Pneumocystis jiroveci (carinii) Pneumonia After Infliximab Therapy: A Review of 84 Cases

Kaur, Nirmal; Mahl, Thomas C.

doi:10.1007/s10620-006-9250-x

Cited by 197 publications

(122 citation statements)

References 38 publications

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“…The corresponding incidence reported in the US is ϳ0.01% (25). Although the US incidence was derived from voluntary reports to the Food and Drug Administration, a 20 -40-fold higher incidence of PCP with the use of anti-TNF therapy in Japan suggests that this phenomenon might be unique to Japanese patients.…”

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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“…In this regard, Pneumocystis infection of the lung is the most common opportunistic infection in AIDS causing severe pneumonia (Pneumocystis pneumonia); however, it also affects patients undergoing chemotherapy for cancer, anti-TNF-a therapy for some rheumatic diseases (18)(19)(20), or patients with inherited CD4 T cell defects (21). During Pneumocystis pneumonia, significant numbers of neutrophils are recruited from the BM to the lung, although they are unable to clear the pathogen (22,23).…”

mentioning

confidence: 99%

Prevention of Bone Marrow Cell Apoptosis and Regulation of Hematopoiesis by Type I IFNs during Systemic Responses to Pneumocystis Lung Infection

Taylor

Wilkison

Voyich

et al. 2011

The Journal of Immunology

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We recently demonstrated that lack of type I IFN signaling (IFNAR knockout) in lymphocyte-deficient mice (IFrag−/−) results in bone marrow (BM) failure after Pneumocystis lung infection, whereas lymphocyte-deficient mice with intact IFNAR (RAG−/−) had normal hematopoiesis. In the current work, we performed studies to define further the mechanisms involved in the induction of BM failure in this system. BM chimera experiments revealed that IFNAR expression was required on BM-derived but not stroma-derived cells to prevent BM failure. Signals elicited after day 7 postinfection appeared critical in determining BM cell fate. We observed caspase-8– and caspase-9–mediated apoptotic cell death, beginning with neutrophils. Death of myeloid precursors was associated with secondary oxidative stress, and decreasing colony-forming activity in BM cell cultures. Treatment with N-acetylcysteine could slow the progression of, but not prevent, BM failure. Type I IFN signaling has previously been shown to expand the neutrophil life span and regulate the expression of some antiapoptotic factors. Quantitative RT-PCR demonstrated reduced mRNA abundance for the antiapoptotic factors BCL-2, IAP2, MCL-1, and others in BM cells from IFrag−/− compared with that in BM cells from RAG−/− mice at day 7. mRNA and protein for the proapoptotic cytokine TNF-α was increased, whereas mRNA for the growth factors G-CSF and GM-CSF was reduced. In vivo anti–TNF-α treatment improved precursor cell survival and activity in culture. Thus, we propose that lack of type I IFN signaling results in decreased resistance to inflammation-induced proapoptotic stressors and impaired replenishment by precursors after systemic responses to Pneumocystis lung infection. Our finding may have implications in understanding mechanisms underlying regenerative BM depression/failure during complex immune deficiencies such as AIDS.

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“…Systemic glucocorticosteroids are commonly used in addition [62,67,70]. It is always necessary to exclude infective aetiology in patients treated with immunosuppressants or biological drugs, tuberculosis and opportunistic pathogens should be also taken into consideration [75][76][77][78][79][80]. Lung complications of IBD treatment may be fatal [62,67,70,77].…”

Section: Drug-related Pulmonary Toxicitymentioning

confidence: 99%

Respiratory System Involvement in Inflammatory Bowel Diseases

Kacprzak¹,

Szturmowicz²,

Kuś³

2017

Advances in Respiratory Medicine

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Pneumocystis jiroveci (carinii) Pneumonia After Infliximab Therapy: A Review of 84 Cases

Cited by 197 publications

References 38 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

Prevention of Bone Marrow Cell Apoptosis and Regulation of Hematopoiesis by Type I IFNs during Systemic Responses to Pneumocystis Lung Infection

Respiratory System Involvement in Inflammatory Bowel Diseases

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