Factores relacionados con la infección por Pneumocystis jirovecii en pacientes con efermedad pulmonar intersticial difusa (EPID)

espanolObjetivo: Hemos realizado un estudio prospectivo para determinar la prevalencia de colonizacion de Pn. jiroveccii (PnJ) en muestras de LBA en pacientes con EPID y los factores que pueden condicionar esta situacion. Material y metodos: Se incluyen 240 pacientes con EPID con una media de edad de 56 anos. Se estudio el gen mtLSU rRNA de PnJ mediante PCR anidada. La PCR resulto positiva en el 32% (78 pacientes). Resultados: Solo el tabaquismo mostro una asociacion significativa con la evidencia de colonizacion. Hematologicamente, la leucocitosis y eosinofilia son parametros relacionados con esta. Radiologicamente , en el TACAR no hay ningun hallazgo distintivo y tampoco hay diferencia entre ambos subgrupos (PCR+ vs PCR-) en la distribucion de las patologias mas frecuentes en nuestro medio: fibrosis pulmonar idiopatica, sarcoidosis, bronquiolitis obliterante con neumonia organizativa y conectivopatias. En el estudio de los parametros del LBA, tampoco se observan diferencias significativas. En el seguimiento, no se han evidenciado complicaciones infecciosas atribuibles a este patogeno. Conclusiones: PnJ coloniza un tercio de la poblacion con EPID sin que se haya definido con claridad ningun factor determinante. En el seguimiento de estos pacientes no se han evidenciado complicaciones infecciosas significativas. Falta por determinar la posible implicacion de PnJ en la aceleracion del proceso inflamatorio o deterioro funcional en estos pacientes. EnglishObjective: A prospective study was made to determine the prevalence of colonization with Pn. jiroveccii (PnJ) in bronchoalveolar (BAL) samples of patients with DIPD, and the factors that can condition this situation. Material and methods: 240 patients with DIPD were included in the study, with an average age of 56 years. The mtLSU rRNA gene of PnJ was studied by means of nested PCR. The PCR was positive in 32% (78 patients). Results Only tobacco use showed a significant association with the evidence of colonization. Leucocytosis and eosinophilia are parameters related to this phenomenon also. Radiologically, there were no distinctive findings in high-resolution computed tomography (HRCT) nor difference between both sub-groups (PCR+ versus PCR-) in the distribution of the most frequent pathologies in our area: idiopathic pulmonary fibrosis, sarcoidosis, bronchiolitis obliterans with organizing pneumonia and connective tissue diseases. Also, no significant differences were observed in the study of the BAL parameters. Infectious complications attributable to this pathogen have not been demonstrated in the follow-up. Conclusions: PnJ colonises a third of the population with DIPD without any determining factor having been clearly defined so far. Significant infectious complications have not been demonstrated in the followup of these patients. The possible implication of PnJ in the acceleration of the inflammatory process or functional deterioration in these patients has not been demonstrated.