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Ishaq MS, Arabi EY. The prevalence of pneumothorax in human immunodeficiency virus patients. A single center study. Saudi Med J 2024; 45:442-445. [PMID: 38657977 DOI: 10.15537/smj.2024.45.4.20230807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To assess the prevalence, risk factors, and associated complications of pneumothorax that are present in patients with human immunodeficiency virus (HIV) at our institution and to provide an updated local study addressing the association between pneumothorax and HIV. METHODS This retrospective cohort study examined 161 patients who were admitted with a diagnosis of HIV from June 2017 to May 2022. They were divided into 2 groups depending on the presence of pneumothorax during their stay. Multiple variables were studied, including age, gender, tuberculosis infection, pneumocystis jiroveci pneumonia (PJP)infection, bacterial pneumonia, and pneumothorax type and treatment course. RESULTS There were 11 patients diagnosed with pneumothorax (prevalence rate: 6.8%). Bacterial lung infection was found in 9 (81.8%) of these patients, while fungal infection was found in 6 (54.5%) (p<0.001, 0.010). The MTB was found in 3 (27.3%) patients (p=0.728), while none were infected with PJP. Intercostal tube insertion was attempted in 9 (81.8%) patients, the mean duration of tube stay was 39.3±30.7 days, and the mortality rate was 72.7% (p=0.007). CONCLUSION Pneumothorax in patients with HIV is a manifestation of the progression of the disease and its poor outcome. It has a complicated treatment course and a high mortality rate.
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Affiliation(s)
- Mohammed S Ishaq
- From the Thoracic Surgery Department (Ishaq), King Saud Medical City, and from the General Surgery Department (Arabi), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Esraa Y Arabi
- From the Thoracic Surgery Department (Ishaq), King Saud Medical City, and from the General Surgery Department (Arabi), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Saadatzadeh T, Angarone M, Stosor V. Pneumocystis jirovecii in solid organ transplant recipients: updates in epidemiology, diagnosis, treatment, and prevention. Curr Opin Infect Dis 2024; 37:121-128. [PMID: 38230604 DOI: 10.1097/qco.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
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.
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Affiliation(s)
| | | | - Valentina Stosor
- Divisions of Infectious Diseases
- Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Ahmadpour E, Valilou S, Ghanizadegan MA, Seyfi R, Hosseini SA, Hatam-Nahavandi K, Hosseini H, Behravan M, Barac A, Morovati H. Global prevalence, mortality, and main characteristics of HIV-associated pneumocystosis: A systematic review and meta-analysis. PLoS One 2024; 19:e0297619. [PMID: 38526997 PMCID: PMC10962827 DOI: 10.1371/journal.pone.0297619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 03/27/2024] Open
Abstract
The epidemiology of Human Immunodeficiency Virus (HIV)-associated pneumocystosis (HAP) is poorly described on a worldwide scale. We searched related databases between January 2000 and December 2022 for studies reporting HAP. Meta-analysis was performed using StatsDirect (version 2.7.9) and STATA (version 17) according to the random-effects model for DerSimonian and Laird method and metan and metaprop commands, respectively. Twenty-nine studies with 38554 HIV-positive, 79893 HIV-negative, and 4044 HAP populations were included. The pooled prevalence of HAP was 35.4% (95% CI 23.8 to 47.9). In contrast, the pooled prevalence of PCP among HIV-negative patients was 10.16% (95% CI 2 to 25.3). HIV-positive patients are almost 12 times more susceptible to PCP than the HIV-negative population (OR: 11.710; 95% CI: 5.420 to 25.297). The mortality among HAP patients was 52% higher than non-PCP patients (OR 1.522; 95% CI 0.959 to 2.416). HIV-positive men had a 7% higher chance rate for PCP than women (OR 1.073; 95% CI 0.674 to 1.706). Prophylactic (OR: 6.191; 95% CI: 0.945 to 40.545) and antiretroviral therapy (OR 3.356; 95% CI 0.785 to 14.349) were used in HAP patients six and three times more than HIV-positive PCP-negatives, respectively. The control and management strategies should revise and updated by health policy-makers on a worldwide scale. Finally, for better management and understanding of the epidemiology and characteristics of this coinfection, designing further studies is recommended.
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Affiliation(s)
- Ehsan Ahmadpour
- Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sevda Valilou
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rouhollah Seyfi
- Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Abdollah Hosseini
- Department of Parasitology and Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hanieh Hosseini
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Behravan
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia
| | - Hamid Morovati
- Department of Medical Mycology and Parasitology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Sun YS, Huang DF, Chen WS, Liao HT, Chen MH, Tsai MT, Yang CY, Lai CC, Tsai CY. Risk Factors and Incidence of Serious Infections in Patients With Systemic Lupus Erythematosus Undergoing Rituximab Therapy. J Rheumatol 2024; 51:160-167. [PMID: 37839817 DOI: 10.3899/jrheum.2023-0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To evaluate the risk and protective factors of serious infection (SI) in patients with systemic lupus erythematosus (SLE) within 180 days of rituximab (RTX) treatment. METHODS Patients with SLE treated with RTX were analyzed. SI was defined as any infectious disease requiring hospitalization. The clinical characteristics, laboratory profiles, medications, and incidence rate (IR) are presented. Multivariate Cox proportional hazards models and Kaplan-Meier analysis for risk factors of SI were performed. RESULTS A total of 174 patients with SLE receiving RTX treatment were enrolled. The overall IR of SIs was 51.0/100 patient-years (PYs). Pneumonia (30.4/100 PYs), followed by soft tissue infections, intra-abdominal infections, and Pneumocystis jiroveci pneumonia (all 6.1/100 PYs) were the leading types of SIs. Twelve patients died during the 180-day follow-up (crude mortality rate: 14.6/100 PYs). Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 (hazard ratio [HR] 2.88, 95% CI 1.30-6.38), and a background prednisolone (PSL) equivalent dosage ≥ 15 mg/day (HR 3.50, 95% CI 1.57-7.78) were risk factors for SIs among all patients with SLE. Kaplan-Meier analysis confirmed the risk of SI for patients with SLE with CKD and a background PSL equivalent dosage ≥ 15 mg/day (log-rank P = 0.001 and 0.02, respectively). Hydroxychloroquine (HCQ) reduced the risk of SIs in patients with SLE (HR 0.35, 95% CI 0.15-0.82; log-rank P = 0.003). CONCLUSION SI was prevalent in patients with SLE after RTX treatment. Patients with SLE with CKD and high-dose glucocorticoid use required constant vigilance. HCQ may reduce the risk of SI among patients with SLE administered RTX.
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Affiliation(s)
- Yi-Syuan Sun
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - De-Feng Huang
- D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei
| | - Wei-Sheng Chen
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Hsien-Tzung Liao
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Han Chen
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Tsun Tsai
- M.T. Tsai, MD, PhD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, and Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chih-Yu Yang
- C.Y. Yang, MD, PhD, Division of Nephrology, Department of Medicine, Veterans General Hospital, and Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, and Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, and Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, and Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Chien-Chih Lai
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei;
| | - Chang-Youh Tsai
- C.Y. Tsai, MD, PhD, Division of Immunology and Rheumatology, Department of Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
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Nettleton E, Sattui SE, Wallace Z, Putman M. Incidence of Pneumocystis Jiroveci Pneumonia in Patients With ANCA-Associated Vasculitis Initiating Therapy With Rituximab or Cyclophosphamide. Arthritis Care Res (Hoboken) 2024; 76:288-294. [PMID: 37643919 PMCID: PMC10841679 DOI: 10.1002/acr.25222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/28/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This manuscript assesses the incidence of Pneumocystis jiroveci pneumonia (PJP) among patients receiving contemporary treatment regimens for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and adverse events associated with PJP prophylaxis. METHODS Incident users of rituximab or cyclophosphamide for AAV were identified in the TriNetX electronic health records database from 2011 to 2022. The incidence rates (IRs) of PJP in the first 6 months of induction therapy with rituximab and/or cyclophosphamide and during postinduction maintenance therapy with rituximab were calculated. Cox proportional hazard models were used to estimate hazard ratios (HRs) and confidence intervals (CIs) for the risk of adverse events commonly associated with PJP prophylaxis. RESULTS We identified 1,461 AAV cases who received induction therapy with rituximab (69.7%), cyclophosphamide (18.9%), or both (11.4%). Prophylaxis prescribed within 30 days of induction included trimethoprim-sulfamethoxazole (30.7%), atovaquone (5.4%), dapsone (3.8%), and pentamidine (0.8%). During induction therapy, 10 cases of PJP were identified (IR 15.0 cases per 1,000 patient-years); no deaths occurred. In adjusted analyses, those who received prophylaxis had a higher risk of leukopenia (HR 3.1; 95% CI 1.1-8.6), rash (HR 1.9; 95% CI 1.0-3.6), and nephropathy (HR 2.6; 95% CI 1.3-5.1) than those who did not. During rituximab maintenance therapy (n = 709), five cases of PJP were identified (IR 2.1 cases per 1,000 person-years), one of whom died during the hospitalization associated with a PJP diagnosis. CONCLUSION Rates of PJP in patients with AAV were lower than previously observed, and few cases occurred during rituximab maintenance therapy. PJP prophylaxis was associated with adverse events.
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Affiliation(s)
| | - Sebastian E Sattui
- University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Hashimoto M, Hiraiwa M, Uchitani K, Ueda M, Tanaka M, Nishiyama N, Miyashita N. Sulfamethoxazole-trimethoprim for pneumocystis pneumonia prophylaxis, causes of discontinuation and thrombocytopenia observed during administration: A single-center retrospective study. J Infect Chemother 2024; 30:141-146. [PMID: 37797822 DOI: 10.1016/j.jiac.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The development of pneumocystis pneumonia (PCP) has recently become a growing concern; thus, its prevention has become increasingly important. Sulfamethoxazole-trimethoprim (ST) is a cost-effective first-line and prophylactic treatment for PCP. However, ST administration criteria for PCP prophylaxis remain unclear and are often discontinued because of adverse events (AEs). In this study, we aimed to investigate the causes of ST discontinuation and the associated AEs using objective data. METHODS We retrospectively analyzed the data of 162 patients admitted to Kansai Medical University Hospital between January 2018 and December 2020, who received ST for PCP prophylaxis. We compared clinical characteristics, laboratory data, and incidence of AEs between ST non-discontinuation and ST discontinuation groups. Additionally, we divided the patients into non-developing and developing thrombocytopenia (≥ Grade 1) groups based on the investigation results. RESULTS No patients developed PCP while receiving ST. The most common causes of ST discontinuation were thrombocytopenia (37%), liver dysfunction (20%), and rash (18%). Multivariate analysis revealed thrombocytopenia (≥ Grade 1) as a factor significantly associated with ST discontinuation. Furthermore, we identified three factors correlated with thrombocytopenia (≥ Grade 1): age ≥50 years, lymphocyte count <1000/μL, and platelet count <180,000/μL. CONCLUSIONS Patients with the aforementioned factors are at higher risk of developing thrombocytopenia (≥ Grade 1) during ST administration for PCP prophylaxis. Therefore, platelet count monitoring is essential to enhance safety and efficacy of ST treatment. Nonetheless, further research is warranted to explore additional implications and interventions.
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Affiliation(s)
- Misaki Hashimoto
- Department of Pharmacy, Kansai Medical University Hospital, Osaka, Japan.
| | - Miho Hiraiwa
- Department of Pharmacy, Kansai Medical University Hospital, Osaka, Japan
| | - Kazuki Uchitani
- Department of Pharmacy, Kansai Medical University Hospital, Osaka, Japan
| | - Masahiro Ueda
- Faculty of Pharmaceutical Sciences, Setsunan University, Osaka, Japan
| | - Masayuki Tanaka
- Faculty of Pharmaceutical Sciences, Setsunan University, Osaka, Japan
| | - Norito Nishiyama
- Department of Pharmacy, Kansai Medical University Hospital, Osaka, Japan; Department of Infection Control, Kansai Medical University Hospital, Osaka, Japan
| | - Naoyuki Miyashita
- Department of Infection Control, Kansai Medical University Hospital, Osaka, Japan
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Robin C, Cordonnier C, Tridello G, Knelange N, Xhaard A, Chantepie S, Tanguy-Schmidt A, Schouten HC, Yeshurun M, Rocha V, Srour M, Kröger N, Ledoux MP, Dalgaard J, Thiebaut A, Giardino S, Calore E, Zuckerman T, Groll AH, Raida L, Avcin S, Vicent MG, Kaare A, Drozd-Sokolowska J, Turlure P, Bretagne S, Mikulska M, Camara RDL, Cesaro S, Styczynski J. Pneumocystis Pneumonia After Allogeneic Hematopoietic Cell Transplantation: A Case-Control Study on Epidemiology and Risk Factors on Behalf of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:235.e1-235.e10. [PMID: 38007092 DOI: 10.1016/j.jtct.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
Pneumocystis pneumonia (PCP) is a life-threatening complication after allogeneic hematopoietic cell transplantation (allo-HCT). However, allo-HCT procedures have evolved toward older patients, unrelated donors, and reduced-intensity conditioning, possibly modifying the risks. Polymerase chain reaction (PCR), widely used nowadays, is more sensitive than microscopy diagnostic methods. This study aimed to assess the factors associated with PCP in allo-HCT recipients within 2 years of HCT and managed according to current procedures. This multicenter, nested case-control study included PCP cases diagnosed by PCR, cytology, or immunofluorescence on bronchoalveolar lavage fluid between 2016 and 2018. Two controls per case were selected from the ProMISe registry and matched for the center, transplant date, and underlying disease. Fifty-two cases and 104 controls were included among the 5452 patients who underwent allo-HCT in the participating centers. PCP occurred at a median of 11.5 months after transplantation. The mortality rate was 24% on day 30 after the PCP diagnosis and 37% on day 90. The clinical presentation and mortality rates of the 24 patients diagnosed using only PCR were not different from those diagnosed with microscopy methods. Our study demonstrates a substantial incidence of, and mortality from, PCP, after allogeneic HCT despite well-established prophylactic approaches. In our experience, PCP nowadays occurs later after transplant than previously reported, justifying the prolongation of prophylaxis after six months in many cases. Allo-HCT recipients diagnosed with PCR as the only PCP marker should benefit from specific treatment as for other patients.
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Affiliation(s)
- Christine Robin
- Department of Haematology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France.
| | - Catherine Cordonnier
- Department of Haematology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
| | - Gloria Tridello
- Department of Mother and Child, Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Alienor Xhaard
- Haematology Transplant Unit, APHP, Saint-Louis Hospital, Paris, France
| | - Sylvain Chantepie
- Basse-Normandie Haematology Institute, Caen University Hospital, Caen, France
| | - Aline Tanguy-Schmidt
- Blood Diseases Department, France Federation University Hospital "Grand Ouest against Leukemia", Angers France; CRCI2NA, Angers, France
| | | | - Moshe Yeshurun
- Institute of Hematology, Rabin Medical Center, Petach Tikva, Israel
| | - Vanderson Rocha
- Hematology Bone Marrow Transplant Unit, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Micha Srour
- Department of Haematology, Lille University Hospital, Lille, France
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Marie-Pierre Ledoux
- Department of Haematology, Cancer Institute of Strasburg, Strasbourg, France
| | - Jakob Dalgaard
- Department of Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Thiebaut
- Department of Haematology, Grenoble Alpes University Hospital, Grenoble, France
| | - Stefano Giardino
- Haematopoietic Stem Cell Transplantation Unit IRCCS Istituto Giannina Gaslini, Pediatric Haematology and Oncology, Genova, Italy
| | - Elisabetta Calore
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Tsila Zuckerman
- Department of Haematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Pediatric Haematology/Oncology, University Children's Hospital, Infectious Disease Research Program, Munster, Germany
| | - Ludek Raida
- Department of Haemato-Oncology, Olomouc University Hospital, Olomouc, Czech Republic
| | | | | | - Ain Kaare
- Clinic of Haematology and Oncology, Tartu University Hospital, Tartu, Estonia
| | - Joanna Drozd-Sokolowska
- Department of Haematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Pascal Turlure
- Department of Haematology, Limoges University Hospital, Limoges, France
| | | | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL), Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rafael de la Camara
- Department of Haematology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Simone Cesaro
- Department of Mother and Child, Pediatric Haematology Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Jan Styczynski
- Pediatric Haematology and Oncology, University Hospital, Collegium Medicum UMK, Bydgoszcz, Poland
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Lukose L, Shantaram PM, Raj A, Nair G, Shaju AM, K Subeesh V. Purine antimetabolites associated Pneumocystis jirovecii pneumonia. Pharmacoepidemiol Drug Saf 2023; 32:1244-1251. [PMID: 37265365 DOI: 10.1002/pds.5647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/06/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To detect the possible safety signal of purine antimetabolites associated with Pneumocystis jirovecii pneumonia through disproportionality analysis in the FDA Adverse Event Reporting System (FAERS) Database. METHODS A case/non-case retrospective disproportionality analysis was performed in the publicly available FAERS database using AERSmine (2004Q1-2021Q3). Four models were developed to explore the signal strength of PAs among different populations with possible confounding factors. Reporting odds ratio (ROR) and Proportional reporting ratio (PRR) was used as the data mining algorithm for the analysis. A value of ROR-1.96SE > 1 and PRR ≥ 2 with an associated X2 value of 4 or more was considered the threshold for a signal. RESULTS A total of 7073 reports associated with Pneumocystis jirovecii pneumonia were present in the database, of which 899 reports were associated with purine antimetabolites. A crude signal strength of ROR 15.76(14.70-16.91) was obtained for purine antimetabolites associated PJP, with the highest signal strength reported with fludarabine and thioguanine [ROR 19.63(17.42-22.13); 19.45(13.21-28.63)]. Stratifying the cases based on autoimmune disorders and the cancer population revealed an ROR of 3.33(2.46-4.50) and 2.93(2.26-3.79) respectively. The highest risk of PJP with use of PAs was observed amongst children with a higher risk of nearly 2 times than the adult population [ROR 11.57(9.16-14.62)]. CONCLUSIONS Our study provided evidence on the occurrence of PJP with the use of purine antimetabolites among the autoimmune and cancer population. We identified signals for PJP with azathioprine, mercaptopurine, thioguanine, cladribine, fludarabine, and clofarabine. More research with a superior epidemiological study design of a defined population is required to validate these findings.
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Affiliation(s)
- Lipin Lukose
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pawar Mansi Shantaram
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Alan Raj
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gouri Nair
- Faculty of Pharmacy, Department of Pharmacology, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Aina M Shaju
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Viswam K Subeesh
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sugi T, Mita M, Kushi R, Hanai H, Uchida T, Inoue M, Hagihara M. Prevention of pneumocystis pneumonia in patients with hematological diseases: Efficacy of low-dose atovaquone. Int J Clin Pharmacol Ther 2023; 61:515-519. [PMID: 37622674 DOI: 10.5414/cp204368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE At our institution, patients with hematological disease who require Pneumocystis jirovecii pneumonia (PJP) prophylaxis were administered atovaquone at a low dose (750 mg/day). However, there have been few reports on the efficacy of low-dose atovaquone administration, and the purpose of this study is, therefore, to investigate its effectiveness. MATERIALS AND METHODS We investigated the expression of PJP in patients with hematological disease who received atovaquone administration. Atovaquone was administered at a low dose of 750 mg once daily, and the follow-up time was the period of PJP prophylaxis that included atovaquone administration. RESULTS 85 patients were included in the study. The median age of the study population was 72 years (range: 33 - 97). The duration of atovaquone treatment and follow-up time were 150 days (22 - 1,018) and 258 days (22 - 1,457), respectively. In hematologic diseases, multiple myeloma was high in 31 patients and malignant lymphoma in 28 patients. No patients exhibited PJP during the observation period. CONCLUSION In hematological disease patients with relatively low risk of PJP, low-dose atovaquone may prevent the onset of PJP.
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Park JW, Curtis JR, Choi SR, Kim MJ, Ha YJ, Kang EH, Lee YJ, Lee EB. Risk-Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab. Arthritis Rheumatol 2023; 75:2036-2044. [PMID: 37096489 DOI: 10.1002/art.42541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To identify a specific population of patients with rheumatic diseases receiving rituximab treatment for whom the benefit from primary prophylaxis against Pneumocystis jirovecii pneumonia (PJP) outweighs the risk of adverse events (AEs). METHODS This study included 818 patients treated with rituximab for rheumatic diseases, among whom 419 received prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) with rituximab, while the remainder did not. Differences in 1-year PJP incidence between the groups were estimated using Cox proportional hazards regression. Risk-benefit assessment was performed in subgroups stratified according to risk factors based on the number needed to treat (NNT) to prevent 1 case of PJP and the number needed to harm (NNH) due to severe AEs. Inverse probability of treatment weighting was applied to minimize the confounding by indication. RESULTS During the 663.1 person-years, there were 11 PJP cases, with a mortality rate of 63.6%. Concomitant use of high-dose glucocorticoids (≥30 mg/day of prednisone or equivalent during 4 weeks after rituximab administration) was the most important risk factor. The PJP incidence (per 100 person-years) was 7.93 (95% confidence interval [95% CI] 2.91-17.25) in the subgroup receiving high-dose glucocorticoids compared with 0.40 (95% CI 0.01-2.25) in the subgroup without high-dose glucocorticoid use. Although prophylactic TMP/SMX significantly reduced the overall PJP incidence (HR 0.11 [95% CI 0.03-0.43]), the NNT to prevent 1 case of PJP (146) was higher than the NNH (86). In contrast, the NNT fell to 20 (95% CI 10.7-65.7) in patients receiving concomitant high-dose glucocorticoids. CONCLUSION The benefit associated with primary PJP prophylaxis outweighs the risk of severe AEs in patients with rheumatic diseases receiving rituximab and concomitant high-dose glucocorticoid treatment.
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Affiliation(s)
- Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeffrey R Curtis
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham
| | - Se Rim Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Min Jung Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University, Boramae Medical Center, Seoul, Republic of Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, and Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
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11
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Chen X, Shu X, He L, Yang H, Lu X, Wang G, Ge Y. High prevalence and mortality of Pneumocystis jirovecii pneumonia in anti-MDA5 antibody-positive dermatomyositis. Rheumatology (Oxford) 2023; 62:3302-3309. [PMID: 36734589 DOI: 10.1093/rheumatology/kead063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/15/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To identify potential risk factors and prognostic factors of Pneumocystis jirovecii pneumonia (PJP) infection in anti-melanoma differentiation-associated gene 5 antibody-positive DM (anti-MDA5+ DM) patients, and to evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS). METHODS Anti-MDA5+ DM patients who underwent mNGS or real-time PCR for PJP detection were recruited. The potential risk factors for PJP occurrence and death were analysed via Logistic regression and Cox proportional hazards regression, respectively. The diagnostic efficacy of mNGS was compared with the conventional methods. RESULTS 91 patients were enrolled and 44 were assigned to PJP+ group. The PJP detection rate was 48.4%. PJP often occurred in the first 3 months (68.2%) of the disease; this period also showed the highest mortality rate (20.5%). Fever and increased lactate dehydrogenase (LDH) were independent risk factors for PJP occurrence, while trimethoprim-sulfamethoxazole (TMP/SMZ) prophylaxis was an independent protective factor (all P < 0.05). Older age and increased LDH were predictors for mortality in patients with anti-MDA5+ DM and PJP (all P < 0.05). In addition, we found that mNGS had a sensitivity of 100.0% and specificity of 90.0% in diagnosing PJP, with the highest area under the curve of 0.95 (P < 0.001). CONCLUSION PJP has high prevalence and mortality in anti-MDA5+ DM. It is crucial for clinicians to identify high-risk patients and promptly institute TMP/SMZ to prevent PJP. mNGS is the preferred approach for pathogen detection in anti-MDA5+ DM when PJP is suspected.
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Affiliation(s)
- Xixia Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xiaoming Shu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Linrong He
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Hanbo Yang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Xin Lu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Yongpeng Ge
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
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Lala MM. The 'pulmonary diseases spectrum' in HIV infected children. Indian J Tuberc 2023; 70 Suppl 1:S49-S58. [PMID: 38110260 DOI: 10.1016/j.ijtb.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 12/20/2023]
Abstract
Despite advances in diagnostic, therapeutic and preventive strategies for HIV, pulmonary diseases continue to be the major cause of morbidity and mortality in infants and children infected with HIV. With effective programs to prevent perinatal HIV-1 transmission to early diagnosis in infants, we have seen a substantial decline in paediatric HIV incidence. Early initiation of Highly Active Anti-Retroviral Therapy (HAART) in all HIV infected children coupled with consistent use of Pneumocystis prophylaxis in all HIV exposed/infected children under 5 years of age has considerably reduced associated infections overall and respiratory infections in particular. In developing countries already burdened with poverty, malnutrition, suboptimal immunization coverage and limited access to health care and treatment, acute and chronic HIV-associated respiratory disease remain a major cause for concern. Prevention of severe respiratory infections in advanced HIV disease among children consists mostly of rapid and optimal HAART initiation & continuation, preventing severe TB disease with BCG and TB preventive treatment, preventing Pneumocystis jirovecii pneumonia with cotrimoxazole prophylaxis and administering age-appropriate vaccinations and catch-up vaccines as per National Immunization schedule.
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Affiliation(s)
- Mamatha Murad Lala
- Department of Pediatrics, KB Bhabha Hospital, Bandra West, D-9, Park Bay, 295, Vidyanagari Road, Kalina, Santacruz [E], Mumbai, 400098, Maharashtra, India.
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Zhong Y, Ji T, Qin D, Cheng D. Clinical characteristics and risk factors of in-hospital mortality in patients coinfected with Pneumocystis jirovecii and Aspergillus. J Mycol Med 2023; 33:101330. [PMID: 36265259 DOI: 10.1016/j.mycmed.2022.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/20/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To analyze clinical characteristics and risk factors for in-hospital mortality in patients coinfected with P. jirovecii and Aspergillus. METHODS This study included 53 patients with coinfection of P. jirovecii pneumonia (PJP) and invasive pulmonary aspergillosis (IPA) in our center from January 2011 to December 2021. All cases were divided into survivor (n=27) and non-survivor groups (n=26). Medical records, laboratory and radiology data were collected. Risk factors for in-hospital mortality were identified by multivariable analyses. RESULTS HIV-positive patients accounted for 3.8%. Fever (77.4%), dyspnea (69.8%) and wet cough (24.5%) were common symptoms. Ground-glass opacity (83.0%), consolidation (71.7%), septal thickening (66.0%), and nodules (54.7%) were the most common radiological signs. CD4+ T cell count and serum albumin (ALB) level were significantly lower in non-survival group than in the survival group. Conversely, serum lactate dehydrogenase (LDH) and procalcitonin (PCT) levels were higher in non-survival group than in survival group. Lactic acidosis [odds ratio (OR): 33.999,95% confidential interval (CI): 3.112-371.409; p=0.004], low CD4+ T cell count (<114 cell/µL) [OR: 19.343, 95% CI: 1.533-259.380; p=0.022] and high level of LDH (> 519 U/L) [OR: 11.422, 95% CI: 1.271-102.669; p=0.030] were independent risk factors for mortality. CONCLUSION PJP coinfected with IPA incurs high mortality with nonspecific clinical characteristics and is more likely to involve HIV-negative patients. Lactic acidosis, low CD4+ T cell count and high LDH level are independent risk factors for mortality, close monitoring of these parameters is necessary to help distinguish high-risk patients and make appropriate clinical decisions.
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Affiliation(s)
- Yuxia Zhong
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China
| | - Ting Ji
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China
| | - Dan Qin
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China
| | - Deyun Cheng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China.
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Szydłowicz M, Królak-Olejnik B, Vargas SL, Zajączkowska Ż, Paluszyńska D, Szczygieł A, Matos O, Hendrich AB, Kicia M. Pneumocystis jirovecii Colonization in Preterm Newborns With Respiratory Distress Syndrome. J Infect Dis 2022; 225:1807-1810. [PMID: 33857302 PMCID: PMC9113508 DOI: 10.1093/infdis/jiab209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/14/2021] [Indexed: 11/14/2022] Open
Abstract
We describe the prevalence of Pneumocystis jirovecii in mother-infant pairs of very low birth weight newborns <32 weeks gestation. Molecular and microscopic methods were used for detection of P. jirovecii in patients' specimens. Pneumocystis DNA was detected in 8 nasopharyngeal aspirates (14%) of 56 newborns and in 7 oral washes (21%) of 34 mothers. Pneumocystis detection immediately after birth suggests the possibility of its transplacental transmission. Compared to noncolonized infants, more frequent occurrence of bronchopulmonary dysplasia was seen in colonized infants (P = .02), suggesting a potential clinical importance of this pathogen in abnormal lung development.
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Affiliation(s)
- Magdalena Szydłowicz
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Sergio L Vargas
- Instituto de Ciencias Biomédicas, Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Żaneta Zajączkowska
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Paluszyńska
- Department and Clinic of Neonatology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Szczygieł
- Department and Clinic of Neonatology, Wroclaw Medical University, Wroclaw, Poland
| | - Olga Matos
- Unit of Medical Parasitology, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Andrzej B Hendrich
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Kicia
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
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Sonomoto K, Tanaka H, Nguyen TM, Yoshinari H, Nakano K, Nakayamada S, Tanaka Y. Prophylaxis against pneumocystis pneumonia in rheumatoid arthritis patients treated with b/tsDMARDs: insights from 3787 cases in the FIRST registry. Rheumatology (Oxford) 2022; 61:1831-1840. [PMID: 34382090 PMCID: PMC9071566 DOI: 10.1093/rheumatology/keab647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The use of biologic and targeted synthetic (b/ts) DMARDs in the treatment of RA is increasing. Therefore, prevention of b/tsDMARDs-induced infection is important. Here we describe a prophylaxis protocol for preventing pneumocystis pneumonia (PCP) in RA patients treated with b/tsDMARDs. METHODS The study subjects were 3787 RA patients from the FIRST registry. They were divided into cohort 1 (n = 807, requiring prophylaxis against PCP based on physicians' assessment at the point of new treatment with or switch to b/tsDMARDs) and cohort 2 (n = 2980, receiving strategic PCP prophylaxis). The incidence and risk factors for PCP were investigated. RESULTS Twenty-six PCP cases were observed throughout the study. After the introduction of strategic PCP prophylaxis, PCP incidence diminished from 0.51/100 person-years (PYs) to 0.21/100 PYs (risk ratio = 0.42). Sulfamethoxazole and trimethoprim in combination (SMX-TMP) showed greater efficacy in the prevention of PCP than pentamidine inhalation (P <0.0001). The prophylaxis rate increased chronologically despite the falls in the average SMX-TMP dose and in the incidence of PCP. Subanalysis of the data for 929 patients from both groups who did not receive prophylaxis showed that old age, high BMI, coexisting lung diseases, low lymphocyte count, and low serum IgG levels increased the risk of PCP development. Development of PCP could be predicted (using an equation based on these variables) in patients not treated with glucocorticoids [area under the curve (AUC) = 0.910)], but less accurately in those on glucocorticoids (AUC = 0.746). CONCLUSIONS Our study clarified the risk factors for PCP in RA patients on b/tsDMARDs treatment and highlighted and defined the criteria for effective prophylaxis against PCP.
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Affiliation(s)
- Koshiro Sonomoto
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Hiroaki Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Tuan Manh Nguyen
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Hiroko Yoshinari
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Kazuhisa Nakano
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Shingo Nakayamada
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
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Ohmura SI, Homma Y, Masui T, Miyamoto T. Factors Associated with Pneumocystis jirovecii Pneumonia in Patients with Rheumatoid Arthritis Receiving Methotrexate: A Single-center Retrospective Study. Intern Med 2022; 61:997-1006. [PMID: 34511571 PMCID: PMC9038457 DOI: 10.2169/internalmedicine.8205-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the risk factors for the development of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy. Methods This single-center retrospective cohort study included consecutive patients with RA who received MTX for at least one year. The study population was divided into PCP and non-PCP groups, depending on the development of PCP, and their characteristics were compared. We excluded patients who received biologic disease-modifying anti-rheumatic drugs (DMARDs), Janus kinase inhibitors, and anti-PCP drugs for prophylaxis. Results Thirteen patients developed PCP, and 333 did not develop PCP. At the initiation of MTX therapy, the PCP group had lower serum albumin levels, a higher frequency of pulmonary disease and administration of DMARDs, and received a higher dosage of prednisolone (PSL) than the non-PCP group. A multivariate Cox regression analysis revealed that the concomitant use of PSL [hazard ratio (HR) 5.50, p=0.003], other DMARDs (HR 5.98, p=0.002), and serum albumin <3.5 mg/dL (HR 4.30, p=0.01) were risk factors for the development of PCP during MTX therapy. Patients with these risk factors had a significantly higher cumulative probability of developing PCP than patients who lacked these risk factors. Conclusion Clinicians should pay close attention to patients with RA who possess risk factors for the development of PCP during MTX therapy.
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Affiliation(s)
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Takayuki Masui
- Department of Radiology, Seirei Hamamatsu General Hospital, Japan
| | - Toshiaki Miyamoto
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Japan
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Haseeb A, Abourehab MAS, Almalki WA, Almontashri AM, Bajawi SA, Aljoaid AM, Alsahabi BM, Algethamy M, AlQarni A, Iqbal MS, Mutlaq A, Alghamdi S, Elrggal ME, Saleem Z, Radwan RM, Mahrous AJ, Faidah HS. Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review. Int J Environ Res Public Health 2022; 19:ijerph19052833. [PMID: 35270525 PMCID: PMC8910260 DOI: 10.3390/ijerph19052833] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: Pneumocystis jirovecii pneumonia (PCP) has a substantial impact on the morbidity and mortality of patients, especially those with autoimmune disorders, thus requiring optimal dosing strategies of Trimethoprim–Sulfamethoxazole (TMP-SMX). Therefore, to ensure the safety of TMP-SMX, there is a high demand to review current evidence in PCP patients with a focus on dose optimization strategies; (2) Methods: Various databases were searched from January 2000 to December 2021 for articles in English, focusing on the dose optimization of TMP-SMX. The data were collected in a specific form with predefined inclusion and exclusion criteria. The quality of each article was evaluated using a Newcastle–Ottawa Scale (NOS) for retrospective studies, Joanna Briggs Institute (JBI) critical checklist for case reports, and Cochrane bias tool for randomized clinical trials (RCTs); (3) Results: Thirteen studies met the inclusion criteria for final analysis. Of the 13 selected studies, nine were retrospective cohort studies, two case reports, and two randomized controlled trials (RCT). Most of the studies compared the high-dose with low-dose TMP-SMX therapy for PCP. We have found that a low dose of TMP-SMX provides satisfactory outcomes while reducing the mortality rate and PCP-associated adverse events. This strategy reduces the economic burden of illness and enhances patients’ compliance to daily regimen plan; (4) Conclusions: The large-scale RCTs and cohort studies are required to improve dosing strategies to prevent initial occurrence of PCP or to prevent recurrence of PCP in immune compromised patients.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (W.A.A.); (A.M.A.); (S.A.B.); (M.E.E.); (A.J.M.)
- Correspondence:
| | - Mohammed A. S. Abourehab
- Department of Pharmaceutics, Faculty of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Wesam Abdulghani Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (W.A.A.); (A.M.A.); (S.A.B.); (M.E.E.); (A.J.M.)
| | - Abdulrahman Mohammed Almontashri
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (W.A.A.); (A.M.A.); (S.A.B.); (M.E.E.); (A.J.M.)
| | - Sultan Ahmed Bajawi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (W.A.A.); (A.M.A.); (S.A.B.); (M.E.E.); (A.J.M.)
| | - Anas Mohammed Aljoaid
- Department of Internal Medicine, Alnoor Specialist Hospital, Makkah 21955, Saudi Arabia; (A.M.A.); (B.M.A.)
| | - Bahni Mohammed Alsahabi
- Department of Internal Medicine, Alnoor Specialist Hospital, Makkah 21955, Saudi Arabia; (A.M.A.); (B.M.A.)
| | - Manal Algethamy
- Department of Infection Prevention and Control Program, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia;
| | - Abdullmoin AlQarni
- Infectious Diseases Department, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia;
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia;
| | - Alaa Mutlaq
- General Department of Pharmaceutical Care, Ministry of Health, Riyadh 12211, Saudi Arabia;
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 57911, Saudi Arabia;
| | - Mahmoud E. Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (W.A.A.); (A.M.A.); (S.A.B.); (M.E.E.); (A.J.M.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 40050, Pakistan;
| | - Rozan Mohammad Radwan
- Pharmaceutical Care Department, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia;
| | - Ahmad Jamal Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (W.A.A.); (A.M.A.); (S.A.B.); (M.E.E.); (A.J.M.)
| | - Hani Saleh Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah 21955, Saudi Arabia;
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Elango K, Mudgal M, Murthi S, Yella PR, Nagrecha S, Srinivasan V, Sekar V, Koshy M, Ramalingam S, Gunasekaran K. Trends in the Epidemiology and Outcomes of Pneumocystis Pneumonia among Human Immunodeficiency Virus (HIV) Hospitalizations. Int J Environ Res Public Health 2022; 19:ijerph19052768. [PMID: 35270461 PMCID: PMC8910294 DOI: 10.3390/ijerph19052768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Introduction: Pneumocystis Pneumonia (PCP) is a common opportunistic infection among people living with the human immunodeficiency virus (HIV). This study’s objective was to assess temporal trends in PCP epidemiology among hospitalized patients with HIV/AIDS in the US and to compare data for hospitalizations with HIV with PCP to those without PCP. Methods: The national inpatient sample (NIS) data were analyzed from 2002−2014. The discharge coding identified hospitalized patients with HIV or AIDS and with or without PCP. Results: We identified 3,011,725 hospitalizations with HIV/AIDS during the study period; PCP was present in 5% of the patients with a diagnosis of HIV. The rates of PCP progressively declined from 6.7% in 2002 to 3.5 % in 2014 (p < 0.001). Overall mortality in patients with HIV was 3.3% and was significantly higher in those with PCP than without PCP (9.9% vs. 2.9%; p < 0.001). After adjusting for demographics and other comorbidities, PCP had higher odds of hospital mortality 3.082 (OR 3.082; 95% CI, 3.007 to 3.159; p < 0.001). Conclusion: From 2002 to 2014, the rate of PCP in HIV patients has decreased significantly in the United States but is associated with substantially higher mortality.
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Affiliation(s)
- Kalaimani Elango
- Division of Cardiology, University of Nevada, 4505 S Maryland Pkwy, Las Vegas, NV 89154, USA;
| | - Mayuri Mudgal
- Department of Geriatric Medicine, Montefiore Medical Center, Wakefield Campus, 600 E 233rd Street Bronx, New York, NY 10466, USA;
| | - Swetha Murthi
- Department of Endocrinology, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Prashanth Reddy Yella
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Savan Nagrecha
- Department of Pharmacy, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Vedhapriya Srinivasan
- Department of Internal Medicine, Suny Downstate Medical Center, New York, NY 11203, USA;
| | - Vijaykumar Sekar
- Department of Endocrinology, Lehigh Valley Health Center, 1243 S Cedar Crest Blvd, Allentown, PA 18103, USA;
| | - Maria Koshy
- Department of Internal Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
| | - Sathishkumar Ramalingam
- Department of Internal Medicine, Lovelace Medical Center, 601 Dr. Martin Luther King Jr. Avenue NE, Albuquerque, NM 87102, USA;
| | - Kulothungan Gunasekaran
- Department of Pulmonary Diseases and Critical Care, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
- Correspondence: ; Tel.: +1-928-336-2434
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19
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Bretagne S, Sitbon K, Botterel F, Dellière S, Letscher-Bru V, Chouaki T, Bellanger AP, Bonnal C, Fekkar A, Persat F, Costa D, Bourgeois N, Dalle F, Lussac-Sorton F, Paugam A, Cassaing S, Hasseine L, Huguenin A, Guennouni N, Mazars E, Le Gal S, Sasso M, Brun S, Cadot L, Cassagne C, Cateau E, Gangneux JP, Moniot M, Roux AL, Tournus C, Desbois-Nogard N, Le Coustumier A, Moquet O, Alanio A, Dromer F. COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave. Microbiol Spectr 2021; 9:e0113821. [PMID: 34668768 PMCID: PMC8528108 DOI: 10.1128/spectrum.01138-21] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate diagnostic means, host factors, delay of occurrence, and outcome of patients with COVID-19 pneumonia and fungal coinfections in the intensive care unit (ICU). From 1 February to 31 May 2020, we anonymously recorded COVID-19-associated pulmonary aspergillosis (CAPA), fungemia (CA-fungemia), and pneumocystosis (CA-PCP) from 36 centers, including results on fungal biomarkers in respiratory specimens and serum. We collected data from 154 episodes of CAPA, 81 of CA-fungemia, 17 of CA-PCP, and 5 of other mold infections from 244 patients (male/female [M/F] ratio = 3.5; mean age, 64.7 ± 10.8 years). CA-PCP occurred first after ICU admission (median, 1 day; interquartile range [IQR], 0 to 3 days), followed by CAPA (9 days; IQR, 5 to 13 days), and then CA-fungemia (16 days; IQR, 12 to 23 days) (P < 10-4). For CAPA, the presence of several mycological criteria was associated with death (P < 10-4). Serum galactomannan was rarely positive (<20%). The mortality rates were 76.7% (23/30) in patients with host factors for invasive fungal disease, 45.2% (14/31) in those with a preexisting pulmonary condition, and 36.6% (34/93) in the remaining patients (P = 0.001). Antimold treatment did not alter prognosis (P = 0.370). Candida albicans was responsible for 59.3% of CA-fungemias, with a global mortality of 45.7%. For CA-PCP, 58.8% of the episodes occurred in patients with known host factors of PCP, and the mortality rate was 29.5%. CAPA may be in part hospital acquired and could benefit from antifungal prescription at the first positive biomarker result. CA-fungemia appeared linked to ICU stay without COVID-19 specificity, while CA-PCP may not really be a concern in the ICU. Improved diagnostic strategy for fungal markers in ICU patients with COVID-19 should support these hypotheses. IMPORTANCE To diagnose fungal coinfections in patients with COVID-19 in the intensive care unit, it is necessary to implement the correct treatment and to prevent them if possible. For COVID-19-associated pulmonary aspergillosis (CAPA), respiratory specimens remain the best approach since serum biomarkers are rarely positive. Timing of occurrence suggests that CAPA could be hospital acquired. The associated mortality varies from 36.6% to 76.7% when no host factors or host factors of invasive fungal diseases are present, respectively. Fungemias occurred after 2 weeks in ICUs and are associated with a mortality rate of 45.7%. Candida albicans is the first yeast species recovered, with no specificity linked to COVID-19. Pneumocystosis was mainly found in patients with known immunodepression. The diagnosis occurred at the entry in ICUs and not afterwards, suggesting that if Pneumocystis jirovecii plays a role, it is upstream of the hospitalization in the ICU.
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Affiliation(s)
- Stéphane Bretagne
- Institut Pasteur, Université de Paris, CNRS UMR2000, unité de Mycologie Moléculaire, Centre national de Référence Mycoses Invasives et Antifongiques, Paris, France
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux De Paris (AP-HP), Paris, France
- Université de Paris, Paris, France
| | - Karine Sitbon
- Institut Pasteur, Université de Paris, CNRS UMR2000, unité de Mycologie Moléculaire, Centre national de Référence Mycoses Invasives et Antifongiques, Paris, France
| | - Françoise Botterel
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Henri Mondor, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Sarah Dellière
- Institut Pasteur, Université de Paris, CNRS UMR2000, unité de Mycologie Moléculaire, Centre national de Référence Mycoses Invasives et Antifongiques, Paris, France
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux De Paris (AP-HP), Paris, France
- Université de Paris, Paris, France
| | - Valérie Letscher-Bru
- Service de Parasitologie et de Mycologie Médicale, CHU de Strasbourg, Strasbourg, France
| | - Taieb Chouaki
- Laboratoire de Parasitologie-Mycologie, CHU Amiens-Picardie, Amiens, France
| | | | - Christine Bonnal
- Assistance Publique-Hôpitaux De Paris (AP-HP), Laboratoire de Parasitologie-Mycologie, Hôpital Universitaire Bichat, Paris, France
| | - Arnault Fekkar
- Assistance Publique-Hôpitaux De Paris (AP-HP), Groupe Hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, Sorbonne Université, Inserm, CNRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI), Paris, France
| | - Florence Persat
- Hospices Civils de Lyon, Service de Parasitologie et Mycologie Médicale, Hôpital de la Croix-Rousse, Lyon–Université Claude Bernard Lyon 1, Lyon, France
| | - Damien Costa
- Laboratoire de Parasitologie-Mycologie, CHU Charles-Nicolle, Rouen, France
| | - Nathalie Bourgeois
- Laboratoire de Parasitologie-Mycologie, CHU de Montpellier, Montpellier, France
| | - Frédéric Dalle
- Laboratoire de Parasitologie Mycologie, Centre Hospitalier Universitaire de Dijon—Hôpital François Mitterrand, Dijon, France
| | | | - André Paugam
- Université de Paris, Paris, France
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Sophie Cassaing
- Service de Parasitologie-Mycologie, Hôpital Purpan Toulouse, CHU Toulouse, Toulouse, France
| | - Lilia Hasseine
- Laboratoire de Parasitologie Mycologie CHU de Nice, Nice, France
| | - Antoine Huguenin
- Parasitologie Mycologie-Laboratoire de Parasitologie-Mycologie, Pôle de Biopathologie, CHU de Reims, Université de Reims Champagne Ardenne, Reims, France
| | - Nadia Guennouni
- Assistance Publique-Hôpitaux De Paris (AP-HP), Service de Bactériologie, Virologie, Parasitologie et Hygiène, Hôpital Necker-Enfants Malades, IHU Imagine, Paris, France
| | - Edith Mazars
- CH de Valenciennes, Laboratoire de Microbiologie, Valenciennes, France
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
| | - Milène Sasso
- Laboratoire de Parasitologie Mycologie CHU Nîmes, Nîmes, France
| | - Sophie Brun
- Assistance Publique-Hôpitaux De Paris (AP-HP), Laboratoire de Parasitologie Mycologie Hôpital Avicenne, Bobigny, France
| | - Lucile Cadot
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France
| | - Carole Cassagne
- IHU Marseille—Institut Hospitalier Universitaire Méditerranée Infection, Marseille, France
| | - Estelle Cateau
- Laboratoire de Parasitologie-Mycologie, CHU de Poitiers, Poitiers, France
| | - Jean-Pierre Gangneux
- CHU de Rennes, Université de Rennes, Institut de Recherche en Santé, Environnement et Travail (IRSET), Rennes, France
| | - Maxime Moniot
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne-Laure Roux
- Assistance Publique-Hôpitaux De Paris (AP-HP), Hôpital Raymond Poincaré Garches, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Céline Tournus
- Laboratoire de Microbiologie, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Nicole Desbois-Nogard
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Martinique, Fort-de-France, La Martinique, France
| | | | - Olivier Moquet
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Beauvais, Beauvais, France
| | - Alexandre Alanio
- Institut Pasteur, Université de Paris, CNRS UMR2000, unité de Mycologie Moléculaire, Centre national de Référence Mycoses Invasives et Antifongiques, Paris, France
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux De Paris (AP-HP), Paris, France
- Université de Paris, Paris, France
| | - Françoise Dromer
- Institut Pasteur, Université de Paris, CNRS UMR2000, unité de Mycologie Moléculaire, Centre national de Référence Mycoses Invasives et Antifongiques, Paris, France
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20
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Abstract
BACKGROUND Pneumocystis jirovecii pneumonia (PJP) is a serious infective complication of immunosuppressive therapy. There are insufficient data concerning the incidence or mortality rate in children undergoing treatment for malignancies and how these may be influenced by prophylaxis. OBJECTIVE Prospective collection of clinical information for all suspected and proven cases of PJP in children with cancer in the UK and Ireland. DESIGN A surveillance survey was undertaken using a key contact at each paediatric oncology Principle Treatment Centre (PTC). MAIN OUTCOME MEASURES To describe the mortality, outcomes and use of prophylaxis in this at-risk group. RESULTS The study confirms that PJP is rare, with only 32 cases detected in the UK over a 2-year period reported from all 20 PTCs. No deaths were directly attributed to PJP, in contrast to previously reported high mortality rates. Breakthrough infection may occur despite prescription of ostensibly adequate prophylaxis with co-trimoxazole; 11 such cases were identified. Six infections occurred in patients for whom prophylaxis was not thought to be indicated. Two infections occurred in patients for whom prophylaxis was specifically omitted due to concerns about potential bone marrow suppression or delayed engraftment. CONCLUSION PJP in children treated for malignant disease is rare. Breakthrough infection despite prophylaxis with co-trimoxazole may represent pathogen resistance or non-compliance. Further consideration of the use of PJP prophylaxis during acute myeloid leukaemia and non-Hodgkin's lymphoma treatment is warranted, alongside appraisal of the clinical implications of the possible marrow suppressive effects of co-trimoxazole and its interactions with methotrexate.
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Affiliation(s)
| | - Bob Phillips
- University of York Centre for Reviews and Dissemination, York, York, UK
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21
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Huang L, Fu Q, Ye Y, Lin Y, Yan Q, Chen S. High incidence and mortality of Pneumocystis jirovecii infection in anti-MDA5-antibody-positive dermatomyositis: experience from a single center. Arthritis Res Ther 2021; 23:232. [PMID: 34481528 PMCID: PMC8417987 DOI: 10.1186/s13075-021-02606-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIM) are associated with a significantly higher risk of opportunistic infections including Pneumocystis jirovecii pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated PJP infection in subtypes of IIM. OBJECTIVES To investigate the prevalence and mortality rate of PJP infection in subgroups of IIM patients stratified according to myopathy-specific antibodies. METHODS In the first part of the study, 463 consecutive patients with IIM were prospectively followed for a period of at least 1 year to analyze the incidence of PJP. In the second part of the study, we enrolled 30 consecutive PJP patients with any rheumatic disease in order to identify the mortality rate and risk factors by Cox regression analysis. The Kaplan-Meier method with log-rank testing was used to assess differences in survival. RESULTS The prevalence of PJP in IIM patients was found to be 3.0/100 person-years, while in MDA5+ DM patients it was 7.5/100 person-years and in MDA5- IIM patients 0.7/100 person-years (P < 0.05). PJP typically occurred in the first 2 months in the case of MDA5+ DM patients who had a significant decrease in their CD4+ T cell counts and lymphocyte counts (P < 0.05). In PJP patients, 3-month mortality was higher for MDA5+ DM patients than in those with other rheumatic diseases (83.3% vs 38.9%, P < 0.05). Alarmingly, MDA5+ DM patients seemed not to benefit from prompt anti-PJP treatment, unlike patients with other rheumatic diseases whose survival improved when anti-PJP treatment was started within 6 days (P < 0.05). CONCLUSION PJP has an alarming high incidence and mortality in MDA5+ DM patients. Timely treatment for PJP seems not to improve the prognosis of patients with this particular subtype. Hence, there remains a crucial unmet need to develop PJP prophylaxis for MDA5+ DM patients.
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Affiliation(s)
- Linlin Huang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Qiong Fu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Yan Ye
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Yanwei Lin
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Qingran Yan
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China.
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China.
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22
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Kann G, Wetzstein N, Bielke H, Schuettfort G, Haberl AE, Wolf T, Kuepper-Tetzel CP, Wieters I, Kessel J, de Leuw P, Bickel M, Khaykin P, Stephan C. Risk factors for IRIS in HIV-associated Pneumocystis-pneumonia following ART initiation. J Infect 2021; 83:347-353. [PMID: 34242683 DOI: 10.1016/j.jinf.2021.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/27/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND HIV-infected patients with Pneumocystis-pneumonia (PCP) may develop paradoxical immune reconstitution inflammatory syndrome (IRIS), when combination antiretroviral therapy (cART) is started early during the course of PCP-treatment (PCPT). The aim of this study was to identify risk factors and predictors for PCP-IRIS and to improve individualized patient care. METHODS An ICD-10 code hospital database query identified all Frankfurt HIV Cohort patients being diagnosed with PCP from January 2010 - June 2016. Patient charts were evaluated retrospectively for demographic, clinical and therapeutic (cART/PCPT) characteristics and incidence of paradoxical IRIS according to French's case definitions. RESULTS IRIS occurred in 12/97 patients that started cART while on PCPT (12.4%). They had a higher rate of re-hospitalization (41.7vs. 4.7%; odds ratio (OR) 14.46; p = 0.009), intensive care treatment (66.7vs. 30.6%; OR = 4.54; p = 0.018), and longer median hospitalization (48 days vs. 23; p < 0.001). A high HIV-RNA level (> 6Log10/ml) before cART initiation was associated with IRIS development (41.6vs. 15.0%; OR 4.05; p = 0.042). Serum immunoglobulin G-levels (IgG) [mg/dl] were lower (894.0 vs. 1446.5; p = 0.023). CONCLUSION Higher hospitalization rate and morbidity parameters underscore the clinical importance of PCP-related paradoxical IRIS. A baseline viral load of > 6Log10/ml and serum IgG may help to assess individual risks for PCP-IRIS.
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Affiliation(s)
- Gerrit Kann
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Nils Wetzstein
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Hannah Bielke
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Gundolf Schuettfort
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Annette E Haberl
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Timo Wolf
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Claus P Kuepper-Tetzel
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Imke Wieters
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | | | | | | | | | - Christoph Stephan
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany.
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23
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Nesheim SR, Balaji A, Hu X, Lampe M, Dominguez KL. Opportunistic Illnesses in Children With HIV Infection in the United States, 1997-2016. Pediatr Infect Dis J 2021; 40:645-648. [PMID: 34014622 DOI: 10.1097/inf.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among children with HIV infection, opportunistic illness (OI) rates decreased after introduction of highly active antiretroviral therapy (ART) in 1997. We evaluated whether such decreases have continued. METHODS Data from the Centers for Disease Control and Prevention's National HIV Surveillance System for children with HIV living in the US during 1997-2016 was used to enumerate infants experiencing the first OI by birth year and OIs among all children <13 years of age (stratified by natality). We calculated the time to first OI among infants using Kaplan-Meier methods. RESULTS Among infants born during 1997-2016, 711 first OIs were diagnosed. The percentage of the first OIs diagnosed in successive 5-year birth periods was: 60.0% (1997-2001), 24.6% (2002-2006), 11.3% (2007-2011), and 3.4% (2012-2016). For every OI, the number of first cases decreased nearly annually. Time to first OI increased in successive birth periods. Among children <13 years of age, 2083 OI were diagnosed, including Pneumocystis jiroveci pneumonia, candidiasis, recurrent bacterial infection, wasting syndrome, cytomegalovirus, lymphocytic interstitial pneumonitis, tuberculosis, nontuberculous mycobacteriosis and herpes simplex virus. The rate (#/1000 person-years) decreased overall (60-7.2) and for all individual OIs. Earlier during 1997-2016, rates for all OIs were higher among foreign-born than US-born children but later became similar for all OIs except tuberculosis. CONCLUSIONS Among children with HIV in the US, numbers and rates of all OIs decreased during 1997-2016. Earlier, OI rates were highest among non-US-born children but were later comparable with those among US-born children for all OIs except tuberculosis.
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Affiliation(s)
- Steven R Nesheim
- From the Division of HIV/AIDS Prevention (DHAP), Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention (NCHHSTP)
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24
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Zalmanovich A, Ben-Ami R, Rahav G, Alon D, Moses A, Olshtain-Pops K, Weinberger M, Shitrit P, Katzir M, Gottesman BS, Chowers M. Healthcare-associated Pneumocystis jirovecii Pneumonia (PJP) Infection in HIV-negative Adults: a Multicenter Study. Isr Med Assoc J 2021; 23:312-317. [PMID: 34024049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection in immunocompromised patients. Clusters of PJP, especially among organ transplant recipients in clinic settings were described. Data regarding nosocomial PJP infection among inpatients are limited. OBJECTIVES To assess the magnitude and characteristics of inpatient healthcare-associated PJP infection (HCA-PJP) in HIV-negative patients. METHODS A retrospective chart review of hospitalized PJP patients was performed to identify HCA-PJP. The study was performed at six medical centers in Israel from 2006 to 2016. HCA-PJP was defined as cases of hospital-onset or those with documented contact with a PJP patient. We reviewed and cross-matched temporal and spatial co-locations of patients. Clinical laboratory characteristics and outcomes were compared. RESULTS Seventy-six cases of PJP were identified. Median age was 63.7 years; 64% men; 44% hematological malignancies; 18% inflammatory diseases; and 61% steroid usage. Thirty-two patients (42%) were defined as HCA-PJP: 18/32 (23.6%) were hospitalized at onset and 14/32 (18.4%) had a previous encounter with a PJP patient. Time from onset of symptoms to diagnosis was shorter in HCA-PJP vs. community-PJP (3.25 vs. 11.23 days, P = 0.009). In multivariate analysis, dyspnea at presentation (odds ratio [OR] 16.79, 95% confidence interval [95%CI] 1.78-157.95) and a tendency toward higher rate of ventilator support (72% vs. 52%, P = 0.07, OR 5.18, 95%CI 0.7-30.3) were independently associated with HCA-PJP, implying abrupt disease progression in HCA-PJP. CONCLUSIONS HCA-PJP was common. A high level of suspicion for PJP among selected patients with nosocomial respiratory infection is warranted. Isolation of PJP patients should be considered.
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Affiliation(s)
- Anat Zalmanovich
- Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
| | - Ronen Ben-Ami
- Department of Infectious Disease, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Infectious Disease, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Galia Rahav
- Department of Infectious Disease, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Infectious Disease, Sheba Medical Center, Tel Hashomer, Israel
| | - Danny Alon
- Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
- Department of Infectious Disease, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Allon Moses
- Department of Infectious Disease, Hadassah Medical Center, Ein Kerem Campus, Jerusalem, Israel
- Department of Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Karen Olshtain-Pops
- Department of Infectious Disease, Hadassah Medical Center, Ein Kerem Campus, Jerusalem, Israel
- Department of Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Miriam Weinberger
- Department of Infectious Disease, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Infectious Disease, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Pnina Shitrit
- Department of Infectious Disease, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Infectious Disease, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Katzir
- Department of Infectious Disease, Meir Medical Center, Kfar Saba, Israel
| | | | - Michal Chowers
- Department of Infectious Disease, Meir Medical Center, Kfar Saba, Israel
- Department of Infectious Disease, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Pougnet L, Hoffmann CV, Pougnet R, Le Ny F, Gaitan L, Cros P, Artus M, Le Gal S, Nevez G. Pneumocystis exhalation by infants developing Pneumocystis primary infection: putative infectious sources in hospitals and the community. J Hosp Infect 2021; 113:10-13. [PMID: 33894307 DOI: 10.1016/j.jhin.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
Pneumocystis jirovecii DNA was detected using a polymerase chain reaction assay in air samples collected using an air-liquid impaction device at 1 m distance from three out of 14 infants who had developed Pneumocystis primary infection. P. jirovecii genotype identification was successful in one out of three pairs of air samples. Matching of P. jirovecii genotypes between the nasopharyngeal and air samples suggested that P. jirovecii was effectively exhaled by the infected infant. These original results represent a proof of concept of the role of infants with primary pneumocystis infection as infectious sources of P. jirovecii in hospitals and in the community.
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Affiliation(s)
- L Pougnet
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Hôpital d'Instruction des Armées Clermont-Tonnerre, CC41, 29240 Brest Cedex 9, France.
| | - C V Hoffmann
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - R Pougnet
- Centre de Recherche de Pathologies Professionnelles et Environnementales, CHRU de Brest, Brest, France; Laboratoire d'études et de Recherche en Sociologie (LABERS), Université de Bretagne Occidentale, Brest
| | - F Le Ny
- Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - L Gaitan
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - P Cros
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - M Artus
- Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - S Le Gal
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - G Nevez
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France.
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26
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Varlamov EV, Langlois F, Vila G, Fleseriu M. MANAGEMENT OF ENDOCRINE DISEASE: Cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing's syndrome: a practical approach. Eur J Endocrinol 2021; 184:R207-R224. [PMID: 33539319 DOI: 10.1530/eje-20-1309] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/03/2021] [Indexed: 11/08/2022]
Abstract
Cushing's syndrome (CS) is associated with increased mortality that is driven by cardiovascular, thromboembolic, and infection complications. Although these events are expected to decrease during disease remission, incidence often transiently increases postoperatively and is not completely normalized in the long-term. It is important to diagnose and treat cardiovascular, thromboembolic, and infection complications concomitantly with CS treatment. Management of hyperglycemia/diabetes, hypertension, hypokalemia, hyperlipidemia, and other cardiovascular risk factors is generally undertaken in accordance with clinical care standards. Medical therapy for CS may be needed even prior to surgery in severe and/or prolonged hypercortisolism, and treatment adjustments can be made based on disease pathophysiology and drug-drug interactions. Thromboprophylaxis should be considered for CS patients with severe hypercortisolism and/or postoperatively, based on individual risk factors of thromboembolism and bleeding. Pneumocystis jiroveci pneumonia prophylaxis should be considered for patients with high urinary free cortisol at the initiation of hypercortisolism treatment.
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Affiliation(s)
- Elena V Varlamov
- Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Fabienne Langlois
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Greisa Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maria Fleseriu
- Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA
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Kim TO, Lee JK, Kwon YS, Kim YI, Lim SC, Kim MS, Kho BG, Park CK, Oh IJ, Kim YC, Park HY, Shin HJ. Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness. PLoS One 2021; 16:e0246296. [PMID: 33539407 PMCID: PMC7861382 DOI: 10.1371/journal.pone.0246296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/16/2021] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Tae-Ok Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Kyeong Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min-Seok Kim
- Chonnam National University Medical School, Gwangju, Republic of Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Joennam, Republic of Korea
| | - Bo Gun Kho
- Chonnam National University Medical School, Gwangju, Republic of Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Joennam, Republic of Korea
| | - Cheol-Kyu Park
- Chonnam National University Medical School, Gwangju, Republic of Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Joennam, Republic of Korea
| | - In-Jae Oh
- Chonnam National University Medical School, Gwangju, Republic of Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Joennam, Republic of Korea
| | - Young-Chul Kim
- Chonnam National University Medical School, Gwangju, Republic of Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Joennam, Republic of Korea
| | - Ha Young Park
- Chonnam National University Medical School, Gwangju, Republic of Korea
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Republic of Korea
| | - Hong-Joon Shin
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
- * E-mail:
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Kanj A, Samhouri B, Abdallah N, Chehab O, Baqir M. Host Factors and Outcomes in Hospitalizations for Pneumocystis Jirovecii Pneumonia in the United States. Mayo Clin Proc 2021; 96:400-407. [PMID: 33549258 DOI: 10.1016/j.mayocp.2020.07.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/02/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess host factors in pneumocystis jirovecii pneumonia (PCP)-related hospitalizations and compare outcomes between HIV and non-HIV patients. METHODS Using the National Inpatient Sample database, we identified 3384 hospitalizations with PCP (International Classification of Diseases, Ninth Revision, Clinical Modification code: 136.3) as the primary discharge diagnosis from 2005 to 2014. We evaluated hospitalizations for the following host factors: HIV, malignancies, organ transplantation, rheumatologic diseases, and vasculitides. We compared the prevalence of individual host factors among PCP hospitalizations over time, and compared intervention rates and outcomes between HIV and non-HIV patients with PCP. RESULTS Among all hospitalizations for PCP, malignancy was the most prevalent host factor (46.0%, n=1559), followed by HIV (17.8%, n=604); 60.7% (n=946) of malignancies were hematologic. The prevalence of HIV among hospitalizations for PCP decreased from 25.1% in 2005 to 9.2% in 2014 (P<.001), whereas the prevalence of non-HIV immunocompromising conditions increased. Compared with HIV patients, PCP patients without HIV had higher rates of bronchoscopy (52.3% vs 26.7%, P<.001) and endotracheal intubation (17.0% vs 7.9%, P<.001), prolonged hospitalizations (11.5 vs 8.7 days, P<.001), higher hospitalization costs (86.8 vs 48.2×103 USD, P<.001) and increased in-hospital mortality (16.0% vs 5.0%, P<.001). After adjusting for age, sex, and smoking status, there was no difference in mortality between non-HIV and HIV patients with PCP (adjusted odds ratio, 1.4; 95% CI, 0.9 to 2.3). CONCLUSION The epidemiology of PCP has shifted with an increase in the prevalence of non-HIV patients who have higher intubation rates and prolonged hospitalizations compared with matched HIV patients.
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Affiliation(s)
- Amjad Kanj
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Bilal Samhouri
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Nadine Abdallah
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Omar Chehab
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Yanagisawa K, Wichukchinda N, Tsuchiya N, Yasunami M, Rojanawiwat A, Tanaka H, Saji H, Ogawa Y, Handa H, Pathipvanich P, Ariyoshi K, Sawanpanyalert P. Deficiency of mannose-binding lectin is a risk of Pneumocystis jirovecii pneumonia in a natural history cohort of people living with HIV/AIDS in Northern Thailand. PLoS One 2020; 15:e0242438. [PMID: 33362211 PMCID: PMC7757797 DOI: 10.1371/journal.pone.0242438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/02/2020] [Indexed: 01/23/2023] Open
Abstract
Background Mannose-binding lectin (MBL) plays a pivotal role in innate immunity; however, its impact on susceptibility to opportunistic infections (OIs) has not yet been examined in a natural history cohort of people living with HIV/AIDS. Methods We used archived samples to analyze the association between MBL expression types and risk of major OIs including Pneumocystis jirovecii pneumonia (PCP), cryptococcosis, talaromycosis, toxoplasmosis, and tuberculosis in a prospective cohort in Northern Thailand conducted from 1 July 2000 to 15 October 2002 before the national antiretroviral treatment programme was launched. Results Of 632 patients, PCP was diagnosed in 96 (15.2%) patients, including 45 patients with new episodes during the follow-up period (1006.5 person-years). The total history of PCP was significantly associated with low MBL expression type: high/intermediate (81/587, 13.8%), low (10/33, 30.3%) and deficient (5/12, 41.7%) (p = 0.001), whereas the history of other OIs showed no relation with any MBL expression type. Kaplan–Meier analysis (n = 569; log-rank p = 0.011) and Cox’s proportional hazards model revealed that deficient genotype dramatically increased the risk of PCP, which is independent upon sex, age, CD4 count, HIV-1 viral load and hepatitis B and C status (adjusted hazard ratio 7.93, 95% confidence interval 2.19–28.67, p = 0.002). Conclusions Deficiency of MBL expression is a strong risk factor determining the incidence of PCP but not other major OIs.
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Affiliation(s)
- Kunio Yanagisawa
- Department of Hematology, Gunma University Hospital, Maebashi, Japan
- Infection Control and Prevention Center, Gunma University Hospital, Maebashi, Japan
| | | | - Naho Tsuchiya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Michio Yasunami
- Department of Laboratory Medicine, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | | | | | | | - Yoshiyuki Ogawa
- Department of Hematology, Gunma University Hospital, Maebashi, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Hospital, Maebashi, Japan
| | | | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail:
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Bateman M, Oladele R, Kolls JK. Diagnosing Pneumocystis jirovecii pneumonia: A review of current methods and novel approaches. Med Mycol 2020; 58:1015-1028. [PMID: 32400869 PMCID: PMC7657095 DOI: 10.1093/mmy/myaa024] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/13/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
Pneumocystis jirovecii can cause life-threatening pneumonia in immunocompromised patients. Traditional diagnostic testing has relied on staining and direct visualization of the life-forms in bronchoalveolar lavage fluid. This method has proven insensitive, and invasive procedures may be needed to obtain adequate samples. Molecular methods of detection such as polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), and antibody-antigen assays have been developed in an effort to solve these problems. These techniques are very sensitive and have the potential to detect Pneumocystis life-forms in noninvasive samples such as sputum, oral washes, nasopharyngeal aspirates, and serum. This review evaluates 100 studies that compare use of various diagnostic tests for Pneumocystis jirovecii pneumonia (PCP) in patient samples. Novel diagnostic methods have been widely used in the research setting but have faced barriers to clinical implementation including: interpretation of low fungal burdens, standardization of techniques, integration into resource-poor settings, poor understanding of the impact of host factors, geographic variations in the organism, heterogeneity of studies, and limited clinician recognition of PCP. Addressing these barriers will require identification of phenotypes that progress to PCP and diagnostic cut-offs for colonization, generation of life-form specific markers, comparison of commercial PCR assays, investigation of cost-effective point of care options, evaluation of host factors such as HIV status that may impact diagnosis, and identification of markers of genetic diversity that may be useful in diagnostic panels. Performing high-quality studies and educating physicians will be crucial to improve the rates of diagnosis of PCP and ultimately to improve patient outcomes.
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Affiliation(s)
- Marjorie Bateman
- Center for Translational Research in Infection and Inflammation, Tulane University School of Medicine, New Orleans, LA 70122, USA
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
| | - Jay K Kolls
- Center for Translational Research in Infection and Inflammation, Tulane University School of Medicine, New Orleans, LA 70122, USA
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Chen YH, Fang XY, Li YT, Liu YL, Hang YP, Xiao YP, Cao XW, Zhong QS, Hu LH. Characterization of Pneumocystis jirovecii pneumonia at three tertiary comprehensive hospitals in southern China. Braz J Microbiol 2020; 51:1061-1069. [PMID: 32363569 PMCID: PMC7455668 DOI: 10.1007/s42770-020-00277-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/16/2020] [Indexed: 12/17/2022] Open
Abstract
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, PaO2, 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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Affiliation(s)
- Yan-Hui Chen
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xue-Yao Fang
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yue-Ting Li
- Clinical Laboratory of People's Hospital, Nanchang, Jiangxi, China
| | - Yan-Ling Liu
- Clinical Laboratory of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ya-Ping Hang
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yan-Ping Xiao
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xing-Wei Cao
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qiao-Shi Zhong
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Long-Hua Hu
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Young N, McBride S, Morpeth S, Bryce A, Siddiqui A, Bhally H. Pneumocystis pneumonia in HIV-negative adults: missed opportunities for prevention. N Z Med J 2020; 133:27-34. [PMID: 32994591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM Pneumocystis pneumonia (PCP) has a high mortality rate in HIV-negative immunocompromised patients, but is preventable with antimicrobial prophylaxis. We aimed to determine the incidence of PCP in three hospitals in Auckland, New Zealand that would have been potentially preventable if patients had been prescribed prophylaxis according to commonly proposed indications. METHODS We conducted a retrospective study of HIV-negative adults with PCP who were admitted to Middlemore, North Shore or Waitakere Hospitals between January 2011 and June 2017. We classified their PCP as potentially preventable if they had not been prescribed prophylaxis despite having a commonly proposed indication for this. RESULTS Of the 108 patients with PCP, 33/108 (30.6%) had potentially preventable infection. Of these, 14/33 (42.4%) died within 30 days of diagnosis of PCP. Most potentially preventable infections occurred in patients with solid organ or haematologic malignancies who were receiving high-dose corticosteroids for >4 weeks. We estimate that 28 cases of PCP and 12 deaths could have been prevented over the study duration if prophylaxis was prescribed to those with commonly proposed indications. CONCLUSION There is a substantial incidence of potentially preventable PCP and PCP-related mortality in the Auckland region. This could be reduced by greater clinician familiarity with commonly proposed indications for PCP prophylaxis, particularly for clinicians prescribing prolonged corticosteroid courses to patients with malignancies.
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Affiliation(s)
- Nicholas Young
- Infectious Diseases Service, Waitemata District Health Board, Auckland
| | - Stephen McBride
- Infectious Diseases Service, Counties Manukau District Health Board, Auckland
| | - Susan Morpeth
- Infectious Diseases Service and Microbiology Service, Counties Manukau District Health Board, Auckland
| | - Aliya Bryce
- Infectious Diseases Service, Waitemata District Health Board, Auckland
| | - Ahsan Siddiqui
- Infectious Diseases Service, Counties Manukau District Health Board, Auckland
| | - Hasan Bhally
- Infectious Diseases Service, Waitemata District Health Board, Auckland
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Riebold D, Lubig J, Wolf P, Wolf C, Russow K, Loebermann M, Slevogt H, Mohr E, Feldhusen F, Reisinger EC. First molecular detection of Pneumocystis spp. in red foxes (Vulpes vulpeslinnaeus, 1758) and raccoon dogs (Nyctereutes procyonoidesgray, 1834). Comp Immunol Microbiol Infect Dis 2020; 73:101531. [PMID: 32871298 DOI: 10.1016/j.cimid.2020.101531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022]
Abstract
Fungal organisms of the genus Pneumocystis may cause Pneumocystis pneumonia (PCP) in humans, but also domestic and wild mammals. Almost every animal species hosts its own genetically distinct Pneumocystis species, however information is sparse. In this study, 62 red foxes (Vulpes vulpes) and 37 raccoon dogs (Nyctereutes procyonoides) were collected in North-East Germany. The lung tissues of the animals were analysed by a new designed specific pan-Pneumocystis mtLSU rRNA gene PCR and sequencing. With this PCR, detection and discrimination of all known Pneumocystis spp. in a single step should be possible. This first detection of Pneumocystis spp. in 29/62 (46.8%) red foxes and 29/37 (78.4%) raccoon dogs indicated, that they harbour two dissimilar strains, as seen by specific single nucleotide position changes (SNPs). Nevertheless, five samples with contrary SNPs showed a probable inter-species transmission.
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Affiliation(s)
- Diana Riebold
- Host Septomics Group, Centre for Innovation Competence (ZIK) Septomics, University Hospital Jena, Jena, Germany; Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University of Rostock, Germany.
| | - Jacob Lubig
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University of Rostock, Germany; Chair for Animal Health and Animal Welfare, Faculty of Agriculture and Environmental Sciences, University of Rostock, Germany
| | - Peter Wolf
- State Office for Agriculture, Food Safety and Fishery Mecklenburg-Western Pomerania (LALLF-MV), Rostock, Germany
| | - Carola Wolf
- State Office for Agriculture, Food Safety and Fishery Mecklenburg-Western Pomerania (LALLF-MV), Rostock, Germany
| | - Kati Russow
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University of Rostock, Germany
| | - Micha Loebermann
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University of Rostock, Germany
| | - Hortense Slevogt
- Host Septomics Group, Centre for Innovation Competence (ZIK) Septomics, University Hospital Jena, Jena, Germany
| | - Elmar Mohr
- Chair for Animal Health and Animal Welfare, Faculty of Agriculture and Environmental Sciences, University of Rostock, Germany
| | - Frerk Feldhusen
- State Office for Agriculture, Food Safety and Fishery Mecklenburg-Western Pomerania (LALLF-MV), Rostock, Germany
| | - Emil Christian Reisinger
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University of Rostock, Germany
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Petrakis V, Panagopoulos P, Maltsan T, Xanthopoulou AM, Terzi I, Papanas N, Maltezos E, Papazoglou D. Late Presenters of HIV Infection in an HIV Unit of a Tertiary University Hospital in a Rural Region of Greece. AIDS Res Hum Retroviruses 2020; 36:601-605. [PMID: 32295383 DOI: 10.1089/aid.2019.0246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A significant progress has been made over the years in the prognosis and treatment of patients with early diagnosis of HIV infection. However, late presentation of a large number of patients remains a serious public health problem. The aim of our study is to highlight the dimensions of the problem by evaluating the data from the HIV Unit of Alexandroupolis, a rural region with population heterogeneity and a strategic position between West and East, Europe, and Asia. This was a retrospective study, including 107 patients diagnosed with HIV infection in our unit from 2010 to 2018. Late presenters (LP) were defined as patients diagnosed with a CD4 cell count <350/mm3 or an AIDS-defining condition regardless of CD4 cell count. The proportion of patients diagnosed late was 49.5%. The majority were males in the age group 31-40 years (41.5%). Men who had sex with men were 37.8%. Among LP, 34% were at Center for Disease Prevention and Control stage C3. The most common AIDS-defining condition observed was Pneumocystis jirovecii Pneumonia (15.1%), followed by esophageal candidiasis (7.5%) and cryptococcal meningitis (3.8%). In addition, immune reconstitution inflammatory syndrome was documented (3.8%). A high percentage of patients were also coinfected with hepatitis B (22.6%) virus. The notably high percentage of LP in our unit demonstrates that late presentation remains a challenge for public health. Further efforts must be made to ensure an early diagnosis of HIV infection. The early initiation of antiretroviral therapy is vital to reduce viral load to undetectable levels and the risk of HIV transmission.
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Affiliation(s)
- Vasileios Petrakis
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Periklis Panagopoulos
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Tzelal Maltsan
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anna-Maria Xanthopoulou
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Irene Terzi
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstratios Maltezos
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Papazoglou
- HIV Unit, 2nd Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
Introduction Pneumocystis jirovecii is the causative organism of Pneumocystis pneumonia (PCP) in humans, which is more common among immunocompromised patients. Classically patients present with fever, non-productive cough, and dyspnoea. In the HIV-infected individuals the symptoms may be subtle at first, but gradually progress over several weeks. In the HIV-uninfected patient, however, the duration of symptoms is shorter and more severe, mainly due to the increased inflammatory response of the HIV-uninfected patient. Methods This article focuses on the diagnostic methods and then the management and prophylaxis principles of PCP by reviewing the best current practices and guidelines in Africa. Conclusion This overview is presented by clinicians who have experience with PCP and is directed mainly at first-line healthcare providers.
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Affiliation(s)
- I Govender
- Department of Family Medicine, Sefako Makgatho Health Sciences University. P.O. BOX 222, MEDUNSA 0204
| | - OM Maphasha
- Department of Family Medicine, Sefako Makgatho Health Sciences University. P.O. BOX 222, MEDUNSA 0204
| | - S Rangiah
- Department of Family Medicine, University of Kwa Zulu Natal
| | - C Steyn
- Department of Family Medicine, Sefako Makgatho Health Sciences University. P.O. BOX 222, MEDUNSA 0204
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McClarey A, Phelan P, O'Shea D, Henderson L, Gunson R, Laurenson IF. Lessons learned from a pneumocystis pneumonia outbreak at a Scottish renal transplant centre. J Hosp Infect 2019; 102:311-316. [PMID: 30802526 DOI: 10.1016/j.jhin.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pneumocystis pneumonia (PCP) is an opportunistic infection occurring in renal transplant patients. Over a 14-month period an increase in PCP cases was identified among our renal transplant cohort. AIM The outbreak population was studied to identify potential risk factors for the development of PCP. METHODS A retrospective analysis of hospital records was carried out, with each case being matched with two case-linked controls. Information was collected on patient demographics, laboratory tests, and hospital visits pre and post development of infection. FINDINGS No patients were receiving PCP prophylaxis at the time of infection and mean time from transplantation to developing PCP was 4.7 years (range: 0.51-14.5). The PCP group had a significantly lower mean estimated glomerular filtration rate than the control group (29.3 mL/min/1.73 m2 vs 70 mL/min-1 (P = 0.0007)). Three patients were treated for active cytomegalovirus (CMV) infection prior to PCP diagnosis and two had active CMV at the time of diagnosis compared to none in the control group (P = 0.001). Those who developed PCP were more likely to have shared a hospital visit with another patient who went on to develop PCP; 37% of clinic visits vs 19% (P = 0.014). CONCLUSION This study highlights the ongoing risk of opportunistic infection several years after transplantation and adds weight to potential person-to-person Pneumocystis jirovecii transmission. Risk factors have been identified which may highlight those most at risk, enabling targeted rather than blanket long-term PCP prophylaxis.
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Affiliation(s)
- A McClarey
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - P Phelan
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D O'Shea
- NHS Lothian Infection Service, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - L Henderson
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - I F Laurenson
- NHS Lothian Infection Service, Clinical Microbiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Chatelanat O, Van Delden C, Adler D, Guerne PA, Nendaz M, Serratrice J. [Risk factors and prophylaxis of Pneumocystis jirovecii pneumonia in HIV-negative patients]. Rev Med Suisse 2018; 14:1829-1833. [PMID: 30329227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pneumocystis jirovecii (formely carinii) pneumonia (PcP) affects immunosuppressed patients. Cotrimoxazole prophylaxis has proven to be effective and its indications in HIV patients are well established. In non-HIV patients, the prognosis is poorer and diagnostic tests are of lower sensitivity. Recommendations for prophylaxis in hematology, oncology and solid organ transplantation are based on expert consensus. In rheumatology, the incidence of PcP is mainly related to the administration of corticosteroids. For some inflammatory diseases, a low CD4 cell count, and the administration of anti-TNFα, rituximab or cyclophosphamide may increase the risk. There are currently no well-defined concise guidelines concerning prophylaxis for immunosuppressed patients with inflammatory bowel diseases.
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Affiliation(s)
| | | | - Dan Adler
- Service de pneumologie, HUG, 1211 Genève 14
| | | | - Mathieu Nendaz
- Service de médecine interne générale, HUG, 1211 Genève 14
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Charpentier E, Garnaud C, Wintenberger C, Bailly S, Murat JB, Rendu J, Pavese P, Drouet T, Augier C, Malvezzi P, Thiébaut-Bertrand A, Mallaret MR, Epaulard O, Cornet M, Larrat S, Maubon D. Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak1. Emerg Infect Dis 2018; 23:1237-1245. [PMID: 28726611 PMCID: PMC5547796 DOI: 10.3201/eid2308.161295] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pneumocystis jirovecii is a major threat for immunocompromised patients, and clusters of pneumocystis pneumonia (PCP) have been increasingly described in transplant units during the past decade. Exploring an outbreak transmission network requires complementary spatiotemporal and strain-typing approaches. We analyzed a PCP outbreak and demonstrated the added value of next-generation sequencing (NGS) for the multilocus sequence typing (MLST) study of P. jirovecii strains. Thirty-two PCP patients were included. Among the 12 solid organ transplant patients, 5 shared a major and unique genotype that was also found as a minor strain in a sixth patient. A transmission map analysis strengthened the suspicion of nosocomial acquisition of this strain for the 6 patients. NGS-MLST enables accurate determination of subpopulation, which allowed excluding other patients from the transmission network. NGS-MLST genotyping approach was essential to deciphering this outbreak. This innovative approach brings new insights for future epidemiologic studies on this uncultivable opportunistic fungus.
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Deodhar D, Koshy JM, John M, Oberoi A. Clinical Profile of Pneumocystis jirovecii Infection - A Comparative Study. J Assoc Physicians India 2018; 66:28-31. [PMID: 30341841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Pneumocystis jirovecii pneumonia (PCP) can differ in HIV and non HIV population due to degree of immunity. This study was undertaken with an aim to highlight the differences between the two groups. METHODS It was an observational study conducted in the department of Medicine of a tertiary care institution in North India. All cases tested positive for Pneumocystis jirovecii from January 2009 to December 2014 were included in the study. Demographic profile, clinical presentation, risk factors, treatment and course in hospital were noted and analyzed. RESULTS Among the 42 patients who had PCP, 13 (30.9%) patients were HIV positive and 29 (69%) were HIV negative.Cough was seen maximum in 10(79.3%) patients in HIV group compared to non HIV whereas fever and breathlessness predominated in the non HIV group. The outcome was better in the non HIV group compared to the HIV group which was 16 (55.2%) versus 6 (46.1%) patients respectively. CONCLUSION Clinical presentation differed slightly in both these groups. Difference in the outcome was also noted, however, larger numbers may be required to show the difference. It may form the basis of further research. The study successfully compared the presentation and outcome of PCP in the two groups.
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Affiliation(s)
- Divya Deodhar
- Associate Professor, Dept. of Medicine, Christian Medical College and Hospital, Ludhiana, Punjab
| | - Jency Maria Koshy
- Associate Professor, Department of Medicine, Believers Church Medical College, Thiruvalla, Kerala
| | - Mary John
- Professor and Head, Dept. of Medicine
| | - Aroma Oberoi
- Professor and Head, Department of Microbiology, Christian Medical College, Ludhiana, Punjab
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Vera C, Aguilar YA, Vélez LA, Rueda ZV. High transient colonization by Pneumocystis jirovecii between mothers and newborn. Eur J Pediatr 2017; 176:1619-1627. [PMID: 28913714 DOI: 10.1007/s00431-017-3011-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/23/2017] [Accepted: 09/04/2017] [Indexed: 12/20/2022]
Abstract
UNLABELLED The aim of the study was to explore the frequency and dynamics of acquisition and colonization of Pneumocystis jirovecii among neonates, as well as the epidemiological and genotypic characteristics in mother-child binomial. In a prospective enrolled cohort of women in their third trimester of pregnancy, nasopharyngeal swabs (NPS) and clinical and epidemiological data were collected at four different times: 17 days, 2nd, 4th, and 6th month of life of the newborn. P. jirovecii was detected by nested-PCR for the mtLSU-rRNA gene in each NPS; the genotypes were determined amplifying four genes. Forty-three pairs and 301 NPS were included. During the third trimester, 16.3% of pregnant women were colonized. The rate of colonization in mothers at delivery was 16, 6, 16, and 5% and in their children 28, 43, 42, and 25%, respectively. Within pregnant women, 53% remained negative throughout follow-up, and among these, 91% of their children were positive in at least one of their samples. In both, mothers and children, the most frequent genotype of P. jirovecii was 1. CONCLUSION The frequency of colonization by P. jirovecii was higher in newborns than in their respective progenitors. Colonization of both mothers and children is transitory; however, the mother of the newborn is not necessarily the source of primary infection. What is Known: • We did not find studies comparing P. jirovecii colonization between mothers and children simultaneously, yet the frequency of colonization by serologic and molecular methods in pregnant women has been reported. What is New: • According to our findings, 3/4 of the children had transient colonization during the first 6 months of life, in only half in the mothers, without proof of mother-to-child transmission or vice versa.
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Affiliation(s)
- Cristian Vera
- Grupo investigador de Problemas en Enfermedades Infecciosas (GRIPE), Universidad de Antioquia, Medellín, Colombia.
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
| | - Yudy A Aguilar
- Grupo investigador de Problemas en Enfermedades Infecciosas (GRIPE), Universidad de Antioquia, Medellín, Colombia
| | - Lázaro A Vélez
- Grupo investigador de Problemas en Enfermedades Infecciosas (GRIPE), Universidad de Antioquia, Medellín, Colombia
- Sección de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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Gangcuangco LMA, Sawada I, Tsuchiya N, Do CD, Pham TTT, Rojanawiwat A, Alejandria M, Leyritana K, Yokomaku Y, Pathipvanich P, Ariyoshi K. Regional Differences in the Prevalence of Major Opportunistic Infections among Antiretroviral-Naïve Human Immunodeficiency Virus Patients in Japan, Northern Thailand, Northern Vietnam, and the Philippines. Am J Trop Med Hyg 2017; 97:49-56. [PMID: 28719295 PMCID: PMC5508895 DOI: 10.4269/ajtmh.16-0783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/22/2017] [Indexed: 11/07/2022] Open
Abstract
To identify regional differences in the distribution of opportunistic infections (OIs) among human immunodeficiency virus (HIV)-infected patients in Asia, the medical records of antiretroviral therapy (ART)-naïve patients who attended the following tertiary hospitals from 2003 to 2011 were reviewed: Nagoya Medical Center (NMC, Nagoya, Japan), Lampang Hospital (LPH, Lampang, northern Thailand), Bach Mai Hospital (BMH, Hanoi, northern Vietnam), and Philippine General Hospital (PGH, Manila, Philippines). Logistic regression analyses were performed to identify associations between country of origin and risk of major OIs. In total, 1,505 patients were included: NMC, N = 365; LPH, N = 442; BMH, N = 384; and PGH, N = 314. The median age was 32 years, and 73.3% of all patients were male. The median CD4 count was 200 cells/μL. Most patients at NMC and PGH were men who have sex with men. Injection drug users were most common at BMH (35.7%). Mycobacterium tuberculosis (TB) was most common at PGH (N = 75) but was rare at NMC (N = 4). Pneumocystis pneumonia (PCP) prevalence was highest at NMC (N = 74) and lowest at BMH (N = 13). Multivariable logistic regression showed increased odds of TB at PGH (adjusted odds ratio [aOR] = 42.2, 95% confidence interval [CI] = 14.6-122.1), BMH (aOR = 12.6, CI = 3.9-40.3), and LPH (aOR = 6.6, CI = 2.1-21.1) but decreased odds of PCP at BMH (aOR = 0.1, CI = 0.04-0.2) and LPH (aOR = 0.2, CI = 0.1-0.4) compared with those at NMC. The cryptococcosis risk was increased at LPH (aOR = 6.2, CI = 0.9-41.0) compared with that at NMC. Cytomegalovirus (CMV) retinitis prevalences were similar in all countries. OI prevalence remained high among ART-naïve patients in our cohort. The risks of TB, PCP, and cryptococcosis, but not CMV retinitis, differed between countries. Improved early HIV detection is warranted.
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Affiliation(s)
- Louie Mar A. Gangcuangco
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
- Bridgeport Hospital-Yale New Haven Health, Bridgeport, Connecticut
| | - Ikumi Sawada
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Naho Tsuchiya
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | | | | | | | - Marissa Alejandria
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Katerina Leyritana
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | | | - Koya Ariyoshi
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
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Cotter TG, Gathaiya N, Catania J, Loftus EV, Tremaine WJ, Baddour LM, Harmsen WS, Zinsmeister AR, Sandborn WJ, Limper AH, Pardi DS. Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression. Clin Gastroenterol Hepatol 2017; 15:850-856. [PMID: 28013116 PMCID: PMC5440197 DOI: 10.1016/j.cgh.2016.11.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/23/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Use of immunosuppressants and inflammatory bowel disease (IBD) may increase the risk of pneumonia caused by Pneumocystis jirovecii (PJP). We assessed the risk of PJP in a population-based cohort of patients with IBD treated with corticosteroids, immune-suppressive medications, and biologics. METHODS We performed a population-based cohort study of residents of Olmsted County, Minnesota, diagnosed with Crohn's disease (n = 427) or ulcerative colitis (n = 510) from 1970 through 2011. Records of patients were reviewed to identify all episodes of immunosuppressive therapies and concomitant PJP prophylaxis through February 2016. We reviewed charts to identify cases of PJP, cross-referenced with the Rochester Epidemiology Project database (using diagnostic codes for PJP) and the Mayo Clinic and Olmsted Medical Center databases. The primary outcome was risk of PJP associated with the use of corticosteroids, immune-suppressive medications, and biologics by patients with IBD. RESULTS Our analysis included 937 patients and 6066 patient-years of follow-up evaluation (median, 14.8 y per patient). Medications used included corticosteroids (520 patients; 55.5%; 555.4 patient-years of exposure), immunosuppressants (304 patients; 32.4%; 1555.7 patient-years of exposure), and biologics (193 patients; 20.5%; 670 patient-years of exposure). Double therapy (corticosteroids and either immunosuppressants and biologics) was used by 236 patients (25.2%), with 173 patient-years of exposure. Triple therapy (corticosteroids, immunosuppressants, and biologics) was used by 70 patients (7.5%) with 18.9 patient-years of exposure. There were 3 cases of PJP, conferring a risk of 0.2 (95% CI, 0.01-1.0) to corticosteroids, 0.1 (95% CI, 0.02-0.5) cases per 100 patient-years of exposure to immunosuppressants, 0.3 (95% CI, 0.04-1.1) cases per 100 patient-years of exposure to biologics, 0.6 (95% CI, 0.01-3.2) cases per 100 patient-years of exposure to double therapy, and 0 (95% CI, 0.0-19.5) cases per 100 patient-years of exposure to triple therapy. Primary prophylaxis for PJP was prescribed to 37 patients, for a total of 24.9 patient-years of exposure. CONCLUSIONS In a population-based cohort of patients with IBD treated with corticosteroids, immunosuppressants, and biologics, there were only 3 cases of PJP, despite the uncommon use of PJP prophylaxis. Routine administration of PJP prophylaxis in these patients may not be warranted, although it should be considered for high-risk groups, such as patients receiving triple therapy.
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Affiliation(s)
- Thomas G Cotter
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nicola Gathaiya
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jelena Catania
- Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - William J Tremaine
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Larry M Baddour
- Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota
| | - W Scott Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Alan R Zinsmeister
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Andrew H Limper
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Ricciardi A, Gentilotti E, Coppola L, Maffongelli G, Cerva C, Malagnino V, Mari A, Di Veroli A, Berrilli F, Apice F, Toschi N, Di Cave D, Parisi SG, Andreoni M, Sarmati L. Infectious disease ward admission positively influences P. jiroveci pneumonia (PjP) outcome: A retrospective analysis of 116 HIV-positive and HIV-negative immunocompromised patients. PLoS One 2017; 12:e0176881. [PMID: 28505159 PMCID: PMC5432209 DOI: 10.1371/journal.pone.0176881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 01/15/2023] Open
Abstract
P. jiroveci (Pj) causes a potentially fatal pneumonia in immunocompromised patients and the factors associated with a bad outcome are poorly understood. A retrospective analysis on Pj pneumonia (PjP) cases occurring in Tor Vergata University Hospital, Italy, during the period 2011–2015. The patients’ demographic, clinical and radiological characteristics and the Pj genotypes were considered. The study population included 116 patients, 37.9% of whom had haematological malignancy or underwent haematological stem cell transplantation (HSCT), 22.4% had HIV infection, 16.4% had chronic lung diseases (CLD), 7.8% had a solid cancer, and 3.4% underwent a solid organ transplant (SOT). The remaining 12.1% had a miscellaneous other condition. At univariate analysis, being older than 60 years was significantly correlated with a severe PjP (OR [95%CI] 2.52 [0.10–5.76]; p = 0.031) and death (OR [95%CI] 2.44 [1.05–5.70]; p = 0.036), while a previous trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were significantly associated with a less severe pneumonia (OR[95%CI] 0.35 [0.15–0.84], p = 0.023); moreover, death due to PjP was significantly more frequent in patients with CLD (OR[95%CI] 3.26 [1.17–9.05]; p = 0.019) while, admission to the Infectious Diseases Unit was significantly associated with fewer deaths (OR[95%CI] 0.10 [0.03–0.36], p = 0.002). At multivariate analysis, a better PjP outcome was observed in patients taking TMP/SMX prophylaxis and that were admitted to the Infectious Diseases Unit (OR[95%CI] 0.27 [0.07–1.03], p = 0.055, OR[95%CI] 0.16 [0.05–0.55]; p = 0.004, respectively). In conclusion, in our study population, TMP/SMX prophylaxis and infectious disease specialist approach were variables correlated with a better PjP outcome.
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Affiliation(s)
| | | | - Luigi Coppola
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Carlotta Cerva
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Alessia Mari
- Respiratory Diseases Unit, Tor Vergata University, Rome, Italy
| | - Ambra Di Veroli
- Department of Haematology, Tor Vergata University, Rome, Italy
| | - Federica Berrilli
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Fabiana Apice
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, United States of America
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padua, Padua, Italy, Clinical Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | | | - Loredana Sarmati
- Infectious Diseases, Tor Vergata University, Rome, Italy
- * E-mail:
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Abstract
Haemodialysis patients have been found to have an increased risk of developing Pneumocystis pneumonia (PcP) compared to the control population. To the best of our knowledge, no data are available on pulmonary colonization with Pneumocystis jirovecii in haemodialysis patients; therefore, the aim of this study was to determine the prevalence of pulmonary colonization with P. jirovecii in haemodialysis patients, and to find the related risk factors. Induced sputa of 62 haemodialysis patients were investigated using quantitative polymerase chain reaction for the presence of P. jirovecii. 20.9% of the patients were colonized with P. jirovecii and 46.2% of whom had CD4 cell counts below 400/μl. There was no significant correlation between colonization and time on dialysis treatment. As haemodialysis patients seem to be at higher risk of PcP than the general population, doctors should be aware of the high rate of P. jirovecii colonization amongst them. Furthermore, colonized patients remain a potential source of transmission of P. jirovecii to other patients or to health care workers.
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Affiliation(s)
- Carlos Fritzsche
- a Department of Medicine, Division of Tropical Medicine and Infectious Diseases , University of Rostock Medical School , Rostock , Germany
| | - Hosam Ghanem
- a Department of Medicine, Division of Tropical Medicine and Infectious Diseases , University of Rostock Medical School , Rostock , Germany
| | - Sebastian Koball
- b Department of Medicine, Division of Nephrology , University of Rostock Medical School , Rostock , Germany
| | - Brigitte Mueller-Hilke
- c Medical Faculty , Institute for Immunology, University of Rostock Medical School , Rostock , Germany
| | - Emil C Reisinger
- a Department of Medicine, Division of Tropical Medicine and Infectious Diseases , University of Rostock Medical School , Rostock , Germany
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Abstract
With improved prevention of mother to child transmission of HIV, paediatric HIV disease is less common. However, the number of HIV exposed but uninfected infants is growing. Exposure to maternal HIV impacts infant respiratory health through an increase in known risk factors such as increased preterm birth and low birth weight, suboptimal breastfeeding, increased psychosocial stressors and increased exposure to infective pathogens. Exposure to the HIV virus and altered maternal immune environment result in immunologic changes in the infant that may contribute to respiratory disease risk. HIV exposed infants are at increased risk for severe pneumonia with poorer outcomes compared to unexposed infants. Maternal ART and optimal nutrition, including breastfeeding in high infective disease burden settings, reduce morbidity and mortality in HIV exposed infants and should be prioritized. The impact of exposure to maternal HIV on normal lung growth and risk for chronic respiratory disease is unknown and warrants further investigation.
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Affiliation(s)
- A L Slogrove
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
| | - L Frigati
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - D M Gray
- Division Pulmonology, Department of Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, 7700, South Africa.
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Karat AS, Omar T, von Gottberg A, Tlali M, Chihota VN, Churchyard GJ, Fielding KL, Johnson S, Martinson NA, McCarthy K, Wolter N, Wong EB, Charalambous S, Grant AD. Autopsy Prevalence of Tuberculosis and Other Potentially Treatable Infections among Adults with Advanced HIV Enrolled in Out-Patient Care in South Africa. PLoS One 2016; 11:e0166158. [PMID: 27829072 PMCID: PMC5102350 DOI: 10.1371/journal.pone.0166158] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/23/2016] [Indexed: 11/19/2022] Open
Abstract
Background Early mortality among HIV-positive adults starting antiretroviral therapy (ART) remains high in resource-limited settings, with tuberculosis (TB) the leading cause of death. However, current methods to estimate TB-related deaths are inadequate and most autopsy studies do not adequately represent those attending primary health clinics (PHCs). This study aimed to determine the autopsy prevalence of TB and other infections in adults enrolled at South African PHCs in the context of a pragmatic trial of empiric TB treatment (“TB Fast Track”). Methods and Findings Adults with CD4 ≤150 cells/μL, not on ART or TB treatment, were enrolled to TB Fast Track and followed up for at least six months. Minimally invasive autopsy (MIA) was conducted as soon as possible after death. Lungs, liver, and spleen were biopsied; blood, CSF, and urine aspirated; and bronchoalveolar lavage fluid obtained. Samples underwent mycobacterial, bacterial, and fungal culture; molecular testing (including Xpert® MTB/RIF); and histological examination. 34 MIAs were conducted: 18 (53%) decedents were female; median age was 39 (interquartile range 33–44) years; 25 (74%) deaths occurred in hospitals; median time from death to MIA was five (IQR 3–6) days. 16/34 (47%) had evidence of TB (14/16 [88%] with extrapulmonary disease; 6/16 [38%] not started on treatment antemortem); 23 (68%) had clinically important bacterial infections; four (12%) cryptococcal disease; three (9%) non-tuberculous mycobacterial disease; and two (6%) Pneumocystis pneumonia. Twenty decedents (59%) had evidence of two or more concurrent infections; 9/16 (56%) individuals with TB had evidence of bacterial disease and two (13%) cryptococcal disease. Conclusions TB, followed by bacterial infections, were the leading findings at autopsy among adults with advanced HIV enrolled from primary care clinics. To reduce mortality, strategies are needed to identify and direct those at highest risk into a structured pathway that includes expedited investigation and/or treatment of TB and other infections.
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Affiliation(s)
- Aaron S. Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Tanvier Omar
- Department of Anatomical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mpho Tlali
- The Aurum Institute, Johannesburg, South Africa
| | - Violet N. Chihota
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin J. Churchyard
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherine L. Fielding
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne Johnson
- Foundation for Professional Development, Pretoria, South Africa
| | - Neil A. Martinson
- Perinatal HIV Research Unit, and Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
- Department of Science and Technology / National Research Foundation Centre of Excellence for Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Public Health, Surveillance and Response, National Institute for Communicable Disease of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily B. Wong
- Africa Health Research Institute, Durban, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, Durban, South Africa
- University of KwaZulu-Natal, Durban, South Africa
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47
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El Fane M, Sodqi M, Oulad Lahsen A, Chakib A, Marih L, Marhoum El Filali K. [Pneumocystosis during HIV infection]. Rev Pneumol Clin 2016; 72:248-254. [PMID: 27349824 DOI: 10.1016/j.pneumo.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 06/06/2023]
Abstract
Pneumocystosis is an opportunistic disease caused by invasion of unicellular fungus Pneumocystic jirovecii which is responsible for febrile pneumonia among patients with cellular immunodeficiency especially those HIV infected. Despite the decreasing of its incidence due to the introduction of antiretroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients, Pneumocystis pneumonia remains the first AIDS-defining event and a leading cause of mortality among HIV-infected patients. The usual radiological presentation is that of diffuse interstitial pneumonia. The diagnosis is confirmed by the detection of trophozoides and/or cysts P. jirovecii in bronchoalveolar lavage (BAL) samples using several staining techniques. The use of polymerase chain reaction in the BAL samples in conjunction with standard immunofluorescent or colorimetric tests have allowed for more has allowed for more rapid and accurate diagnosis. The standard regimen of treatment is the association of trimethoprim-sulfamethoxazole which has been utilized as an effective treatment with a favourable recovery. Early HIV diagnosis and antiretroviral therapy should reduce the incidence of this dreaded disease.
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Affiliation(s)
- M El Fane
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc.
| | - M Sodqi
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
| | - A Oulad Lahsen
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
| | - A Chakib
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
| | - L Marih
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
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48
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Bardgett HP, Dixon M, Beeching NJ. Increase in hospital mortality from non-communicable disease and HIV-related conditions in Bulawayo, Zimbabwe, between 1992 and 2000. Trop Doct 2016; 36:129-31. [PMID: 16884612 DOI: 10.1258/004947506777978217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The HIV/AIDS pandemic is creating a strain on health care services in the developing world, with knock-on consequences for HIV negative patients. We looked for possible changes over time in the patterns of illness and outcomes of admission to an adult medical unit in Zimbabwe. We performed a prospective descriptive study of discharge diagnoses and causes of in-hospital ;mortality for all medical patients under the care of one consultant at Mpilo Central Hospital, Bulawayo, Zimbabwe. Two similar 7-month periods were compared in 1992 and 2000. Data recorded included: initials, sex, alive or dead status, diagnosis and HIV/AIDS status. Similar numbers of patients were admitted in 1992 and 2000 (1305 and 1369), but in-hospital mortality increased from 13.3% to 28.6% ( P<0.001), especially in male patients (13.1% to 33.9% P<0.001). Mortality rates increased for both infectious and non-communicable diseases such as cardiac failure, stroke and diabetes. The 10 most common diagnoses were similar, apart from Pneumocystis carinii pneumonia (PCP) cases, which increased from 18 to 90. The proportion of patients clinically or serologically positive for HIV/AIDS rose from 13.9% to 51.1% ( P<0.001), but the number of cases of the HIV wasting syndrome (SLIM)/chronic gastroenteritis did not change significantly. In 1992 there happened to be a large number of cases of malaria transmission. Mortality related to both communicable and non-communicable diseases increased, confirming that HIV negative patients are also being affected by the strain on health services. Although based on clinical and radiological diagnosis, PCP pneumonia appears to be increasingly common in this area.
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Affiliation(s)
- H P Bardgett
- Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
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49
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Bienvenu AL, Traore K, Plekhanova I, Bouchrik M, Bossard C, Picot S. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients. Int J Infect Dis 2016; 46:11-7. [PMID: 27021532 DOI: 10.1016/j.ijid.2016.03.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumocystis pneumonia (PCP) is one of the most devastating fungal diseases in patients with impaired immunity. Effective antiviral therapies have reduced the burden of PCP among AIDS patients, but an increase in the prevalence of this disease among persons receiving immunosuppressive therapies has been reported. METHODS We retrospectively reviewed HIV and non-HIV PCP patients diagnosed in our department during a nine year period. Data were collected from the local database completed during the diagnosis procedure. For each patient, demographic, clinical, radiological, biological and therapeutic data were analyzed. RESULTS A total of 21,274 bronchoalveolar samples were received from patients suspected of pneumocystosis during the study period, leading to a discharge diagnosis of PCP for 604 patients (143 HIV-positive and 461 HIV-negative). The ratio of non-HIV versus HIV patients presenting PCP increased from 1.7 to 5.6 during the study period. The mortality rate at day 14 was 16%, occurring mostly in non-HIV patients (20.6% compared to 1.4%, P<0.0001), while non-HIV patients were less symptomatic at diagnosis than AIDS patients. CONCLUSIONS This study presents one of the higher number of HIV and non-HIV patients presenting with PCP in a single center. Pneumocystosis is now a crucial health challenge for patients receiving immunosuppressive therapy, with a high mortality rate. This study highlights the need for international guidelines for prophylaxis of PCP in non-HIV patients.
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Affiliation(s)
- Anne-Lise Bienvenu
- Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Karim Traore
- Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Irina Plekhanova
- Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Mourad Bouchrik
- Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Cécile Bossard
- Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Picot
- Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France.
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50
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Murray SG, Schmajuk G, Trupin L, Gensler L, Katz PP, Yelin EH, Gansky SA, Yazdany J. National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia. PLoS One 2016; 11:e0144918. [PMID: 26731012 PMCID: PMC4701172 DOI: 10.1371/journal.pone.0144918] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 11/26/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Infection is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE). Therapeutic practices have evolved over the past 15 years, but effects on infectious complications of SLE are unknown. We evaluated trends in hospitalizations for severe and opportunistic infections in a population-based SLE study. METHODS Data derive from the 2000 to 2011 United States National Inpatient Sample, including individuals who met a validated administrative definition of SLE. Primary outcomes were diagnoses of bacteremia, pneumonia, opportunistic fungal infection, herpes zoster, cytomegalovirus, or pneumocystis pneumonia (PCP). We used Poisson regression to determine whether infection rates were changing in SLE hospitalizations and used predictive marginals to generate annual adjusted rates of specific infections. RESULTS We identified 361,337 SLE hospitalizations from 2000 to 2011 meeting study inclusion criteria. Compared to non-SLE hospitalizations, SLE patients were younger (51 vs. 62 years), predominantly female (89% vs. 54%), and more likely to be racial/ethnic minorities. SLE diagnosis was significantly associated with all measured severe and opportunistic infections. From 2000 to 2011, adjusted SLE hospitalization rates for herpes zoster increased more than non-SLE rates: 54 to 79 per 10,000 SLE hospitalizations compared with 24 to 29 per 10,000 non-SLE hospitalizations. Conversely, SLE hospitalizations for PCP disproportionately decreased: 5.1 to 2.5 per 10,000 SLE hospitalizations compared with 0.9 to 1.3 per 10,000 non-SLE hospitalizations. CONCLUSIONS Among patients with SLE, herpes zoster hospitalizations are rising while PCP hospitalizations are declining. These trends likely reflect evolving SLE treatment strategies. Further research is needed to identify patients at greatest risk for infectious complications.
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Affiliation(s)
- Sara G. Murray
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Gabriela Schmajuk
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, Veterans Administration, San Francisco, California, United States of America
| | - Laura Trupin
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Lianne Gensler
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Patricia P. Katz
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Edward H. Yelin
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Stuart A. Gansky
- Division of Oral Epidemiology and Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jinoos Yazdany
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
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