The mycological and molecular study of Pneumocystis jiroveci pneumonia among HIV and non-HIV immunocompromised patients hospitalized in pulmonary units in Guilan, Northern Iran

Zahra Rafat; Keyhan Ashrafi; Seyed Jamal Hashemi; Elahe Sasani; Alireza Naserani; Hasti Kamali Sarvestani; Farshid Hashemi

doi:10.18502/ijm.v13i4.6977

Zahra Rafat Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Keyhan Ashrafi Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Seyed Jamal Hashemi Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Elahe Sasani Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Alireza Naserani Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Hasti Kamali Sarvestani Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Farshid Hashemi Department of Pharmacognosy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijm.v13i4.6977

Keywords: Pneumonia; Pneumocystis; Human immunodeficiency virus; Diabetes mellitus; Immunosuppression; Epidemi- ology; Iran

Abstract

Background and Objectives: Pneumocystis jirovecii pneumonia (PJP) is a serious infection that usually affects those with a weak immune system. Since the prevalence of this infection in Iran and in the world is not clearly defined, the present study aimed to evaluate the incidence, clinical spectrum, and demographic characteristics of PJP among HIV and non-HIV immunocompromised patients.

Materials and Methods: Bronchoalveolar Lavage (BAL) specimens were obtained from 3 groups of immunocompromised patients, including acquired immunodeficiency syndrome (AIDS) patients, diabetic patients, and patients receiving immuno- suppressive therapies. All were hospitalized in pulmonary units. The specimens were examined using microscopic methods (Giemsa and calcofluor white staining) and the nested-PCR technique based on mtLSU-rRNA gene.

Results: A total of 120 BAL samples were collected. From 12.5% (5 from 40) of HIV-infected patients, 5% (2 from 40) of patients receiving immunosuppressive therapies, and 2.5% (1 from 40) of diabetic patients Pneumocystis jiroveci was iso- lated. There was not any association between the prevalence of PJP and the patient's gender (p= 0.557) and age (p= 0.681). Fever and dyspnea (n=7, 87.5%), nonproductive cough and abnormal auscultation sound (n=5, 62.5%), and also chills and weight loss (n=2, 25%) were the documented clinical symptoms of PJP. Also, the results showed that none of the samples had positive results for P. jiroveci with microscopic tests while using the nested-PCR method 8 samples had positive results.

Conclusion: Since PJP often causes symptoms that are similar to other illnesses, such as the flu or tuberculosis, clinical and laboratory findings should be used simultaneously for making the final decision on drug administration.