Patients with malignancy are at high risk for PJP due to profound treatment related immunosuppression. The mortality rate of PJP in cancer patients can be as high as 34%. Our aim was to review the presentation, diagnosis and outcomes of patients diagnosed with PJP in a large cancer centre.
We conducted a retrospective cross sectional study of patients at our centred diagnosed with PJP from January 2015 to December 2017 in the setting of malignancy. Patients either had a definitive diagnosis of PJP (identification of the organism in sputum, throat swab or BAL) or a presumptive diagnosis (clinical and radiographic findings that were highly suggestive of PJP infection together with a response to therapy directed at PJP).
Eighteen patients with malignancy and PJP were identified (6 haematological, 12 solid organ). The median time from diagnosis of malignancy to presentation with PJP was 21 months (range 2-72). The median time from last chemotherapy to presentation with PJP was 13 days (range 1 – 145). No patients were receiving PJP prophylaxis at presentation. The features at admission were: tachypnoea n=6 (33%); hypoxia n=5 (28%); fever T>38˚C (44%); and tachycardia n= 8 (44%). All patients had abnormal radiological findings on chest imaging (CT Chest n=15; CXR n=33). 11 cases (61%) had a sample sent for PJP PCR. 90% of samples sent (10/11) were positive for PJP. The median length of hospital stay for these patients was 15.5 days (range 6-43). The 30-day mortality in our cohort was 44%.
Mortality was high in our cohort potentially reflecting the underlying burden of malignant disease. Patients may not demonstrate typical signs of respiratory compromise on presentation. Prophylaxis and prompt initiation of diagnostic investigations and treatment may improve outcomes.