Serum Indicators for the Diagnosis of Pneumocystis Pneumonia

Tasaka, Sadatomo; Hasegawa, Naoki; Kobayashi, Seiki; Yamada, Wakako; Nishimura, Tomoyasu; Takeuchi, Tsutomu; Ishizaka, Akitoshi

doi:10.1378/chest.06-1467

Cited by 233 publications

(191 citation statements)

References 18 publications

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“…The median serum levels of IgG, lactate dehydrogenase, and KL-6 antigen were 1,191.5 mg/dl (range 626 -2,112 mg/dl, n ϭ 12), 439.0 IU/liter (range 214 -1,011 IU/liter, n ϭ 16), and 521.5 units/ml (range 156 -1,480 units/ml, nϭ20), respectively. KL-6 antigen is a mucinous high molecular weight glycoprotein that is produced by type II pneumonocytes and is reported to increase in patients with active interstitial pneumonitis as well as in those with PCP (24). Chest radiographs and CT scans were analyzed in all 21 patients.…”

Section: Resultsmentioning

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

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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: Resultsmentioning

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

Self Cite

149

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“…However, these studies have been conducted on a small number of patients. Tasaka et al have reported its usefulness in a large number of patients (8) (19). This marker was not a predictor of outcome.…”

Section: In the Present Study We Evaluated The Laboratory And Bal Fimentioning

confidence: 99%

Clinical Utility of Serum .BETA.-D-Glucan and KL-6 Levels in Pneumocystis jirovecii Pneumonia

et al. 2009

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“…Tasaka et al [19] reported that serum b-D-glucan levels were significantly higher in PCP-positive patients than in PCP-negative patients (p \ 0.0001). They showed that the sensitivity, specificity, and negative predictive value of b-D-glucan levels were 92.3, 86.1, and 98.0%, respectively, and the cutoff level of b-Dglucan was estimated to be 31.1 pg/mL [19]. Other reports describing temozolomide-induced CMV pneumonia so far have not reported the levels of b-D-glucan [4,[6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Reactivation of cytomegalovirus following treatment of malignant glioma with temozolomide

Okita¹,

Narita²,

Miyakita³

et al. 2011

Int Canc Conf J

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Temozolomide is a standard chemotherapeutic agent in the treatment of malignant gliomas. Lymphocytopenia is reported to be the most frequent and severe adverse effect, which causes opportunistic infections such as pneumocystis pneumonia (PCP) and increases the risk of the reactivation of viruses such as hepatitis B virus (HBV) and cytomegalovirus (CMV). However, the incidence of temozolomide-induced CMV reactivation remains unclear. We report on a case of a 62-year-old female with gliomatosis cerebri who had severe lymphocytopenia and pneumonia following concurrent temozolomide treatment and prophylaxis for PCP. She presented cough, fever, and severe lymphocytopenia 1 month after chemoradiotherapy with temozolomide. Her serum b-D-glucan levels remained within the normal range, which was helpful to rule out a diagnosis of PCP. Other opportunistic infections were ruled out, and a blood test for the CMV antigen was positive for pp65 antigenemia. The patient was diagnosed as having CMV pneumonia. She was treated with ganciclovir and recovered. It was very difficult to distinguish between PCP and CMV pneumonia with only the clinical presentation and radiological findings. When a patient receives temozolomide, it is important to be aware of the potential for a CMV reactivation. The serum b-D-glucan levels and pp65 antigenemia are very useful for diagnosis of CMV pneumonia.

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Serum Indicators for the Diagnosis of Pneumocystis Pneumonia

Cited by 233 publications

References 18 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

Clinical Utility of Serum .BETA.-D-Glucan and KL-6 Levels in Pneumocystis jirovecii Pneumonia

Reactivation of cytomegalovirus following treatment of malignant glioma with temozolomide

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