Prophylaxis and treatment of Pneumocystis Jirovecii pneumonia after solid organ transplantation

Brakemeier, Susanne; Pfau, Anja; Zukunft, Bianca; Budde, Klemens; Nickel, Peter

doi:10.1016/j.phrs.2018.06.010

Cited by 38 publications

(37 citation statements)

References 77 publications

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“…19 Even in the most recent edition (2019) of this guideline, PCP prophylaxis is still not recommended. 73 Our case report, together with the widespread adoption of PCP prophylaxis in solid organ transplant recipients in many countries, 72,74,75 highlights the need to add PCP prophylaxis to the relevant guideline in China. In summary, we presented a case of PCP in a Chinese patient who developed acute pneumonia after renal transplantation but showed negative results for P. jirovecii and other common known respiratory pathogens in multiple conventional diagnostic tests.…”

Section: Discussionmentioning

confidence: 93%

“…The increasing incidence of PCP outbreaks in renal transplant recipients worldwide has underscored the necessity of prophylaxis in this patient population. 72 The patient in this report was not given any prophylaxis according to the Diagnosis and Treatment Guideline of Invasive Fungal Infections in Solid Organ Transplant Recipients in China (2016 edition). 19 Even in the most recent edition (2019) of this guideline, PCP prophylaxis is still not recommended.…”

Section: Discussionmentioning

confidence: 99%

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Metagenomic Next-Generation Sequencing in Diagnosis of a Case of Pneumocystis jirovecii Pneumonia in a Kidney Transplant Recipient and Literature Review

Chen¹,

He²,

Li³

et al. 2020

IDR

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Background: Despite the increasing incidences of Pneumocystis jirovecii pneumonia (PCP) in renal transplant recipients, diagnosis of PCP remains challenging due to its nonspecific clinical presentation and the inadequate performance of conventional diagnostic methods. There is a need for novel diagnostic methods. Case Presentation: A 27-year-old woman developed acute pneumonia 4 months after renal transplantation. Blood tests revealed a low CD4 count, a normal 1,3-beta-D-glucan level and other changes typical of inflammatory responses. Chest imaging showed bilateral diffuse infiltrates. Microscopic examination of stained sputum and bronchoalveolar lavage fluid (BALF) smear specimens did not find Pneumocystis organisms. There was also no evidence for other pathogens known to cause pneumonia in various antibody and culture tests. Direct metagenomic next-generation sequencing (mNGS) analysis of a BALF specimen identified a large number of P. jirovecii reads, allowing to confirm the diagnosis of PCP. Following treatment with trimethoprim-sulfamethoxazole for two weeks, the patient was cured and discharged. Conclusion: This case report supports the value of mNGS in diagnosing PCP, highlights the inadequate sensitivity of conventional diagnostic methods for PCP, and calls for the need to add PCP prophylaxis to the current Diagnosis and Treatment Guideline of Invasive Fungal Infections in Solid Organ Transplant Recipients in China.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Metagenomic Next-Generation Sequencing in Diagnosis of a Case of Pneumocystis jirovecii Pneumonia in a Kidney Transplant Recipient and Literature Review

Chen¹,

He²,

Li³

et al. 2020

IDR

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“…We defined the prognosis of patients discharged from the hospital with significant improvements in clinical symptoms, laboratory examination, and chest CT scans as "improved." In contrast, patients who showed a worsening of their clinical symptoms, unfavorable laboratory or radiological findings after PJP therapy, and/or very low blood oxygen levels, even after receiving invasive mechanical ventilator, either abandoned treatment or left the hospital voluntarily, and all eventually died at home [22]. Finally, the prognosis of patients who transferred to other hospitals was unknown.…”

Section: Data Collectionmentioning

confidence: 99%

Characterization of Pneumocystis jirovecii pneumonia at three tertiary comprehensive hospitals in southern China

Chen

Fang

et al. 2020

Braz J Microbiol

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Due to the increasing use of immunosuppressant therapy, Pneumocystis jirovecii pneumonia (PJP) has become an emerging concern in human immunodeficiency virus (HIV)-negative patients. In this study, we conducted a retrospective study of 96 hospitalized patients with PJP from January 2015 to June 2019 at three tertiary comprehensive hospitals in Southern China. Information was collected regarding patient demographics, clinical manifestations, risk factors, laboratory analyses, radiological images, and treatment outcomes. PJP infection was most commonly found in middle-aged men. Kidney diseases (35.5%) and connective tissue diseases (38.7%) were the predominant risk factors for PJP. About half of the patients (48.4%) received glucocorticoid, immunosuppressant, and/or chemotherapy in a low dose or in a short-term (< 3 months). None of the patients had previously received trimethoprim-sulfamethoxazole (TMP-SMX) for PJP prophylaxis. All patients had two or more clinical manifestations (cough, dyspnea, fever, and chest pain). Biochemical investigations of CRP, ESR, PaO 2 , LDH, and KL-6 showed that over 90% of the patients exceeded the reference range of indicators. Our analyses revealed the dominant risk factors (HIV, kidney diseases, and connective tissue diseases) and the most consistent biochemical indicators (LDH, BG, and KL-6) for PJP. Moreover, early prophylaxis, diagnosis, and treatment should contribute to improve the survival of these PJP patients.

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“…1,2 Previous studies have reported increasing incidence of PJP, which can primarily be attributed to the increased use of immunosuppressive drugs. [5][6][7][8] Patients with inflammatory bowel disease (IBD) might be at a high risk of developing PJP because the main strategies for treating IBD consist of immunosuppressive drugs including corticosteroids, immunomodulators, and biologic agents. 1,2 PJP prophylaxis is also recommended in those undergoing chemotherapy owing to solid or hematological malignancies and recipients of solid organ or hematopoietic stem cell transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 PJP prophylaxis is also recommended in those undergoing chemotherapy owing to solid or hematological malignancies and recipients of solid organ or hematopoietic stem cell transplantation. [5][6][7][8] Patients with inflammatory bowel disease (IBD) might be at a high risk of developing PJP because the main strategies for treating IBD consist of immunosuppressive drugs including corticosteroids, immunomodulators, and biologic agents. 4,[9][10][11] However, the need for routine prophylaxis in IBD patients receiving immunosuppressive therapy is debatable.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of Pneumocystis jirovecii pneumonia in Korean patients with inflammatory bowel disease

Nam

Park

Lee

et al. 2019

J of Gastro and Hepatol

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Background and Aim Little is known whether routine prophylaxis against Pneumocystis jirovecii pneumonia (PJP) is needed in patients with inflammatory bowel disease (IBD) on immunosuppression, especially in Asian populations. We, therefore, sought to investigate the incidence and risk factors of PJP in patients with IBD in Korea. Methods We investigated the incidence of PJP in patients with IBD and compared the characteristics of IBD patients with PJP episodes (IBD‐PJP group) with those of matched controls (IBD‐only group) using a large, well‐characterized referral center‐based cohort. Results Among the 6803 IBD patients (3171 with Crohn's disease and 3632 with ulcerative colitis) enrolled in the Asan IBD Registry between June 1989 and December 2016, six patients (0.09%) were diagnosed with PJP. During the 57 776.0 patient‐years of follow‐up (median 7.2 years per patient), the incidence of PJP was 10.4 cases per 100 000 person‐years, and none of these patients had received PJP prophylaxis. In case–control analysis, the IBD‐PJP group (n = 6) showed significantly higher C‐reactive protein level at diagnosis of IBD (P = 0.006), as well as higher exposure to corticosteroids (P = 0.017), than did controls (n = 24). In addition, the IBD‐PJP group showed higher rates of double (50% vs 12.5%) or triple (33.3% vs 4.2%) immunosuppression than did controls, although these are not statistically significant. Conclusions Although the incidence of PJP in Korean patients with IBD is low, careful monitoring is necessary for the early detection of PJP. In addition to the patients receiving double or triple immunosuppression, PJP prophylaxis should be considered especially in patients with severe disease activities requiring corticosteroids.

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Prophylaxis and treatment of Pneumocystis Jirovecii pneumonia after solid organ transplantation

Cited by 38 publications

References 77 publications

<p>Metagenomic Next-Generation Sequencing in Diagnosis of a Case of <em>Pneumocystis jirovecii</em> Pneumonia in a Kidney Transplant Recipient and Literature Review</p>

<p>Metagenomic Next-Generation Sequencing in Diagnosis of a Case of <em>Pneumocystis jirovecii</em> Pneumonia in a Kidney Transplant Recipient and Literature Review</p>

Characterization of Pneumocystis jirovecii pneumonia at three tertiary comprehensive hospitals in southern China

Incidence and risk factors of Pneumocystis jirovecii pneumonia in Korean patients with inflammatory bowel disease

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