Table 1.
Characteristics of the 12 patients who developed febrile pneumonia with positive detection of Pneumocystis jirovecii DNA in broncho-alveolar lavage fluid in the hematology ward between November 2015 and March 2016.
| Patient No. | Age (years) | Sex | Underlying disease | Allogeneic HSCT before PCP, donor type | Date of diagnostic BAL | Microscopy results | qPCR result (Cq) | P. jirovecii Gta | Serum β-D glucane within ±48 h of BAL (value pg/mL) | PCP prophylaxis at time of PCP diagnosis | Possible concomitant causes of pneumonia | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 27 | M | Myelodysplastic syndrome, secondary AML | No | Nov 6, 2015 | MGG−; IFA− | 37.2 | Gt5 | Positive (198) | None | A. fumigatus (positive culture on BAL fluid) | Treated, lost to follow-up 8 days after BAL |
| 2 | 32 | M | Hodgkin disease | Yes Unrelated donor | Nov. 9, 2015 (day 442 after HSCT) | MGG−; IFA− | 34.6 | Gt2 (pure) | Negative | Atovaquone (750 mgX2/d) | RSV (nasal swab and BAL) and S. pneumoniae (Blood cultures and BAL) | Treated, Recovered |
| 3 | 49 | F | Myelodysplastic syndrome | Yes One cord blood unit, no engraftment. 2ndhaplo-identical HSCT | Nov 10, 2015 (day 90 after 1st HSCT) | MGG−; IFA− | 40.0 | Gt1 (pure) | Positive (93) | None | Alveolar hemorrhage | Treated, death from acute respiratory failure |
| 4 | 51 | M | ALL Ph+ | Yes First HLA-identical HSCT in 2007. Relapse. Second HSCT from an unrelated donor | Nov 14, 2015 (day 304 after 2nd HSCT) | MGG+; IFA+ | 29.5 | Mixture (including Gt3 alleles) | Positive (>500) | None | HSV in BAL | Treated, recovered |
| 5 | 50 | F | CLL | Yes Unrelated donor | Dec 21, 2015 (day 301 after HSCT) | MGG+; IFA+ | 26.7 | Gt2 (pure) | Positive (>500) | Monthly aerosols of pentamidine | Rhinovirus on nasal swabs A. fumigatus in BAL | Treated, death from acute respiratory failure |
| 6 | 68 | F | Biphenotypic AL | No | Jan 9, 2016 | MGG−; IFA− | 35.6 | Mixture | Positive (357) | None | – | Treated, recovered |
| 7 | 65 | M | ALL | Yes Unrelated donor | Jan 12, 2016 (day 418 after HSCT) | MGG−; IFA− | 33.3 | Gt2 (pure) | Negative | None | – | Treated, recovered |
| 8 | 55 | M | CLL | Yes HLA-identical donor | Jan 14, 2016 (day 543 after HSCT) | MGG−; IFA− | 39.4 | Not available (insufficient fungal DNA) | Nd | Atovaquone (750 mgx2/d) | – | Not treated. Switched to prophylactic TMP-SMX No recurrence |
| 9 | 64 | M | Biphenotypic AL | No | Jan 19, 2016 | MGG−; IFA− | 27.6 | Gt3 + Gt4 (multiple) | Nd | None | – | Treated, recovered |
| 10 | 65 | M | Secondary myelofibrosis (thrombocythemia) | Yes HLA-identical donor | Mar 15, 2016 (day 250 after HSCT) | MGG+; IFA+ | 23.5 | Gt2 (pure) | Positive (>500) | Atovaquone (750 mgx2/d) | – | Treated, death from acute respiratory failure |
| 11 | 66 | F | AML | No | April 15, 2016 | MGG+; IFA− | 32.8 | Not available (insufficient fungal DNA) | Negative | None | – | Treated, recovered |
| 12 | 26 | F | AML salvage therapy | No | May 11, 2016 | MGG−; IFA− | 41.0 | Not available (insufficient fungal DNA) | Nd | None | – | Not treated. Put on TMP-SMX prophylaxis. No recurrence |
Those indicated as pure showed one allele per marker. Those indicated as multiple showed two alleles for one of six markers. Those indicated as mixture showed two alleles for more than one marker.
ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; BAL, broncho-alveolar lavage; Gt, genotype; Cq, quantification cycle; CLL, chronic lymphocytic leukemia; HSCT, hematopoietic stem cell transplantation; IFA, immunofluorescence assay; MGG, May-Grünwald Giemsa (stain); Nd, not done; Ph+, chromosome Philadelphia positive; RSV, respiratory syncytial virus; TMP-SMX, trimethoprim-sulfamethoxazole.