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      Prognostic significance of crazy paving ground grass opacities in non-HIV Pneumocystis jirovecii pneumonia: an observational cohort study

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          Abstract

          Background

          In patients with non-HIV Pneumocystis jirovecii pneumonia (PjP), computed tomography imaging reveals ground grass opacities (GGO). Previous reports show that some patients with non-HIV PjP exhibit GGO with crazy paving. However, there have been no studies on the association between crazy paving GGO and non-HIV PjP clinical outcomes. Here, at the diagnosis of non-HIV PjP, we reviewed high-resolution computed tomography (HRCT) findings that included GGO types and evaluated the prognostic impact of crazy paving GGO on the clinical outcomes of non-HIV PjP immunocompromised patients.

          Methods

          We retrospectively reviewed the clinical information including the HRCT findings of patients diagnosed with non-HIV PjP from five institutions between 2006 and 2015. The GGO types included those with or without crazy paving. The associations between clinical factors such as HRCT findings and in-hospital mortality were assessed using the Cox regression model.

          Results

          Sixty-one patients were included in our study. Nineteen patients died at a hospital. All patients exhibited GGO on HRCT imaging at diagnosis of non-HIV PjP. The HRCT findings included crazy paving GGO (29 patients, 47.5%), consolidations (23 patients, 37.7%), bronchiectasis (14 patients, 23.0%), and centrilobular small nodules (30 patients, 49.2%). Cysts were not observed in any patient. Multivariate analysis revealed that crazy paving GGO and low serum albumin levels were independent risk factors for mortality.

          Conclusions

          At the diagnosis of non-HIV PjP, patients with crazy paving GGO on HRCT imaging and low serum albumin levels may have a poor prognosis.

          Electronic supplementary material

          The online version of this article (10.1186/s12890-019-0813-y) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          Pneumocystis pneumonia.

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            Pulmonary alveolar proteinosis.

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              Opportunistic infections in patients with and patients without Acquired Immunodeficiency Syndrome.

              In the next decade, longer survival of patients with cancer and more-aggressive therapies applied to common conditions, such as asthma and rheumatoid arthritis, will result in a larger population with significant immune system defects. Many in this population will be at risk for opportunistic infections, which are familiar to doctors who have treated people infected with human immunodeficiency virus (HIV). However, the epidemiology, presentation, and outcome of these infections in patients with an immune system defect, other than that caused by HIV infection, may be different than those encountered in patients with acquired immunodeficiency syndrome. Reviewed are 4 common opportunistic infections: Pneumocystis carinii pneumonia, cryptococcosis, atypical mycobacterial infection, and cytomegalovirus infection. Emphasized are the important differences among these groups at risk.
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                Author and article information

                Contributors
                +81-86-422-0210 , skumagai1212@gmail.com
                ma6390@kchnet.or.jp
                montpeti@kchnet.or.jp
                tk15176@kchnet.or.jp
                d-inoue@kitano-hp.or.jp
                nkgwats0918@gmail.com
                yusuke-k@tenriyorozu.jp
                k.furuta0113@gmail.com
                mfukui@kitano-hp.or.jp
                ktomii@kcho.jp
                ytaguchi@tenriyorozu.jp
                htomy@kcho.jp
                ishidat@kchnet.or.jp
                Journal
                BMC Pulm Med
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central (London )
                1471-2466
                21 February 2019
                21 February 2019
                2019
                : 19
                : 47
                Affiliations
                [1 ]ISNI 0000 0001 0688 6269, GRID grid.415565.6, Department of Respiratory Medicine, , Kurashiki Central Hospital, ; 1-1-1 Miwa, Kurashiki, Okayama, 710-0052 Japan
                [2 ]ISNI 0000 0001 0688 6269, GRID grid.415565.6, Department of Diagnostic Radiology, , Kurashiki Central Hospital, ; Kurashiki, Okayama, Japan
                [3 ]ISNI 0000 0004 0378 7849, GRID grid.415392.8, Respiratory Disease Center, Medical Research Institute, , Kitano Hospital, ; Osaka, Japan
                [4 ]ISNI 0000 0004 0466 8016, GRID grid.410843.a, Department of Respiratory Medicine, , Kobe City Medical Center General Hospital, ; Kobe, Hyogo Japan
                [5 ]ISNI 0000 0004 0378 4277, GRID grid.416952.d, Department of Respiratory Medicine, , Tenri Hospital, ; Tenri, Nara Japan
                [6 ]GRID grid.415419.c, Department of Respiratory Medicine, , Kobe City Medical Center West Hospital, ; Kobe, Hyogo Japan
                Article
                813
                10.1186/s12890-019-0813-y
                6385404
                30791907
                56a3bf10-6760-440d-8450-1f0837267d28
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 June 2017
                : 14 February 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Respiratory medicine
                pneumocystis jirovecii pneumonia,ground grass opacities,computed tomography

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