Pneumocystis jirovecii pneumonia in patients with decompensated cirrhosis: a case series. (March 2023)

• Record Type: Journal Article
• Authors: Franceschini, Erica; Dolci, Giovanni; Santoro, Antonella; Meschiari, Marianna; Riccò, Alice; Menozzi, Marianna; Burastero, Giulia Jole; Cuffari, Biagio; De Maria, Nicola; Serio, Lucia; Biagioni, Emanuela; Catellani, Barbara; Sandro, Stefano Di; Colecchia, Antonio; Girardis, Massimo; Benedetto, Fabrizio Di; Mussini, Cristina
• Is Part Of: International journal of infectious diseases. Volume 128(2023)
• Page Start: 254
• Page End: 256
• Publication Date: 2023-03
• Subjects: Pneumocystis pneumonia -- Liver cirrhosis -- Liver failure -- Primary prophylaxis; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.12.027
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: This is a series of eight patients with advanced liver disease who developed Pneumocystis jirovecii pneumonia (PCP) Advanced liver disease can be a risk factor for PCP Prophylaxis for PCP could be considered in patients with decompensated cirrhosis Abstract: Objectives: Pneumocystis jirovecii pneumonia (PCP) incidence is increasing in people without HIV. Decompensated liver cirrhosis is not currently considered a risk factor for PCP. The aim of this paper is to describe a case series of patients with decompensated liver cirrhosis and PCP. Methods: All consecutive patients hospitalized with decompensated cirrhosis and microbiology-confirmed PCP at Policlinico Modena University Hospital from January 1, 2016 to December 31, 2021 were included in our series. Results: Eight patients were included. All patients had advanced-stage liver disease with a model for end-stage liver disease score above 15 (6/8 above 20). Four were on an active orthotopic liver transplant waiting list at the time of PCP diagnosis. Five patients did not have any traditional risk factor for PCP, whereas the other three were on glucocorticoid treatment for acute-on-chronic liver failure. All patients were treated with cotrimoxazole, except two who died before the diagnosis. Five patients died (62.5%), four of them within 30 days from PCP diagnosis. Of the remaining three, one patient underwent liver transplantation. Conclusion: Although further studies are needed, liver cirrhosis can be an independent risk factor for PCP in patients with decompensated cirrhosis that is mainly due to severe alcoholic hepatitis and who are on corticosteroids therapy, and primary prophylaxis for PCP should be considered.