Clinical and radiological features of pneumocystis pneumonia in immunocompromised non-HIV patients

Background: The number of patients with non-HIV PCP is increasing with widespread immunosuppressive treatment.We assessed the clinical and radiological findings in non -HIV patients over a period of three years. Methods: A retrospective study involving all patients diagnosed with PCP from August 2012 to September 2015 at MKUH NHS. Results: 23 patients were diagnosed to have PCP, 8 were diagnosed HIV and 15 had underlying immunosuppressive factors.Samples that were obtained for PCR were: sputum in 21 patients and BAL in 4 patients.Mortality was as high as 7 patients among non-HIV and none amongst HIV patients. Amongst 15 non-HIV patients 7 had solid malignant tumours,2 had inflammatory conditions and there was only 1 case of organ transplantation, haematological malignancy and interstitial lung disease each.8 patients received corticosteroids,3 received immunosuppressive agents and 4 patients received antitumor chemotherapy. 11 had presented with respiratory symptoms and 10 were hypoxaemic. Chest X-ray revealed a normal study in 2 patients, bilateral infiltration in 2 patients and non-specific consolidation in 7 patients. Chest CT showed a higher proportion of diffuse ground-glass opacities in 4 patients and consolidation in 6 patients. Another interesting point of note is that there was a delay in sending respiratory samples in non-HIV patients due to a low level of clinical suspicion. Around 8 patients who were not on PCP prophylaxis had their samples sent after more than 10 days of admission and were treated with broad spectrum antibiotics. Conclusion: Non-HIV PCP could show a variety of radiological and clinical patterns. A “PCP first” approach should be applied by all clinicians.