Pulmonary co-infections by Pneumocystis jirovecii and Aspergillus fumigatus in non-HIV patients: A report of two cases and literature review.

Abstract

Pneumocystis jirovecii is the causative agent of Pneumocystis pneumonia (PcP), a common and often life-threatening opportunistic infection in HIV-infected patients. However, non-HIV, immunocompromised patients are at risk of PcP as well, whereas the mortality appears to be higher among these patients. Pneumocystis co-infections with other microorganisms are less frequent and only sparse reports of combined PcP and invasive pulmonary fungal infections exist in the literature, especially in the non-HIV patients. Two cases of pulmonary co-infections by P. jirovecii and Aspergillus fumigatus are presented. Both patients were non-HIV infected, the first one was suffering from crescentic IgA nephropathy under immunosuppressive treatment and the second from resistant non-Hodgkin lymphoma under chemotherapy. Both patients were treated with intravenous trimethoprim/sulphamethoxazole (TMP/SMX) combined with voriconazole. The first patient showed gradual clinical improvement while the outcome for the second patient was unfavourable. In addition, a literature review of the previous published cases of co-infection by P. jirovecii and other fungi in non-HIV patients was performed. Our target was to provide comprehensive information on this kind of infections, highlighting the importance of clinical suspicion.

• Authors: Anthi-Marina Markantonatou, Aliki Ioakimidou, Kostoula Arvaniti, Eleni Manou, Vassilios Papadopoulos, Parthena Kiriklidou, Konstantinos Samaras, Anna Kioumi, Timoleon-Achilleas Vyzantiadis
• Journal: Mycoses (Mycoses) Vol. 60 Issue 10 Pg. 626-633 (Oct 2017) ISSN: 1439-0507 [Electronic] Germany
• PMID: 28660636 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: © 2017 Blackwell Verlag GmbH.

Chemical References

• Immunosuppressive Agents
• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• AIDS-Related Opportunistic Infections (microbiology)
• Adult
• Aged, 80 and over
• Aspergillus fumigatus (physiology)
• Coinfection (drug therapy)
• Female
• Humans
• Immunocompromised Host
• Immunosuppressive Agents (therapeutic use)
• Invasive Fungal Infections (drug therapy, microbiology)
• Lung (microbiology)
• Male
• Middle Aged
• Pneumocystis carinii (physiology)
• Pneumonia, Pneumocystis (drug therapy, microbiology, mortality)
• Pulmonary Aspergillosis (complications, drug therapy, microbiology, mortality)
• Retrospective Studies
• Trimethoprim, Sulfamethoxazole Drug Combination (therapeutic use)