Pneumocystis jirovecii pneumonia (PcP) is an opportunistic infection which can have different prognosis and progression among patients with HIV and non-HIV. It is still controversial whether Cytomegalovirus (CMV) co-infection worsens the prognosis or not. In this retrospective study, we aimed to investigate the effect of CMV co-infection in the prognosis of patients with PcP. In the study 20 immunocompromised non-HIV PcP (median age 54.3±15.3 yrs, 13 males) patients who were admitted to our clinic from January 2009 to December 2012 were included. Demographic characteristics of the patients, immunosupressive therapy, anti-microbial prophylaxis, clinical, laboratory, radiological findings, the diagnostic method, the data for the presence and treatment of co-infection and respiratory failure were recorded. On admission, 16 (80%) of the patients were on corticosteroid treatment. The median APACHE II Score was 19.0 (9-40), PaO 2 /FiO 2 ratio was 147.5 (78-471). PcP diagnosis was made by microscopic examination in 2 cases and by PCR in 14 cases while in 4 cases both method was used. During follow-up, co-infection occured in 17 (85%) of the patients. 16 (80%) of them developed ARDS, 17 (85%) of the patients required invasive mechanical ventilation and 14 (70%) of them died. Mortality rates were higher in patients who developed ARDS, were intubated and co-infected (p=0.01, p=0.018, p=0.018, respectively). Twelwe (70.8%) of the patients had CMV co-infection. Progression to ARDS and intubation rates were higher (p=0.036 and p=0.049, respectively) in these patients. In conclusion; among the non-HIV patients with PcP, progression to ARDS and mortality rates are higher in the presence of co-infection especially with CMV.
Töreyin et al. (Sun,) studied this question.