Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia
Background: Pneumocystis pneumonia (PCP) is a common opportunistic infection with high mortality in individuals with decreased immunity. Pulmonary coinfections with PCP are associated with poor prognosis. The study aims to identify radiological predictors for pulmonary coinfections in patients with...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-08-01
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| Series: | Journal of Microbiology, Immunology and Infection |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118220301481 |
| _version_ | 1818902308573937664 |
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| author | Huan-Yi Wu Kuan-Sheng Wu Yi-Luan Huang Shr-Hau Dai Ding-Yu Chang Shu-Hung Kuo Shun-Yi Chen Chih-Chen Chou Ya-Wei Weng Yu-Ting Tseng Jui-Kuang Chen Cheng-Len Sy Hung-Chin Tsai Susan Shin-Jung Lee Yao-Shen Chen |
| author_facet | Huan-Yi Wu Kuan-Sheng Wu Yi-Luan Huang Shr-Hau Dai Ding-Yu Chang Shu-Hung Kuo Shun-Yi Chen Chih-Chen Chou Ya-Wei Weng Yu-Ting Tseng Jui-Kuang Chen Cheng-Len Sy Hung-Chin Tsai Susan Shin-Jung Lee Yao-Shen Chen |
| author_sort | Huan-Yi Wu |
| collection | DOAJ |
| description | Background: Pneumocystis pneumonia (PCP) is a common opportunistic infection with high mortality in individuals with decreased immunity. Pulmonary coinfections with PCP are associated with poor prognosis. The study aims to identify radiological predictors for pulmonary coinfections in patients with PCP and risk factors for mortality. Methods: This is a retrospective, five-year study was conducted in a medical center, enrolling patients diagnosed with PCP, who received a chest computed tomography (CT) scan. The radiological findings and medical records of all participants were reviewed carefully by 2 independent doctors. Univariable and multivariable analysis was performed to identify radiological predictors for pulmonary coinfection and clinical risk factors for poor prognosis. Results: A total of 101 participants were included, of which 39 were HIV-infected and 62 were non-HIV-infected. In multivariable analysis, radiologic predictors on chest CT for coinfection with bacteria pneumonia included lack of ground glass opacity (adjusted odds ratio [aOR], 6.33; 95% confidence interval [CI], 2.03–19.77; p = 0.001) and presence of pleural effusion (aOR, 3.74; 95% CI, 1.27–10.99; p = 0.017). Predictors for fungal pneumonia included diffuse consolidation (adjusted OR, 6.27; 95% CI, 1.72–22.86; p = 0.005) and presence of pleural effusion (adjusted OR, 5.26; 95% CI, 1.44–19.17; p = 0.012). A significantly higher in-hospital mortality was associated with older age, recent corticosteroid exposure, cytomegalovirus coinfection, and acute respiratory failure. Conclusion: Early identification of pulmonary coinfections in PCP using radiological features on the CT scans, will enable appropriate treatment which is crucial to improve the prognosis. |
| first_indexed | 2024-12-19T20:33:35Z |
| format | Article |
| id | doaj.art-133c0e745ab64cd0b5ab536e83f8eff6 |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-12-19T20:33:35Z |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-133c0e745ab64cd0b5ab536e83f8eff62022-12-21T20:06:36ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822021-08-01544701709Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumoniaHuan-Yi Wu0Kuan-Sheng Wu1Yi-Luan Huang2Shr-Hau Dai3Ding-Yu Chang4Shu-Hung Kuo5Shun-Yi Chen6Chih-Chen Chou7Ya-Wei Weng8Yu-Ting Tseng9Jui-Kuang Chen10Cheng-Len Sy11Hung-Chin Tsai12Susan Shin-Jung Lee13Yao-Shen Chen14Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Corresponding author. 386, Ta-chung 1st Rd., Kaohsiung, 813, Taiwan. Fax:+886 7 3468292.Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Pulmonary Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Pulmonary Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDepartment of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDepartment of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Corresponding author. 386, Ta-Chung 1st Rd., Kaohsiung, 813, Taiwan. Fax: +886 7 3468292.Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanBackground: Pneumocystis pneumonia (PCP) is a common opportunistic infection with high mortality in individuals with decreased immunity. Pulmonary coinfections with PCP are associated with poor prognosis. The study aims to identify radiological predictors for pulmonary coinfections in patients with PCP and risk factors for mortality. Methods: This is a retrospective, five-year study was conducted in a medical center, enrolling patients diagnosed with PCP, who received a chest computed tomography (CT) scan. The radiological findings and medical records of all participants were reviewed carefully by 2 independent doctors. Univariable and multivariable analysis was performed to identify radiological predictors for pulmonary coinfection and clinical risk factors for poor prognosis. Results: A total of 101 participants were included, of which 39 were HIV-infected and 62 were non-HIV-infected. In multivariable analysis, radiologic predictors on chest CT for coinfection with bacteria pneumonia included lack of ground glass opacity (adjusted odds ratio [aOR], 6.33; 95% confidence interval [CI], 2.03–19.77; p = 0.001) and presence of pleural effusion (aOR, 3.74; 95% CI, 1.27–10.99; p = 0.017). Predictors for fungal pneumonia included diffuse consolidation (adjusted OR, 6.27; 95% CI, 1.72–22.86; p = 0.005) and presence of pleural effusion (adjusted OR, 5.26; 95% CI, 1.44–19.17; p = 0.012). A significantly higher in-hospital mortality was associated with older age, recent corticosteroid exposure, cytomegalovirus coinfection, and acute respiratory failure. Conclusion: Early identification of pulmonary coinfections in PCP using radiological features on the CT scans, will enable appropriate treatment which is crucial to improve the prognosis.http://www.sciencedirect.com/science/article/pii/S1684118220301481Chest computed tomographyCoinfectionPneumocystis pneumonia |
| spellingShingle | Huan-Yi Wu Kuan-Sheng Wu Yi-Luan Huang Shr-Hau Dai Ding-Yu Chang Shu-Hung Kuo Shun-Yi Chen Chih-Chen Chou Ya-Wei Weng Yu-Ting Tseng Jui-Kuang Chen Cheng-Len Sy Hung-Chin Tsai Susan Shin-Jung Lee Yao-Shen Chen Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia Journal of Microbiology, Immunology and Infection Chest computed tomography Coinfection Pneumocystis pneumonia |
| title | Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia |
| title_full | Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia |
| title_fullStr | Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia |
| title_full_unstemmed | Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia |
| title_short | Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia |
| title_sort | identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with pneumocystis pneumonia |
| topic | Chest computed tomography Coinfection Pneumocystis pneumonia |
| url | http://www.sciencedirect.com/science/article/pii/S1684118220301481 |
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