Opportunistic Infections in Patients with and Patients without Acquired Immunodeficiency Syndrome

Abstract

In the next decade, longer survival of patients with cancer and more-aggressive therapies applied to common conditions, such as asthma and rheumatoid arthritis, will result in a larger population with significant immune system defects. Many in this population will be at risk for opportunistic infections, which are familiar to doctors who have treated people infected with human immunodeficiency virus (HIV). However, the epidemiology, presentation, and outcome of these infections in patients with an immune system defect, other than that caused by HIV infection, may be different than those encountered in patients with acquired immunodeficiency syndrome. Reviewed are 4 common opportunistic infections: Pneumocystis carinii pneumonia, cryptococcosis, atypical mycobacterial infection, and cytomegalovirus infection. Emphasized are the important differences among these groups at risk.

Opportunistic infections in polymyositis and dermatomyositis

“…Opportunistic infections have been frequently reported in patients with acquired immunodeficiency syndrome (AIDS) or other conditions with compromised host defenses, such as malignancy and transplantation (6,13,14). More recently, opportunistic infections have also been increasingly reported in patients with connective tissue diseases, especially systemic lupus erythematosus (SLE).…”

“…More recently, opportunistic infections have also been increasingly reported in patients with connective tissue diseases, especially systemic lupus erythematosus (SLE). Many factors, e.g., immunosuppressive medications, have been mentioned to account for the elevated frequency of opportunistic infections in these patients (6,13,14). However, until now, only few anecdotal reports of opportunistic infections had been previously mentioned in PM/DM patients (6 -9).…”

An analysis of the utilisation of chemoprophylaxis against Pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital

“…Although some have recommended that prophylaxis continue for 1 month after discontinuation of corticosteroids (Sepkowitz, 2002), extended duration may be required with other concurrently administered immunosuppressive therapies. For example, cytarabine (Hughes et al, 1975), cyclophosphamide (Kulke and Vance, 1997), methotrexate (Kane et al, 1993), fluorouracil (Hardy et al, 1987) and fludarabine (Bastion et al, 1991) have all been associated with development of PCP in the absence of corticosteroid treatment, although the absolute risk is unclear.…”

“…The case fatality rate among HIV-negative patients with PCP has remained approximately 50% over the last three decades (Walzer et al, 1974;Sepkowitz et al, 1992;Sepkowitz, 2002), despite identification of risk factors, including malignancy (Sepkowitz et al, 1992;Zahar et al, 2002), haematologic disorders (Sepkowitz et al, 1992), radiation therapy (Mathew and Grossman, 2003), chemotherapy (Hughes et al, 1975;Sepkowitz et al, 1992), organ transplantation (Hardy et al, 1984;Sepkowitz et al, 1995) and CD4 þ lymphopenia (Mansharamani et al, 2000). In patients with solid tumours or haematologic malignancy, corticosteroid therapy is the most common predisposing risk factor for developing PCP (Sepkowitz et al, 1992;Sepkowitz, 1993;Yale and Limper, 1996).…”

Fungal Infections in Transplant and Oncology Patients

“…The risk of Pneumocystis jiroveci infection (previously P. carinii) in HSCT and SOT recipients can be as high as 5-15% without prophylaxis [40,41]. In the era of routine P. jiroveci prophylaxis, transplant recipients that develop infection typically do so after stopping their prophylactic regimen [42].…”