed ground-glass opacities. Nine of 11 patients (82%) were diagnosed by induced sputum testing, 14 of 17 (82%) by bronchoalveolar lavage, and 1 of 24 (4%) by sputum smear. The 1,3-β-D-glucan level was elevated (mean, 259.16 ± 392.34 pg/mL) in 80% of patients, while 75% had elevated C-reactive protein levels (median, 37.85 mg/L). Two of 18 patients (11%) were positive for cytomegalovirus. All patients were treated with trimethoprim-sulfamethoxazole (3 doses of 1-6 g/kg) and third-generation cephalosporin or moxifloxacin monotherapy to prevent bacterial infection. The methylprednisolone dose (40-400 mg/d) varied according to illness. Most patients were treated using a nasal cannula or oxygen mask, and 2 by mechanical ventilation. CT showed improved lesions after treatment, and completely absorbed lesions or residual fibrosis at follow-up. The mean hospitalization cost was 14,644.73 ± 11,101.59 RMB.
Conclusion: Peak PCP incidence occurred during the first 6 months after surgery. Progressive dyspnea, fever, and dry cough are important indicators for PCP. Bilateral and diffuse ground-glass opacities involving both lung apexes are often the first indication for PCP diagnosis. Induced sputum testing may be the method-of-choice for pathogen detection. The cure rate can be improved through early antipathogen, glucocorticoid, and preventive anti-infection therapies, as well as respiratory support.
Keywords: Pneumocystis jirovecii; clinical characteristics; optimize clinical strategies; renal transplantation.
© 2020 Li et al.