Diagnostic microbiology and infectious disease · 2026
A retrospective comparative study: How to distinguish Pneumocystis jirovecii pneumonia from other pneumonias in kidney transplant recipients?
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Hu Min, Chen Hengbing, Chen Ruohong, Xu Xinyi, Cai Jingyao, Song Lei, Wang Ling
Аннотация
BACKGROUND: Pneumocystis jirovecii pneumonia (PCP) is a significant concern among kidney transplant recipients on immunosuppressants, yet differentiating it from other pneumonias remains challenging.
METHODS: This retrospective study included 101 kidney transplant patients diagnosed with PCP (n = 65) or other pneumonias (n = 36) from January 2019 to April 2021. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic efficacy. Nine kidney transplant patients hospitalized with PCP or other pneumonias in matched groups were also analyzed.
RESULTS: 65 PCP patients were identified from 382 kidney transplant patients via GMS staining or NGS. The positive rates for sputum GMS, BALF GMS, and BALF NGS were 12.16%, 14.94%, and 41.94% respectively. Compared to patients with other pneumonias, PCP patients displayed more dry cough (32.31% vs. 8.33%; p = 0.007) and CT consolidation/unilateral infiltrates (32.31% vs. 0.00%; p < 0.001). Serum 1, 3-β-d-glucan (BG) levels were higher in PCP patients (p = 0.008), with a receiver operating characteristic (ROC) curve area under the curve (AUC) of 0.668. After treatment, CRP, PCT, and ESR levels decreased in PCP patients. In the matched analysis, BG levels, the neutrophil percentage and the prevalence of ground-glass opacity (GGO) on CT were higher in the PCP group, while PCT levels were lower.
CONCLUSIONS: Key indicators for distinguishing PCP from other pneumonias in kidney transplant patients include dry cough, GGO on CT, and elevated BG levels. BALF GMS and NGS are helpful diagnostic tools, while CRP, PCT, and ESR are promising biomarkers for assessing PCP therapeutic effectiveness.
METHODS: This retrospective study included 101 kidney transplant patients diagnosed with PCP (n = 65) or other pneumonias (n = 36) from January 2019 to April 2021. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic efficacy. Nine kidney transplant patients hospitalized with PCP or other pneumonias in matched groups were also analyzed.
RESULTS: 65 PCP patients were identified from 382 kidney transplant patients via GMS staining or NGS. The positive rates for sputum GMS, BALF GMS, and BALF NGS were 12.16%, 14.94%, and 41.94% respectively. Compared to patients with other pneumonias, PCP patients displayed more dry cough (32.31% vs. 8.33%; p = 0.007) and CT consolidation/unilateral infiltrates (32.31% vs. 0.00%; p < 0.001). Serum 1, 3-β-d-glucan (BG) levels were higher in PCP patients (p = 0.008), with a receiver operating characteristic (ROC) curve area under the curve (AUC) of 0.668. After treatment, CRP, PCT, and ESR levels decreased in PCP patients. In the matched analysis, BG levels, the neutrophil percentage and the prevalence of ground-glass opacity (GGO) on CT were higher in the PCP group, while PCT levels were lower.
CONCLUSIONS: Key indicators for distinguishing PCP from other pneumonias in kidney transplant patients include dry cough, GGO on CT, and elevated BG levels. BALF GMS and NGS are helpful diagnostic tools, while CRP, PCT, and ESR are promising biomarkers for assessing PCP therapeutic effectiveness.