[Clinical characteristics of Pneumocystis jirovecii pneumonia in non-human immunodeficiency virus infected children].
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Objective: To analyze the clinical characteristics of Pneumocystis jirovecii pneumonia (PJP) in non-human immunodeficiency virus (HIV) infected children, aiming to provide a basis for early diagnosis, timely treatment, and improved prognosis. Methods: A single-center retrospective case series study was conducted to analyze the general information, laboratory indicators, imaging features, treatment, and outcomes of 59 pediatric patients with non-HIV-infected PJP admitted to the Department of Pediatrics, West China Second Hospital, Sichuan University, from February 2022 to June 2025.These patients were categorized into two groups based on the presence or absence of underlying diseases.Comparative analysis was performed to assess differences in hospitalization duration, intensive care unit (ICU) admission rate, mechanical ventilation rate, mortality, and other relevant aspects between the 2 groups.The rank sum test, χ² test or Fisher exact test was employed for intergroup comparisons. Results: The age at presentation of 59 patients: 0.5 (0.3, 2.5) years, including 40 males and 19 females. Among the underlying diseases, there were 12 cases (20%) of primary immunodeficiency, 4 cases (11%) each of autoimmune diseases, hematologic malignancies, and organ transplantation 30 cases (51%) had received treatment with glucocorticoids and immunosuppressants before diagnosis. The main clinical symptoms were cough in 57 cases (97%), dyspnea in 51 cases (86%) and, fever in 35 cases (59%). The peripheral white blood cell count was 9.2 (6.3, 13.9)×109/L, with neutrophils 4.4 (1.8, 7.4)×109/L and lymphocytes 3.4 (2.0, 6.1)×109/L. C-reactive protein (CRP) 1.4 (0.5, 11.6) mg/L, procalcitonin 0.2 (0.1, 0.6) μg/L, the lactate dehydrogenase was (582±49) U/L. Fifty-three percent (16/30) of fungal G-test results were positive, 27% (11/41) of the children had CD4+ T-cell counts <0.5×109/L, and 32% (13/41) had CD4+/CD8+ ratios <1.0.The main imaging findings included consolidation or patchy opacities in 48 cases (81%), diffuse ground-glass opacities in 29 cases (49%), and decreased transparency in 20 cases (34%). Pneumocystis was detected via metagenomic next-generation sequencing (mNGS) in all cases. Co-infections were present in 57 cases (97%). Among the 59 pediatric patients, 34 cases (58%) were treated with trimethoprim-sulfamethoxazole monotherapy, 19 cases (32%) received combination therapy with micafungin, and 7 cases (12%) received combination therapy with clindamycin. Fifty-three cases (90%) required varying degrees of respiratory support. Concurrent glucocorticoid therapy was administered in 70% (41/59) of cases at anti-PJP treatment initiation. Fifty-five cases (93%) improved, and 4 cases (7%) died.There were 36 cases in the group with underlying diseases and 23 cases in the group without underlying diseases. No statistically significant differences were observed between the two groups in terms of length of hospital stay, ICU admission rate and length of ICU stay, mechanical ventilation rate, or mortality rate (all P>0.05). Conclusions: Non-HIV-infected children with PJP tend to occur in infants under 3 years old. It is often complicated by underlying diseases such as immunodeficiency, with most patients having a history of glucocorticoid or immunosuppressant use. Clinical manifestations and imaging findings lack specificity, and mNGS facilitates early diagnosis. The core treatment is trimethoprim-sulfamethoxazole, most children require respiratory support, and combination with low-dose glucocorticoids may improve prognosis.