Clinical characteristics and prognostic factors in non-HIV patients with Pneumocystis jirovecii pneumonia and BALF cytomegalovirus co-detection: a retrospective cohort study.

Authors

Chaomin Guo, Yajiao An, Jingyun Ye, Yanning Ma, Qiang Zhao, Lifeng Wang, Wei Ma, Mingze Zhang, Miaoyu Wang, Yang Wang, Jiyong Yang, Liyan Ye, Liuyang Yang

Published in

Frontiers in public health. Volume 14. Pages 1921801. Epub Aug 26, 2026.

Abstract

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection in immunocompromised patients. BALF cytomegalovirus (CMV) co-detection is frequently observed in PJP patients, but its clinical characteristics and prognostic impact in non-HIV populations remain unclear.
In this single-center retrospective cohort study, we enrolled 62 non-HIV patients with confirmed PJP between 2019 and 2023. BALF CMV co-detection was defined as detectable CMV DNA in bronchoalveolar lavage fluid via metagenomic next-generation sequencing (mNGS), combined with compatible respiratory symptoms and chest computed tomography abnormalities. The Benjamini-Hochberg false discovery rate (FDR) correction was applied for multiple comparisons.
Overall, 31 patients (50.0%) had BALF CMV co-detection. The 28-day all-cause mortality was significantly higher in the CMV co-detection group than in the PJP-only group (54.84% vs. 19.35%, p = 0.008), and dyspnea was more prevalent (p = 0.024). After FDR correction for 39 laboratory parameters, only fibrinogen remained significantly lower in the co-detection group (q = 0.039), while (1,3)-β-D-glucan (BDG) and D-dimer showed independent associations with CMV co-detection in multivariable analyses. mNGS revealed more concurrent viral and fungal pathogens in the co-detection group, and multiple co-pathogens were more frequent in non-survivors within this subgroup. Interleukin-6 (IL-6), procalcitonin (PCT) and D-dimer were identified as independent prognostic factors for 28-day mortality in the CMV co-detection subgroup.
In this single-center retrospective cohort, BALF CMV co-detection is associated with substantially elevated unadjusted 28-day mortality in non-HIV patients with PJP. These findings are hypothesis-generating; IL-6, PCT and D-dimer show potential as exploratory prognostic markers. Comprehensive mNGS-based pathogen screening combined with biomarker monitoring may facilitate risk stratification in this high-risk population, pending validation in larger prospective cohorts.

PMID:
42719094
Bibliographic data and abstract were imported from PubMed on 10 Sep 2026.

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