High incidence of Pneumocystis jirovecii pneumonia in allogeneic hematopoietic cell transplant recipients in the modern era

Evernden, Christopher; Dowhan, Michelle; Dabas, Rosy; Chaudhry, Ahsan; Kalra, Amit; Dharmani‐Khan, Poonam; Gregson, Daniel B.; Johnson, Andrew S.; Jupp, Jennifer; Jiménez-Zepeda, Víctor H.; Jamani, Kareem; Duggan, Peter; Tay, Jason; Khan, Faisal; Daly, Andrew; Storek, Jan

doi:10.1016/j.jcyt.2019.11.002

Cited by 22 publications

(20 citation statements)

References 46 publications

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“…Arend et al also reported that only the additional use of ATG in patients with AR was related to PJP, but the frequency of AR did not increase the incidence of PJP 27 . In allogeneic hematopoietic cell transplant recipients, anti‐pneumocystis prophylaxis was suggested continuously for patients with ATG in graft‐versus‐host disease or on immunosuppressive therapy 28 . Considering the fact that excessive use of ATG could lead to PJP, the safer dosage of ATG after kidney transplantation is in need of further investigation.…”

Section: Discussionmentioning

confidence: 99%

The risk factor analysis and treatment experience in pneumocystis jirovecii pneumonia after kidney transplantation

Yang

Zhu

Liang

et al. 2021

Mycoses

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Background Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection among solid organ transplantation. The occurrence of PJP is dangerous and fatal if there is no early identification and sufficient treatment. Objective The aim of this study was to evaluate the risk factors and provide appropriate strategies of prophylaxis and treatment for PJP after kidney transplantation in our centre. Patients/Methods From January 2009 to December 2018, a total of 167 kidney transplantation recipients with pneumonia were enrolled, including 47 PJP patients as PJP group and 120 non‐PJP patients as control group. The clinical characteristics of the two groups were analysed retrospectively. Results Multivariate analysis showed that high total dosage of ATG [OR, 2.03; 95% CI, 1.12–3.68] and cytomegalovirus (CMV) infection were independent risk factors for PJP. Trimethoprim‐sulfamethoxazole (TMP‐SMX) (1.44 g q6h)–based treatment was used for 2 weeks, and its dosage and course were adjusted according to the therapeutic effect and side effects. Forty‐five cases were recovered after 3 months of follow‐up, and two patients died of respiratory failure. TMP‐SMX (0.48 g/day) prophylaxis was used for 3–6 months and prolonged to 7–8 months after treatment for acute rejection, which reduced the incidence of PJP compared with those without prophylaxis. Conclusion Our study suggests that the high total dosage of ATG and CMV infection indicate the increased risk of PJP. The strategies of prophylaxis and treatment for PJP after kidney transplantation in our centre were effective.

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Section: Discussionmentioning

confidence: 99%

The risk factor analysis and treatment experience in pneumocystis jirovecii pneumonia after kidney transplantation

Yang

Zhu

Liang

et al. 2021

Mycoses

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“…For individuals without HIV infection, immunosuppressive therapies are the main cause of low immunity and the subsequent PJP occurs (5,6). Previous studies have reported that patients with autoimmune diseases and organ transplantation are the main users of immunosuppressive agents, and these patients are at high risk of PJP due to the status of treatment-related immunosuppression (7)(8)(9). Furthermore, absolute peripheral lymphopenia, high doses of corticosteroids with or without combination of other immunosuppressive agents, and concomitant lung disease are strong predictors for the development of PJP, and thus should warrant primary prophylaxis (10).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, absolute peripheral lymphopenia, high doses of corticosteroids with or without combination of other immunosuppressive agents, and concomitant lung disease are strong predictors for the development of PJP, and thus should warrant primary prophylaxis (10). Notably, the CD4 + T-cell < 200 cells/ml is a risk factor for PJP in either HIV-infected patients or those with immunosuppressive treatment (7,11). However, whether other lymphocytes or the function of these lymphocytes could be used in predicting the occurrence of PJP remains obscure.…”

Section: Introductionmentioning

confidence: 99%

Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

Tang

Tong

et al. 2021

Front. Immunol.

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BackgroundPneumocystis jiroveci pneumonia (PJP) is the most common opportunistic infection in immunocompromised patients. The accurate prediction of PJP development in patients undergoing immunosuppressive therapy remains challenge.MethodsPatients undergoing immunosuppressive treatment and with confirmed pneumocystis jiroveci infection were enrolled. Another group of matched patients with immunosuppressant treatment but without signs of infectious diseases were enrolled to control group.ResultsA total of 80 (40 PJP, 40 non-PJP) participants were enrolled from Tongji Hospital. None of the patients were HIV positive. The routine laboratory indicators, such as LYM, MON, RBC, TP, and ALB, were significantly lower in PJP patients than in non-PJP patients. Conversely, LDH in PJP patients was significantly higher than in non-PJP controls. For immunological indicators, the numbers of T, B, and NK cells were all remarkably lower in PJP patients than in non-PJP controls, whereas the functional markers such as HLA-DR, CD45RO and CD28 expressed on CD4+ or CD8+ T cells had no statistical difference between these two groups. Cluster analysis showing that decrease of host immunity markers including CD3+, CD4+ and CD8+ T cells, and increase of tissue damage marker LDH were the most typical characteristics of PJP patients. A further established model based on combination of CD8+ T cells and LDH showed prominent value in distinguishing PJP from non-PJP, with AUC of 0.941 (95% CI, 0.892-0.990).ConclusionsA model based on combination of routine laboratory and immunological indicators shows prominent value for predicting the development of PJP in HIV-negative patients undergoing immunosuppressive therapy.

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“…All other drugs, including pentamidine, atovaquone and dapsone, are considered second-line alternatives when trimethoprim/sulfamethoxazole is poorly tolerated or contraindicated and are preferred over inhaled pentamidine ( 57 ). PJP prophylaxis is relevant in patients with delayed immune reconstitution (CD4 T-cell <200/μL) or patients receiving IST for GvHD ( 58 ).…”

Section: Pharmaceutical Microbial Prophylaxis During and After Hsctmentioning

confidence: 99%

Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

et al. 2021

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Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.

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High incidence of Pneumocystis jirovecii pneumonia in allogeneic hematopoietic cell transplant recipients in the modern era

Cited by 22 publications

References 46 publications

The risk factor analysis and treatment experience in pneumocystis jirovecii pneumonia after kidney transplantation

The risk factor analysis and treatment experience in pneumocystis jirovecii pneumonia after kidney transplantation

Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

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