Background: Pneumocystis jirovecii (P. jirovecii) is an atypical fungus that causes pneumonia and carries a high-mortality rate. Increasing use of pharmacological immunosuppression as part of cancer protocols has led to a rise in P. jirovecii pneumonia (PJP). P. jirovecii is often difficult to predict, making it an under-recognised opportunistic infection [1].
Methods: We conducted a single-center retrospective case series in a tertiary hospital. Electronic medical records of adult patients diagnosed with proven or probable PJP were reviewed, including clinical, laboratory, radiology and treatment outcome data. Patients with hematological malignancies, HIV, AIDS or those who received subsequent lines of chemotherapy at the time of PJP diagnosis were excluded.
Results: Ten adults were included (median age 64 years; 60% male); 80% had metastatic disease. P. jirovecii organisms were identified using bronchoalveolar lavage, induced sputum, mouthwash PCR or diagnosed clinically. Cough (100%), fever (70%) and dyspnoea (50%) were the predominant presenting symptoms. Lymphopenia and hypoalbuminaemia were frequent baseline abnormalities. Ground-glass opacities on CT occurred in 80% of cases. All patients received trimethoprim-sulfamethoxazole as treatment and 80% received adjunctive corticosteroids. Three patients developed respiratory failure, including one requiring ICU admission, and one patient died.
Conclusions: Our findings suggest that in non-HIV patients receiving first-line chemotherapy, older age, male sex, dyspnoea, and multiple presenting symptoms may be associated with more severe PJP. Dyspnoea and having more than two symptoms were linked to respiratory failure, indicating potential prognostic value. Increased awareness of these clinical features may support earlier recognition and treatment of PJP in these patients.
The author acknowledges the support of WARPNINE and the St John of God Subiaco Hospital.