{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T09:04:37Z","timestamp":1780304677291,"version":"3.54.0"},"reference-count":19,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Pneumocystis jirovecii pneumonia (PJP) increasingly affects non-HIV immunocompromised patients; however, the spectrum of computed tomography (CT) findings in this population remains poorly defined. Objectives: To describe and compare chest CT findings of PJP in patients with and without HIV infection and to evaluate the impact of respiratory coinfections on imaging patterns. Methods: This retrospective single-centre cohort study included 72 adult patients with confirmed PJP diagnosed between 2011 and 2024, 27 HIV-positive and 45 non-HIV immunocompromised patients. Chest radiography was available in 71 patients and chest CT in 62. Imaging studies were independently reviewed for predefined patterns, including ground-glass opacities, alveolo-interstitial pattern, mosaic attenuation, crazy paving, pulmonary cysts, consolidation, and pleural effusion. CT findings were compared between HIV-positive and non-HIV patients, and a subgroup analysis was performed in non-HIV patients according to the underlying type of immunosuppression. Respiratory coinfections were recorded and classified based on microbiological results. Results: Chest radiography was normal in 32.4% of patients. An interstitial pattern tended to be more frequent in HIV-positive patients, whereas consolidations were more commonly observed in non-HIV patients (p = 0.051). On CT, ground-glass opacities were the predominant finding in both groups. HIV-positive patients more frequently demostrated an alveolo-interstitial pattern, mosaic attenuation, and pulmonary cysts, while consolidations and pleural effusions were more common in non-HIV patients, particularly among solid organ transplant recipients. Respiratory coinfections were identified in 63.9% of patients; however, no statistically significant differences in CT patterns were observed between patients with and without coinfections. Conclusions: PJP demonstrates different CT presentations according to immune status. HIV-positive patients more frequently demonstrated alveolo-interstitial patterns, mosaic attenuation, and pulmonary cysts, whereas consolidations were more commonly observed in non-HIV immunocompromised patients. Respiratory coinfections do not appear to significantly influence CT patterns.<\/jats:p>","DOI":"10.3390\/diagnostics16111593","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T16:06:08Z","timestamp":1779465968000},"page":"1593","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Computed Tomography Patterns of Pneumocystis jirovecii Pneumonia According to Immune Status"],"prefix":"10.3390","volume":"16","author":[{"given":"Ra\u00fal","family":"Parra-Fari\u00f1as","sequence":"first","affiliation":[{"name":"Service of Infectious Diseases, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"CIBERINFEC\u2014Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL), 39008 Santander, Spain"},{"name":"Department of Medical and Surgical Sciences, University of Cantabria, 39011 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Infante-Armisen","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Cantabria, 39011 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5136-1430","authenticated-orcid":false,"given":"Pilar","family":"Cifri\u00e1n-Casuso","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL), 39008 Santander, Spain"},{"name":"Department of Radiology, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moncef","family":"Belhassen-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario de Salamanca, 37007 Salamanca, Spain"},{"name":"IBSAL\u2014Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca, CIETUS\u2014Centro de Investigaci\u00f3n de Enfermedades Tropicales, University of Salamanca, 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4439-7877","authenticated-orcid":false,"given":"Javier","family":"Pardo-Lled\u00edas","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL), 39008 Santander, Spain"},{"name":"Department of Medical and Surgical Sciences, University of Cantabria, 39011 Santander, Spain"},{"name":"Internal Medicine Department, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Antonio","family":"Parra-Blanco","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL), 39008 Santander, Spain"},{"name":"Department of Medical and Surgical Sciences, University of Cantabria, 39011 Santander, Spain"},{"name":"Department of Radiology, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1055\/s-0043-1764375","article-title":"Pneumocystis jirovecii pneumonia: A review of management in human immunodeficiency virus (HIV) and non-HIV immunocompromised patients","volume":"13","author":"Ibrahim","year":"2023","journal-title":"Avicenna J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e00101","DOI":"10.1128\/cmr.00101-22","article-title":"Pneumocystis jirovecii pneumonia in people living with HIV: A review","volume":"37","author":"McDonald","year":"2024","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.jiph.2023.03.022","article-title":"Impact of pneumocystosis on the Spanish healthcare system, 1997\u20132020: Profile of HIV and non-HIV immunocompromised patients","volume":"1","author":"Vicente","year":"2023","journal-title":"J. Infect. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Apostolopoulou, A., and Fishman, J.A. (2022). The pathogenesis and diagnosis of Pneumocystis jirovecii pneumonia. J. Fungi, 8.","DOI":"10.3390\/jof8111167"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8904","DOI":"10.21037\/jtd-2025-499","article-title":"Clinical characteristics of Pneumocystis jirovecii pneumonia in non-HIV-infected patients","volume":"17","author":"Wang","year":"2025","journal-title":"J. Thorac. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.pulmoe.2019.04.003","article-title":"Pneumocystis jirovecii pneumonia: A comparison study between HIV and non-HIV immunocompromised patients","volume":"25","year":"2019","journal-title":"Pulmonology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.idc.2023.03.005","article-title":"Current concepts in the diagnosis and management of Pneumocystis jirovecii pneumonia in solid organ transplantation","volume":"37","author":"Trubin","year":"2023","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.resinv.2022.04.002","article-title":"Pathophysiological mechanism of non-HIV Pneumocystis jirovecii pneumonia","volume":"60","author":"Asai","year":"2022","journal-title":"Respir. Investig."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"273","DOI":"10.2169\/internalmedicine.49.2871","article-title":"Comparison of clinical and radiological features of Pneumocystis jirovecii pneumonia between malignancy cases and AIDS cases: A multicenter study","volume":"49","author":"Tasaka","year":"2010","journal-title":"Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"ofae146","DOI":"10.1093\/ofid\/ofae146","article-title":"Chest X-ray features of HIV-associated Pneumocystis pneumonia in adults: A systematic review and meta-analysis","volume":"11","author":"Wills","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"W555","DOI":"10.2214\/AJR.11.7329","article-title":"Pneumocystis jirovecii pneumonia: High-resolution CT findings in patients with and without HIV infection","volume":"198","author":"Kanne","year":"2012","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ejrad.2019.04.025","article-title":"Pneumocystis jirovecii pneumonia at high-resolution CT in non-HIV immunocompromised patients: Spectrum of findings and mimickers","volume":"116","author":"Cereser","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kumagai, S., and Arita, M. (2019). Prognostic significance of crazy-paving ground-glass opacities in non-HIV Pneumocystis jirovecii pneumonia: An observational cohort study. BMC Pulm. Med., 19.","DOI":"10.1186\/s12890-019-0813-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e250021","DOI":"10.1148\/rg.250021","article-title":"Pneumonia in immunocompromised patients","volume":"45","author":"Arora","year":"2025","journal-title":"Radiographics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.jmii.2020.06.007","article-title":"Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with Pneumocystis pneumonia","volume":"54","author":"Wu","year":"2021","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1093\/infdis\/jiab460","article-title":"Epidemiology and clinical impact of respiratory coinfections at diagnosis of Pneumocystis jirovecii pneumonia","volume":"225","author":"Issa","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2405","DOI":"10.1093\/jac\/dkw158","article-title":"ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients","volume":"71","author":"Maschmeyer","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00408-009-9214-y","article-title":"Radiological features of Pneumocystis jirovecii pneumonia in immunocompromised patients with and without AIDS","volume":"188","author":"Hardak","year":"2010","journal-title":"Lung"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e14321","DOI":"10.1111\/tid.14321","article-title":"Outcome of Pneumocystis pneumonia in transplant and non-transplant HIV-negative immunocompromised patients","volume":"26","author":"Albasata","year":"2024","journal-title":"Transpl. Infect. Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1593\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T08:19:21Z","timestamp":1780301961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":19,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16111593"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16111593","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]}}}