A clinical analysis of 22 cases of Pneumocystis pneumonia in acquired immunodeficiency syndrome

Objective To investigate the clinical characteristics, therapeutical approaches and outcome of Pneumocystis pneumonia(PCP) in patients with AIDS. Methods The clinical data of 22 PCP patients with AIDS who were treated in Peking Union Medical College Hospital from January 1992 to October 2004 were analyzed, including the routes of HIV infection, clinical profiles, immunological status, chest radiological characteristics, therapeutic managements and outcome. Results (1) Of the 22 PCP patients, 16 were male and 6 female. The average age was (35.0±9.4) years old. The majority of patients got HIV infection through blood transfusion (54.5%) and sexual transmission(27.3%). (2) The common clinical presentations were fever(21/22), progressive exertional dyspnea(20/22), cough(16/22),sputum(12/22)and weight loss(18/22). 68.2%(15/22)of the patients had normal or mild coarse breath sounds on auscultation. 14 patients had an PaO_2 less than 60 mm Hg(1 mm Hg=0.133 kPa). (3) All the 22 PCP cases were in their late stage of AIDS. For the 20 patients who had an immunological test, the peripheral CD~+_4 T lymphocyte count was ranging from 3×10~6/L to 148×10~6/L and 90% of the cases had a CD~+_4 T cell count less than 100×10~6/L, 95% of the cases had a CD~+_4/ CD~+_8 ratio less than 0.20;(4)The most common abnormal chest radiological findings were bilateral diffuse interstitial infiltrations (19/22)and patchy shadows (14/22);(5)All patients were given trimethoprim-sulfamethoxazole (SMZco) and 86.4% of the patients were treated with corticosteroids concomitantly. Of the 22 PCP patients, 13 recovered, 5 gave up after knowing their definite diagnosis, 4 died. Comparing with the recovery patients, the 4 patients who died of PCP had much lesser CD~+_4 T cell count (P=0.07). Conclusions Most PCP occurred in patients who were in their late stage of AIDS and with a CD~+_4 T cell count below 100×10~6/L. For these reasons, we suggest that whenever encountering a young patient presenting with fever, dyspnea, hypoxia, loss of weight, the possibility of PCP complicating AIDS should be considered, especially when chest radiological study revealed interstitial infiltration or patchy shadows. If HIV was confirmed to be positive, the combined therapy of SMZco and corticosteroids should be started immediately.