Pneumocystis carinii Pneumonia Among Patients Without AIDS at a Cancer Hospital

Sepkowitz, Kent A.; Brown, Arthur E.; Telzak, Edward E.; Gottlieb, Scott; Armstrong, Donald

doi:10.1001/jama.1992.03480060078034

Cited by 254 publications

(137 citation statements)

References 56 publications

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“…PCP in patients with HIV infection develops insidiously, taking a subacute to chronic course that usually does not progress to respiratory failure (29). In contrast, patients without HIV infection develop PCP abruptly and progress to acute fulminating pneumonia with a high incidence of acute respiratory failure (30,31). Mortality due to PCP in patients with HIV infection ranges from 9.6 -20%, whereas it exceeds 50% in patients without HIV infection (32,33).…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case–control study of 21 patients

Komano¹,

Harigai²,

Koike³

et al. 2009

Arthritis & Rheumatism

149

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Objective. To establish proper management of Pneumocystis jiroveci pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with infliximab. PCP has been observed in 0.4% of patients with RA treated with infliximab in Japan. Methods. Data from patients with RA (n ‫؍‬ 21) who were diagnosed with PCP during infliximab treatment and from 102 patients with RA who did not develop PCP during infliximab therapy were collected from 14 rheumatology referral centers in Japan. A retrospective review of these patients and a case-control study to compare patients with and without PCP were performed. Results. The median length of time from the first infliximab infusion to the development of PCP was 8.5 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 7.5 mg/day and 8 mg/week, respectively. Pneumocystis jiroveci was microscopically identified in only 2 patients, although the polymerase chain reaction test for the organism was positive in 20 patients. The patients with PCP had significantly lower serum albumin levels (P < 0.001) and lower serum IgG levels (P < 0.001) than the patients without PCP. Computed tomography of the chest in all patients with PCP revealed ground-glass opacity either with sharp demarcation by interlobular septa or without interlobular septal boundaries. Sixteen of the 21 patients with PCP developed acute respiratory failure, but all survived. Conclusion. PCP is a serious complication that may occur early in the course of infliximab therapy in patients with RA. For the proper clinical management of this infectious disease, physicians need to be aware of the possibility of PCP developing during infliximab therapy.

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Section: Discussionmentioning

confidence: 99%

Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case–control study of 21 patients

Komano¹,

Harigai²,

Koike³

et al. 2009

Arthritis & Rheumatism

149

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“…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).…”

mentioning

confidence: 99%

“…Risk assessment based on intensity of corticosteroid therapy is possible as dose, duration and tapering of corticosteroid therapy appear to impact upon the risk for development of PCP (Sepkowitz et al, 1992;Slivka et al, 1993;Sepkowitz, 1996;Yale and Limper, 1996). In a study of 116 HIV-negative patients with PCP, the median daily dose of corticosteroid was equivalent to 30 mg prednisolone, and the median duration of therapy before the onset of infection was 12 weeks (Yale and Limper, 1996).…”

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confidence: 99%

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

et al. 2005

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Pneumocystis jirovecii pneumonia (PCP) is associated with high mortality in immunocompromised patients without human immunodeficiency virus infection. However, chemoprophylaxis is highly effective. In patients with solid tumours or haematologic malignancy, several risk factors for developing PCP have been identified, predominantly corticosteroid therapy. The aims of this study were to identify the potentially preventable cases of PCP in patients receiving corticosteroid therapy at a tertiary care cancer centre and to estimate the frequency of utilisation of chemoprophylaxis in these patients. Two retrospective reviews were performed. Over a 10-year period, 14 cases of PCP were identified: no cases were attributable to failed chemoprophylaxis, drug allergy or intolerance. During a 6-month period, 73 patients received high-dose corticosteroid therapy (X25 mg prednisolone or X4 mg dexamethasone daily) for X4 weeks. Of these, 22 (30%) had haematologic malignancy, and 51 (70%) had solid tumours. Fewer patients with solid tumours received prophylaxis compared to patients with haematologic malignancy (3.9 vs 63.6%, Po0.0001). Guidelines for PCP chemoprophylaxis in patients with haematologic malignancy or solid tumours who receive corticosteroid therapy are proposed. Successful primary prevention of PCP in this population will require a multifaceted approach targeting the suboptimal prescribing patterns for chemoprophylaxis.

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“…[4][5] Corticosteroid therapy is a rare but possible independent predisposition to Pneumocystis jirovecii infection. [6][7] Prolonged corticosteroid therapy is characterised by a significant immunological dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Oral Manifestations of A Patient of Systemic Lupus Erythomatosus: A Case Report

Urmee

Ferdoushi

Islam

et al. 2015

Bangladesh J of Otorhinolaryngology

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Patients with systemic lupus eythematosus (SLE) have increased susceptibility to infection by Pneumocystis jerovecii but this condition has rarely been reported in Bangladesh. Pneumonias due to Pneumocystis jerovecii commonly occur in immunocompromised hosts. Although it is a treatable infection, it is associated with high motility. Patient with systemic lupus erythomatosus increased susceptibility to infection by Pneumocystis jerovecii. Here we describe a patient with SLE who developed Pneumocystis pneumonia (PCP). A 37-years old female is a known case of SLE for 12 years admitted in BSMMU with the complaints of fever & cough for 3 months and breathlessness for 1 month. The patient is treated with corticosteroids and cyclosporine within 2months before presentation. Diagnosis is established based on the findings of induced sputum by Giemsa staining.This case demonstrates that PCP should be included in the differential diagnosis of patients of SLE presenting with pneumonic process.

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Pneumocystis carinii Pneumonia Among Patients Without AIDS at a Cancer Hospital

Cited by 254 publications

References 56 publications

Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case–control study of 21 patients

Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case–control study of 21 patients

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

Oral Manifestations of A Patient of Systemic Lupus Erythomatosus: A Case Report

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