Examination of availability of the criteria for protective therapy against Pneumocystis pneumonia.

Abstract

summaryTwenty patients with collagen diseases complicated with Pneumocystis pneumonia (PCP) were retrospectively examined in reference to the criteria for its protective therapy provided by the Ministry of Health Labor and Welfare. The breakdown of 20 patients was rheumatoid arthritis (RA) in 5 cases, systemic lupus erythematosus (SLE) in 5, dermatomyositis (DM) in 2, systemic scleroderma (SSc) in 1, mixed connective tissue disease (MCTD) in 1, Sj äogren syndrome (SjS) in 1, polyarteritis nodosa (PN) in 3, rapidly progressive glomerulonephritis (RPGN) in 1, Sch äonlein Henoch purpura in 1. Patients having interstitial pneumonia (IP) or renal dysfunction before acquiring PCP showed poor prognosis. High level of b D glucan was observed in all patients, and elevated levels of LDH and KL 6 were also characteristic of PCP. For the treatment of their own collagen diseases, high dose steroids had been given in 11 patients (55), and immunosuppressive agents in 12 (60), resulting in severe suppression of immune function in these patients. They were treated with Sulfamethoxazole/trimethoprim (ST) after Pneumocystis infection, however, 10 patients died and 8 of them died of respiratory failure in spite of high dose steroids. Nine patients fulˆlled the criteria for PCP protective therapy provided by Ministry of Health Labor and Welfare, and 7 of them died of respiratory failure. The frequency of PCP remarkably decreased in our hospital after we had started the protective therapy with ST using the criteria, suggesting that it is eŠective for the protection of PCP. However, some patients who do not fulˆll the criteria may acquire severe PCP.

Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases

“…However, patients treated with ST monotherapy might have been less likely to have complications such as chronic kidney disease, which is a prognostic factor for PCP and should be considered as a confounding factor. 21 The present study results suggest that the prognosis might be relatively poor in patients treated with pentamidine-including regimens. Since low-dose ST with 4-10 mg/kg/day trimethoprim has also been suggested to be as effective as high-dose ST in patients with non-HIV-PCP, a reduction in ST dose might be considered as a next step in patients with inadequate response to ST. 22 There are several potential reasons that might explain the poor prognosis observed in the pentamidine group.…”