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Infection Aug 2022In the era of effective prophylaxis, the objective of this study was to describe pneumocystis pneumonia (PCP) patients' profile and evaluate the consistency of clinical...
PURPOSE
In the era of effective prophylaxis, the objective of this study was to describe pneumocystis pneumonia (PCP) patients' profile and evaluate the consistency of clinical situations encountered with the recommended indications for prophylaxis.
METHODS
This was a single-centre, retrospective study. All adults (> 18 years) with a definitive diagnosis of PCP were included. Data were collected from patients' electronic medical files.
RESULTS
The study examined the medical files of 225 patients diagnosed with PCP and treated between 1 January, 2015, and 30 June, 2020. More than 95% of the patients were not on anti-PCP prophylaxis at the time of PCP diagnosis. There were 32 (14%) deaths before the end of PCP treatment, mainly in auto-immune disease (30%) and solid tumours (38%) groups unlike the solid-organ transplants group, among whom deaths were infrequent. Indeed, 48% of our cohort (n = 107) had both corticosteroid (CS) therapy, immunosuppressive or immunomodulatory treatment, and lymphopaenia and could have been considered at high risk for PCP. Trimethoprim/sulfamethoxazole was administered as first-line PCP curative treatment in 95% of the patients. Toxicities of this drug led to treatment interruption in 25% of the patients (except death).
CONCLUSIONS
This study found a high number of PCP cases over 5 years. Unsurprisingly, most of the patients were immunosuppressed, with risk factors for PCP already described in the literature. This large number of PCP cases should be avoidable and, consequently, questions arise. Faced with these data, prophylaxis should be common sense for immunocompromised patients with risk factors, even if formalised recommendations do not exist.
Topics: Adult; Humans; Pneumocystis; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 35274281
DOI: 10.1007/s15010-022-01790-2 -
Current Rheumatology Reports Feb 2020The management of patients with idiopathic inflammatory myositis (IIM) can be complex and challenging due to the myriad of complications they can experience. The... (Review)
Review
PURPOSE OF REVIEW
The management of patients with idiopathic inflammatory myositis (IIM) can be complex and challenging due to the myriad of complications they can experience. The continued use of corticosteroids, in addition to the rise of combination immunosuppressive therapy, has contributed to the ongoing concern for infection. Perhaps the most feared infection in IIM patients is Pneumocystis jirovecii pneumonia (PJP) given its infrequent occurrence yet high mortality. The field has been, and continues to be, without evidence-based guidelines to help clinicians determine which patients with IIM to prescribe prophylaxis. Herein, we review this literature to provide the clinician with an up-to-date view of infections in IIM.
RECENT FINDINGS
In the past 5 years, a number of studies have been reported highlighting various infectious complications, which help us better understand their frequency and associated risk factors. In addition, data has been published on the potential harms of PJP prophylaxis, to better inform the risk/benefit of our decision-making. Infection remains a major contributor to morbidity and mortality in IIM. A better understanding of which patient subgroups are at risk for particular infections will inform optimal management strategies.
Topics: Antibiotic Prophylaxis; Glucocorticoids; Humans; Immunosuppressive Agents; Incidence; Infection Control; Infections; Myositis; Pneumocystis carinii; Pneumonia, Pneumocystis; Vaccines
PubMed: 32020305
DOI: 10.1007/s11926-020-0883-0 -
Chest Jun 2024
Topics: Humans; Pneumonia, Pneumocystis
PubMed: 38852956
DOI: 10.1016/j.chest.2024.02.038 -
Zhongguo Fei Ai Za Zhi = Chinese... Apr 2022In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency... (Review)
Review
In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency virus (HIV) patients, such as those with malignancies, post-transplantation and autoimmune diseases. Although the risk factors and management of PJP have been extensively studied in the hematologic tumor and post-transplant populations, the research on real tumor cases is insufficient. Lung cancer has been the most common tumor with the highest number of incidence and death worldwide, and the prognosis of lung cancer patients infected with PJP is poor in clinical practice. By reviewing the previous studies, this paper summarized the epidemiology and clinical manifestations of PJP in lung cancer patients, the risk factors and possible mechanisms of PJP infection in lung cancer patients, diagnosis and prevention, and other research progresses to provide reference for clinical application. .
Topics: Humans; Incidence; Lung Neoplasms; Pneumocystis carinii; Pneumonia, Pneumocystis; Risk Factors
PubMed: 35340199
DOI: 10.3779/j.issn.1009-3419.2022.101.14 -
World Neurosurgery Feb 2022A 67-year-old male with chronic lymphocytic leukemia was admitted with headaches and ring-enhancing lesions on magnetic resonance imaging of the brain. His current...
A 67-year-old male with chronic lymphocytic leukemia was admitted with headaches and ring-enhancing lesions on magnetic resonance imaging of the brain. His current regimen included rituximab and ibrutinib with trimethoprim-sulfamethoxazole for secondary Pneumocystis jirovecii pneumonia prevention. All other elements of his history were noncontributory. The diagnosis of an invasive fungal infection was made via light microscopy of a stereotactic brain biopsy specimen.
Topics: Abscess; Aged; Brain; Humans; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 34883274
DOI: 10.1016/j.wneu.2021.12.002 -
MSphere Sep 2019pneumonia is the most common serious opportunistic infection in patients with HIV/AIDS. Furthermore, pneumonia is a feared complication of the immunosuppressive drug...
pneumonia is the most common serious opportunistic infection in patients with HIV/AIDS. Furthermore, pneumonia is a feared complication of the immunosuppressive drug regimens used to treat autoimmunity, malignancy, and posttransplantation rejection. With an increasing at-risk population, there is a strong need for novel approaches to discover diagnostic and vaccine targets. There are multiple challenges to finding these targets, however. First, has a largely unannotated genome. To address this, we evaluated each protein encoded within the genome by comparisons to proteins encoded within the genomes of other fungi using NCBI BLAST. Second, relies on a multiphasic life cycle, as both the transmissible form (the ascus) and the replicative form (the trophozoite [troph]) reside within the alveolar space of the host. To that end, we purified asci and trophs from and utilized transcriptomics to identify differentially regulated genes. Two such genes, and , are differentially regulated in the ascus and the troph, respectively, and can be utilized to characterize the state of the life cycle , encoding a β-1,3-glucan synthase with a large extracellular domain previously identified using surface proteomics, was more highly expressed on the ascus form of GSC-1 ectodomain immunization generated a strong antibody response that demonstrated the ability to recognize the surface of the asci. GSC-1 ectodomain immunization was also capable of reducing ascus burden following primary challenge with Finally, mice immunized with the GSC-1 ectodomain had limited fungal burden following natural transmission of using a cohousing model. The current report enhances our understanding of biology in a number of ways. First, the current study provided a preliminary annotation of the genome, addressing a long-standing issue in the field. Second, this study validated two novel transcripts enriched in the two predominant life forms of These findings allow better characterization of the life cycle and could be valuable diagnostic tools. Furthermore, this study outlined a novel pipeline of -omics techniques capable of revealing novel antigens (e.g., GSC-1) for the development of vaccines against .
Topics: Animals; Antigens, Fungal; Female; Fungal Proteins; Gene Expression Profiling; Gene Expression Regulation, Fungal; Genome, Fungal; Lung; Mice; Mice, Inbred C57BL; Pneumocystis; Pneumonia, Pneumocystis; Proteomics; Transcriptome
PubMed: 31484742
DOI: 10.1128/mSphere.00488-19 -
Current Opinion in Infectious Diseases Apr 2024This review highlights the epidemiology of Pneumocystis jirovecii pneumonia in solid organ transplant recipients, advancements in the diagnostic landscape, and updates... (Review)
Review
PURPOSE OF REVIEW
This review highlights the epidemiology of Pneumocystis jirovecii pneumonia in solid organ transplant recipients, advancements in the diagnostic landscape, and updates in treatment and prevention.
RECENT FINDINGS
The increasing use of immune-depleting agents in the context of solid organ transplantation has given rise to P. jirovecii pneumonia in this population. The use of prophylaxis has dramatically reduced risk of infection; however, late-onset infections occur after cessation of prophylaxis and in the setting of lymphopenia, advancing patient age, acute allograft rejection, and cytomegalovirus infection. Diagnosis requires respiratory specimens, with PCR detection of Pneumocystis replacing traditional staining methods. Quantitative PCR may be a useful adjunct to differentiate between infection and colonization. Metagenomic next-generation sequencing is gaining attention as a noninvasive diagnostic tool. Trimethoprim-sulfamethoxazole remains the drug of choice for treatment and prevention of Pneumocystis pneumonia. Novel antifungal agents are under investigation.
SUMMARY
P. jirovecii is a fungal opportunistic pathogen that remains a cause of significant morbidity and mortality in solid organ transplant recipients. Early detection and timely treatment remain the pillars of management.
Topics: Humans; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Organ Transplantation; Transplantation, Homologous; Transplant Recipients
PubMed: 38230604
DOI: 10.1097/QCO.0000000000001002 -
Expert Review of Respiratory Medicine 2022is an opportunistic, human-specific fungus that causes pneumonia (PCP). PCP symptoms are nonspecific. A patient with and another lung infection faces a diagnostic... (Review)
Review
INTRODUCTION
is an opportunistic, human-specific fungus that causes pneumonia (PCP). PCP symptoms are nonspecific. A patient with and another lung infection faces a diagnostic challenge. It may be difficult to determine which of these agents is responsible for the clinical symptoms, preventing effective treatment. Diagnostic and treatment efforts have been made more difficult by the rising frequency with which coronavirus 2019 (COVID-19) and PCP co-occur.
AREAS COVERED
Herein, we provide a comprehensive review of clinical and pharmacological recommendations along with a literature review of PCP in immunocompromised patients focusing on HIV-uninfected patients.
EXPERT OPINION
PCP may be masked by identifying co-existing pathogens that are not necessarily responsible for the observed infection. Patients with severe form COVID-19 should be examined for underlying immunodeficiency, and co-infections must be considered as co-infection with may worsen COVID-19's severity and fatality. PCP should be investigated in patients with PCP risk factors who come with pneumonia and suggestive radiographic symptoms but have not previously received PCP prophylaxis. PCP prophylaxis should be explored in individuals with various conditions that impair the immune system, depending on their PCP risk.
Topics: Humans; Pneumonia, Pneumocystis; COVID-19; Pneumocystis carinii; Immunocompromised Host; HIV Infections
PubMed: 36440485
DOI: 10.1080/17476348.2022.2152332 -
Der Internist Jul 2019Pneumocystis jirovecii pneumonia (PcP) has for many years been reported mostly in human immunodeficiency virus-infected patients. Increasingly, it also affects other... (Review)
Review
Pneumocystis jirovecii pneumonia (PcP) has for many years been reported mostly in human immunodeficiency virus-infected patients. Increasingly, it also affects other immunocompromised patients, e.g. after organ or allogeneic stem cell/bone marrow transplantation, patients with hematologic malignancies or autoimmune diseases. The diagnosis of PcP relies on a critical evaluation of clinical symptoms, risk factors, radiologic features and microbiological tests. High dose cotrimoxazole is the most effective therapeutic option. Rapid initiation is essential, since mortality is especially high in patients admitted to intensive care with respiratory failure. This article reviews the current epidemiology of PcP and highlights the diagnostic and therapeutic options. Recommendations for primary and secondary prophylaxis are summarized.
Topics: Anti-Bacterial Agents; HIV Infections; Humans; Immunocompromised Host; Opportunistic Infections; Pneumocystis Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 31089770
DOI: 10.1007/s00108-019-0616-5 -
BMJ Open Respiratory Research Mar 2021Although asthma is the most commonly diagnosed respiratory disease, its pathogenesis is complex, involving both genetic and environmental factors. A role for the...
BACKGROUND
Although asthma is the most commonly diagnosed respiratory disease, its pathogenesis is complex, involving both genetic and environmental factors. A role for the respiratory microbiome in modifying asthma severity has been recently recognised. Airway colonisation by has previously been associated with multiple chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and severe asthma (SA). Decreased incidence of pneumonia in HIV-infected individuals and reduced severity of COPD is associated with naturally occurring antibody responses to the antigen, Kexin (KEX1).
METHODS
104 paediatric patients were screened for KEX1 IgG reciprocal end point titre (RET), including 51 with SA, 20 with mild/moderate asthma, 20 non-asthma and 13 with cystic fibrosis (CF) in a cross-sectional study.
RESULTS
Patients with SA had significantly reduced KEX1 titres compared with patients with mild/moderate asthma (p=0.018) and CF (p=0.003). A binary KEX1 RET indicator was determined at a threshold of KEX1 RET=1000. Patients with SA had 4.40 (95% CI 1.28 to 13.25, p=0.014) and 17.92 (95% CI 4.15 to 66.62, p<0.001) times the odds of falling below that threshold compared with mild/moderate asthma and patients with CF, respectively. Moreover, KEX1 IgG RET did not correlate with tetanus toxoid IgG (r=0.21, p=0.82) or total IgE (r=0.03, p=0.76), indicating findings are specific to antibody responses to KEX1.
CONCLUSIONS
Paediatric patients with SA may be at higher risk for chronic infections and asthma symptom exacerbation due to reduced levels of protective antibodies. Plasma KEX1 IgG titre may be a useful parameter in determining the clinical course of treatment for paediatric patients with asthma.
Topics: Antibody Formation; Asthma; Child; Cross-Sectional Studies; Humans; Pneumocystis; Pneumonia, Pneumocystis
PubMed: 33762359
DOI: 10.1136/bmjresp-2020-000842