Prevention and Treatment of Pneumocystis Pneumonia

Wood, Alastair J.J.; Masur, Henry

doi:10.1056/nejm199212243272606

Cited by 196 publications

(5 citation statements)

References 97 publications

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“…Immunocompromised status such as that caused by human immunodeficiency virus (HIV) infection, hematological malignancies, solid organ tumors under chemotherapy, rheumatic diseases, and medication with immunosuppressive agents is associated with PCP development [1][2][3]. First-line anti-PCP therapy with trimethoprim/sulfamethoxazole should be initiated as soon as possible after a confirmed diagnosis because PCP is fatal [4,5]. The clinical course is more gradual, and outcomes are better among patients with PCP with HIV infection than in those without HIV [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness

et al. 2021

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Objective Pneumocystis jirovecii pneumonia (PCP) is a fatal respiratory infection, mostly associated with immunocompromised conditions. Several reports have described PCP development in patients who were not immunocompromised, but the clinical course and prognosis of PCP are not well understood. We compared the clinical characteristics and prognoses between patients with and without immunocompromised conditions who developed PCP. Methods We retrospectively analyzed patients who had been treated for PCP from three hospitals. We defined immunocompromised (IC) status as following: human immunodeficiency virus (HIV) infection; hematological malignancy; solid organ tumor under chemotherapy; rheumatic disease; medication with immunosuppressive agents. Patients without immunocompromised status were defined as being non-immunocompromised (non-IC). Results The IC and non-IC groups comprised 173 and 14 patients. The median ages were 62.0 and 74.0 years in the IC and the non-IC group, respectively. The median interval between admission and anti-PCP treatment was significantly longer for patients in the non-IC group than that for patients in the IC group (7 vs. 2 days). The in-hospital mortality rates were significantly higher for patients in the non-IC group than that for patients in the IC group (71.4% vs. 43.9%; P = 0.047). A longer interval between admission and anti-PCP therapy was associated with increased 90-day mortality rate in patients with PCP (hazard ratio, 1.082; 95% confidence interval, 1.015–1.153; P = 0.016). Conclusions Patients with PCP with no predisposing illnesses were older and had higher mortality rates than IC patients with PCP. Delayed anti-PCP treatment was associated with increased 90-day mortality.

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Section: Introductionmentioning

confidence: 99%

Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness

et al. 2021

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“…It is a major cause of life-threatening illness in patients with acquired immune deficiency syndrome (AIDS) and solid-organ transplant recipients treated with potent immunosuppressive agents. (1, 2) PJP also occurs in patients with lymphoma or leukemia following chemotherapy. (3–10)…”

Section: Introductionmentioning

confidence: 99%

Immunosuppression in Patients with High-Grade Gliomas Treated with Radiation and Temozolomide

Grossman

Lesser

et al. 2011

Clinical Cancer Research

472

384

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Purpose Patients with high grade gliomas (HGG) routinely receive radiation, temozolomide, and glucocorticoids. As each of these is immunosuppressive, we conducted a prospective, multicenter study to follow CD4 counts over time and determine if low CD4 counts were associated with adverse outcomes. Experimental design Patients with newly diagnosed HGG had CD4 counts drawn before initiating standard therapy and monthly thereafter for one year. Information on hospitalizations, infections, glucocorticoid use, survival, and cause of death were also collected. Results Ninety-six evaluable patients were accrued (85% glioblastoma, median age of 57, median KPS 90). The median CD4 count before radiation and temozolomide was 664 cells/mm3. The CD4 count nadir occurred 2 months after initiating therapy when 73% of patients had CD4 counts <300 cells/mm3 and 40% had <200 cells/mm3. CD4 counts remained low throughout the year of follow-up. Patients with CD4 counts <200 cells/mm3 at 2 months had shorter survival than those with higher counts (median 13.1 versus 19.7 months, p=0.002). Median survival was related to CD4 toxicity grades (I=23.8 months, II=19.7 months, III–IV=13.1 months, p=0.009). The adjusted hazard ratio for death attributable to 2-month CD4 count below 200 was 1.66 (p=0.03). Eighty-eight percent of deaths resulted from disease progression while only 2.5% were due to infection. Conclusions Severe reductions in CD4 counts in patients with newly diagnosed HGG treated with radiation and temozolomide are common, treatment-related, long-lasting, and associated with early death from tumor progression.

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“…Cotrimoxazole (sulfamethoxazole in combination with trimethoprim) is the recommended first-line agent for both prevention and treatment of PCP. 83 , 86 However, resistance to cotrimoxazole, mediated by mutations in the dihydropteroate synthase (DHPS) enzymes, the main target of sulfamethoxazole, which inhibits the synthetic pathway of folate, has emerged due to widespread use of the drug in both HIV and non-HIV populations. 87 , 88 The anti-malarial agent, primaquine is an alternative medication for the treatment of PCP, when combined with clindamycin; however, its usage is challenged by the high burden of glucose-6-phosphate dehydrogenase (G6PD) deficiency in many African countries.…”

Section: Discussionmentioning

confidence: 99%

Re-estimation of the burden of serious fungal diseases in Uganda

Bongomin,

Kwizera,

Namusobya

et al. 2024

Therapeutic Advances in Infection

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Background: It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. Objective: We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Methods: Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. Results: With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Conclusion: Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.

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Prevention and Treatment of Pneumocystis Pneumonia

Cited by 196 publications

References 97 publications

Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness

Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness

Immunosuppression in Patients with High-Grade Gliomas Treated with Radiation and Temozolomide

Re-estimation of the burden of serious fungal diseases in Uganda

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