Pneumocystis jiroveci pneumonia (PCP) in HIV-1-negative patients: a retrospective study 2002-2004

Scand J Infect Dis. 2007;39(6-7):589-95. doi: 10.1080/00365540601150497.


A retrospective study was conducted to describe risk factors associated with Pneumocystis jiroveci pneumonia (PCP) among HIV-negative patients. During 2002-2004, 50 cases of PCP were identified at Rigshospitalet University Hospital on the basis of histology, PCR and clinical symptoms of PCP. Predisposing conditions included haematological malignancy (72%), inflammatory diseases (14%), solid organ transplantation (6%) and other conditions associated with immunodeficiency (8%). The most common treatment related risk factors were steroid usage (76%) and chemotherapy (72%). In 88% of patients who received steroids, dosage was either lowered or given as pulse-therapy in the 2 weeks preceding the onset of symptoms. Only 1 patient was on PCP prophylaxis at diagnosis and only 8 (16%) patients had previously been given PCP prophylaxis. At diagnosis, 78% of patients were lymphopenic. CD4 counts were available in 17 patients. Only 9 patients (52%) had CD4 count values below 300 cells/microl. The overall mortality attributable to PCP was 14% and was significantly associated with delayed diagnosis and treatment. Among immunocompromized HIV-negative patients, PCP should be particularly suspected in the context of steroid treatment and lymphopenia. Although low CD4 count is associated with a higher risk of PCP, the use of CD4 count as guidance for risk identification or prophylaxis among HIV-negative patients appears insufficient.

MeSH terms

  • Adolescent
  • Adult
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / cytology
  • CD4-Positive T-Lymphocytes / immunology
  • Child
  • Child, Preschool
  • Female
  • HIV Infections / microbiology
  • HIV-1
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Pneumocystis carinii / genetics
  • Pneumocystis carinii / isolation & purification*
  • Pneumonia, Pneumocystis / drug therapy
  • Pneumonia, Pneumocystis / epidemiology*
  • Pneumonia, Pneumocystis / immunology*
  • Pneumonia, Pneumocystis / virology
  • Polymerase Chain Reaction
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome