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Pneumocystis jirovecii pneumonia in children. A retrospective study in a single center over three decades.

Abstract：

INTRODUCTION:Pneumocystis jirovecii pneumonia (PJP) is a life-threatening condition in immunocompromised children. Our aim is to analyze the epidemiologic and clinical characteristics of PJP cases in our setting, describing the prognosis and related risk factors. METHODS:Retrospective study including all pediatric patients (≤18 years) with PJP admitted to our hospital (January 1989-December 2016). Case definition: patient with acute pneumonitis and P.jirovecii detection in bronchoalveolar lavage or tracheal aspirate using methenamine silver or direct antibody fluorescence staining, or Real-Time Polymerase Chain Reaction. RESULTS:Twenty-five cases (0.9 cases/year) were identified. Median age was 2.2 years (interquartile range: 0.5-12.3), 64% were male, and 12% were receiving appropriate antimicrobial prophylaxis. Cytomegalovirus coinfection was detected in 26% cases. The most common underlying diseases were primary immunodeficiencies (36%) and 16% were human immunodeficiency virus (HIV)-infected children. Eighteen were admitted to the pediatric intensive care unit (PICU) and overall 30-day mortality was 20% (31.25% in HIV non-infected vs 0% in HIV-infected patients; OR: 0.33, 95% CI: 0.02-7.24, p=0.55). Clinical outcome was worse in girls and those patients requiring adjuvant steroid therapy. HIV non-infected patients, higher initial LDH, younger age and shorter time elapsed between diagnosis of PJP and the underlying disease were identified as risk factors to be admitted to the PICU (p=0.05, p=0.026, p=0.04 and p=0.001 respectively). CONCLUSION:Accompanying the widespread use of combined antiretroviral therapy, PJP has been diagnosed almost exclusively in HIV non-infected children at our institution. Moreover, significant higher morbidity rates associated with PJP are seen in this group of patients.

journal_name

Enferm Infecc Microbiol Clin

journal_title

Enfermedades infecciosas y microbiologia clinica

authors

García-Moreno J,Melendo-Pérez S,Martín-Gómez MT,Frick MA,Balcells-Ramírez J,Pujol-Jover M,Martín-Nalda A,Mendoza-Palomar N,Soler-Palacín P

doi

10.1016/j.eimc.2019.05.005

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

111-118

issue

eissn

0213-005X

issn

1578-1852

pii

S0213-005X(19)30187-9

journal_volume

pub_type

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Pneumocystis jirovecii pneumonia in children. A retrospective study in a single center over three decades.