Non-HIV Pneumocystis Jirovecii Pneumonia Survival Predicted by CT Patterns

The presence of low serum albumin and crazy paving ground glass opacities (GGOs) on high-resolution computed tomography (HRCT) at the time of non-HIV Pneumocystis jirovecii pneumonia (PjP) diagnosis were predictive of poor prognosis, according to study findings published in BMC Pulmonary Medicine.

Researchers from Japan retrospectively reviewed HRCT findings in 61 patients who were diagnosed with non-HIV PjP between 2006 and 2015. All HRCT findings were obtained at the time of non-HIV PjP diagnosis. Comparisons were made between GGO types, particularly types that included those with vs without crazy paving. Adjusted analyses were performed to assess associations between various clinical factors (eg, HRCT findings and in-hospital mortality) and outcomes.

A total of 19 patients died at the hospital after receiving a diagnosis. At the time of non-HIV PjP diagnosis, all patients demonstrated GGO on HRCT imaging. In 47.5% of patients, imaging findings included crazy paving GGO, as well as consolidations (37.7%), bronchiectasis (23.0%), and centrilobular small nodules (49.2%). No patient exhibited cysts or pneumomediastinum at the time of imaging. According to the multivariate adjusted analysis, independent risk factors for mortality in the cohort included crazy paving GGO (hazard ratio [HR], 10.8; 95% CI, 1.40-83.0; P =.02) and low serum albumin levels (HR, 0.20; 95% CI, 0.07-0.58; P <.01).

Limitations of the study included its retrospective nature and the fact that researchers were unable to evaluate the effect of broncoalveolar lavage findings on survival because the procedures were not performed in 30% of patients, mostly because of respiratory failure.

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“[T]hese results suggest that treatment strategies for HIV-negative patients with PjP should consider the serum [albumin] level and crazy paving GGO appearance on HRCT findings at diagnosis because these observations indicate a poor prognosis,” the researchers concluded.


Kumagai, Arita M, Koyama T, et al. Prognostic significance of crazy paving ground glass opacities in non-HIV Pneumocystis jirovecii pneumonia: an observational cohort study. BMC Pulm Med. 2019;19(1):47.

Editor’s Note: The original reference mistakenly referred to the CT pattern as “crazy paving ground grass opacities.” We contacted the corresponding author and were told the publisher would be alerted to the error.