Pneumocystis jirovecii Pneumonia: Retrospective Comparative Analysis of Clinical, Laboratory, and Radiographic Features in Human Immunodeficiency Virus and Nonhuman Immunodeficiency Virus Immunocompromised Patients.

Abstract

Introduction: Pneumocystis jirovecii pneumonia (PJP) is a severe opportunistic infection in patients with weakened immune function, especially those infected with human immunodeficiency virus (HIV) and various non-HIV immunocompromised patients. Here, we retrospectively compared the clinical, laboratory, and imaging features of PJP between HIV-infected and non-HIV-immunodepressed patients in Jiangxi Province to improve diagnostic accuracy and guide clinical treatment. Statistical analysis using normality tests (Shapiro-Wilk), t-tests, and nonparametric tests highlighted major differences between the two groups.

Methods: The study included patients diagnosed with PJP from January 2020 to December 2024 in a tertiary A hospital in Jiangxi Province. The patients were divided into two groups: HIV infection (n = 30) and non-HIV immunosuppression (n = 60). Clinical data, laboratory results, and imaging findings of the two groups were analyzed. Statistical tests including Shapiro-Wilk normality test, t-test for normally distributed variables, and nonparametric test were performed using SPSS version 26.0 to determine significant differences between groups.

Results: Compared with the HIV group, non-HIV immunocompromised patients had a higher mechanical ventilation rate and a higher likelihood of intensive care unit admission (P < 0.05). HIV-infected patients are younger and exhibit more severe systemic and respiratory symptoms (fever, dyspnea, cough, and asthma). Blood analysis showed white blood cell (WBC), Neutrophilicgranulocyte (NE), blood urea nitrogen (blood urea nitrogen) in non-HIV group. BUN) and Creatine Kinase MB Isoenzyme (CK-MB) levels were significantly increased (p<0.05), suggesting that most of these patients were complicated with immune function disorders such as heart, lung and kidney. The level of albumin-globulin (GLB) in HIV was significantly reduced, suggesting that the disease involved the liver or kidney and may be advanced. Imaging studies showed mediastinal lymph nodes, pleural effusion, bilateral infiltration, and ground-glass shadow in both groups. However, bilateral small pulmonary nodules, ground-glass shadows, and mediastinal lymph nodes were predominant in HIV patients, suggesting that various opportunistic infections may have occurred. In non-HIV immunocompromised patients, bilateral small lung nodules, mixed low-density shadows, and pleural effusion were predominant, suggesting a variety of potential diseases. A state of immunosuppression can lead to increased susceptibility to infection, tumorigenesis, and an increase in autoimmune diseases.

Conclusion: The majority of HIV-infected PJP patients in Jiangxi Province are young men, showing systemic symptoms and abnormal early lung imaging features. Non-HIV immunocompromised PJP patients showed nonsystemic symptoms and advanced lung imaging abnormalities. Basophils, total protein (TP), and GLB can reflect some states of the immune system. It can be used to preliminarily distinguish PJP patients with HIV infection from non-HIV immunocompromised patients. PJP co-infection with HIV usually involves complex immune responses and clinical manifestations, and relying on these indicators alone is not ideal for identification. A more accurate identification method should be combined with clinical symptoms, medical history, immune function tests (such as CD4+ T-cell count), viral load, and other indicators for comprehensive evaluation. Therefore, although the above indicators can provide a certain reference value for identification, they cannot be used as the only basis.