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prophylaxis pneumocystis

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https://www.readbyqxmd.com/read/28100282/optimal-regimens-of-sulfamethoxazole-trimethoprim-for-chemoprophylaxis-of-pneumocystis-pneumonia-in-patients-with-systemic-rheumatic-diseases-results-from-a-non-blinded-randomized-controlled-trial
#1
Masako Utsunomiya, Hiroaki Dobashi, Toshio Odani, Kazuyoshi Saito, Naoto Yokogawa, Kenji Nagasaka, Kenchi Takenaka, Makoto Soejima, Takahiko Sugihara, Hiroyuki Hagiyama, Shinya Hirata, Kazuo Matsui, Yoshinori Nonomura, Masahiro Kondo, Fumihito Suzuki, Makoto Tomita, Mari Kihara, Waka Yokoyama, Fumio Hirano, Hayato Yamazaki, Ryoko Sakai, Toshihiro Nanki, Ryuji Koike, Hitoshi Kohsaka, Nobuyuki Miyasaka, Masayoshi Harigai
BACKGROUND: Sulfamethoxazole-trimethoprim (SMX/TMP) is a standard drug for the prophylaxis of Pneumocystis pneumonia (PJP) in immunosuppressed patients with systemic rheumatic diseases, but is sometimes discontinued due to adverse events (AEs). The objective of this non-blinded, randomized, 52-week non-inferiority trial was to quest an effective chemoprophylaxis regimen for PJP with a low drug discontinuation rate. Results at week 24 were reported. METHODS: Adult patients with systemic rheumatic diseases who started prednisolone ≥0...
January 18, 2017: Arthritis Research & Therapy
https://www.readbyqxmd.com/read/28088990/prevention-and-management-of-glucocorticoid-induced-side-effects-a-comprehensive-review-infectious-complications-and-vaccination-recommendations
#2
REVIEW
Avrom Caplan, Nicole Fett, Misha Rosenbach, Victoria P Werth, Robert G Micheletti
Part 3 of this 4-part continuing medical education series reviews several important infectious complications of corticosteroid use, including a focus on pneumocystis pneumonia (PCP) prophylaxis, tuberculosis, viral hepatitis, and other infections, followed by a discussion of vaccination recommendations in immunosuppressed patients.
February 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/28074607/the-use-of-intravenous-pentamidine-for-the-prophylaxis-of-pneumocystis-pneumonia-in-pediatric-patients
#3
Matthijs D Kruizinga, Dorine Bresters, Frans J Smiers, Arjan C Lankester, Robbert G M Bredius
Pneumocystis jiroveci pneumonia was common in the immunocompromised host before the widespread use of prophylaxis. When trimethoprim-sulfamethoxazole is not tolerated, prophylaxis with intravenous pentamidine (IVP) may be initiated. We performed a retrospective analysis of all pediatric patients who received IVP regarding efficacy, safety, and reason for initiation. Of 106 patients included in our analysis, one patient tested positive for Pneumocystis DNA. Adverse events were reported in 18% of IVP courses, and main reason for initiation was cytopenia (59%)...
January 11, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28035717/the-role-of-cd4-cell-count-as-discriminatory-measure-to-guide-chemoprophylaxis-against-pneumocystis-jirovecii-pneumonia-in-human-immunodeficiency-virus-negative-immunocompromised-patients-a-systematic-review
#4
Peter E Messiaen, Senne Cuyx, Tom Dejagere, Jeroen C Van der Hilst
BACKGROUND: In recent years, the incidence of Pneumocystis jirovecii pneumonia (PJP) has increased in immunocompromised patients without human immunodeficiency virus (HIV) infection. Chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is highly effective in preventing PJP in both HIV-positive and -seronegative patients. In HIV-positive patients, the risk of PJP is strongly correlated with decreased CD4 cell count. The role of CD4 cell count in the pathogenesis of PJP in non-HIV immunocompromised patients is less well studied...
December 30, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28018911/a-quantitative-model-to-estimate-drug-resistance-in-pathogens
#5
Frazier N Baker, Melanie T Cushion, Aleksey Porollo
Pneumocystis pneumonia (PCP) is an opportunistic infection that occurs in humans and other mammals with debilitated immune systems. These infections are caused by fungi in the genus Pneumocystis, which are not susceptible to standard antifungal agents. Despite decades of research and drug development, the primary treatment and prophylaxis for PCP remains a combination of trimethoprim (TMP) and sulfamethoxazole (SMX) that targets two enzymes in folic acid biosynthesis, dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS), respectively...
December 2016: Journal of Fungi (Basel, Switzerland)
https://www.readbyqxmd.com/read/28013116/low-risk-of-pneumonia-from-pneumocystis-jirovecii-infection-in-patients-with-inflammatory-bowel-disease-receiving-immune-suppression
#6
Thomas G Cotter, Nicola Gathaiya, Jelena Catania, Edward V Loftus, William J Tremaine, Larry M Baddour, W Scott Harmsen, Alan R Zinsmeister, William J Sandborn, Andrew H Limper, Darrell S Pardi
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...
December 21, 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27932109/risk-evaluation-and-outcome-of-pneumocystis-jirovecii-pneumonia-in-kidney-transplant-patients
#7
S Brakemeier, M Dürr, F Bachmann, D Schmidt, J Gaedeke, K Budde
Pneumocystis jirovecii pneumonia (PJP) affects immunocompromised patients. As a result of effective prophylaxis in the 1st months after kidney transplantation, PJP is increasingly diagnosed in the long term after transplantation. The present study evaluates course and outcome of PJP in a single transplant center from 2010 to 2015. Twenty-three patients presented with PJP at a mean of 53.7 ± 50.2 months after transplantation. Of these, 3 patients underwent ABO-incompatible (ABO-i) living-donor transplantation and 3 patients were treated with the use of belatacept...
November 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27855071/high-prevalence-of-pneumocystis-jirovecii-dihydropteroate-synthase-gene-mutations-in-patients-with-first-episode-of-pneumocystis-pneumonia-in-santiago-chile-and-their-clinical-response-to-trimethoprim-sulfamethoxazole-therapy
#8
Carolina A Ponce, Magali Chabé, Claudio George, Alejandra Cárdenas, Luisa Duran, Julia Guerrero, Rebeca Bustamante, Olga Matos, Laurence Huang, Robert F Miller, Sergio L Vargas
Mutations in the Dihydropteroate synthase (DHPS) gene of Pneumocystis jirovecii associate with failure of sulfa prophylaxis. They can develop by selection in patients receiving sulfa drugs, or be acquired via person-to-person transmission. DHPS mutations raise concern about decreasing efficacy of sulfa drugs, the main available therapeutic tool for Pneumocystis pneumonia (PCP). The prevalence of Pneumocystis DHPS mutations was examined in Pneumocystis isolates from 56 sulfa-prophylaxis-naive adults with first-episode of PCP from 2002-2010 in Santiago, Chile...
November 14, 2016: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/27854149/dissemination-of-trimethoprim-sulfamethoxazole-drug-resistance-genes-associated-with-class-1-and-class-2-integrons-among-gram-negative-bacteria-from-hiv-patients-in-south-india
#9
Marimuthu Ragavan Ramesh Kumar, Narasingam Arunagirinathan, Seetharaman Srivani, Aridoss Dhanasezhian, Nallusamy Vijaykanth, Natesan Manikandan, Sethuramalingam Balakrishnan, Ramachandran Vignesh, Pachamuthu Balakrishnan, Suniti Solomon, Sunil S Solomon
The antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), is generally used for prophylaxis in HIV individuals to protect them from Pneumocystis jiroveci infection. Long-term use of TMP-SMX develops drug resistance among bacteria in HIV patients. The study was aimed to detect the TMP-SMX resistance genes among gram-negative bacteria from HIV patients. TMP-SMX-resistant isolates were detected by the Kirby-Bauer disc diffusion method. While TMP resistance genes such as dfrA1, dfrA5, dfrA7, and dfrA17 and SMX resistance genes such as sul1 and sul2 were detected by multiplex PCR, class 1 and class 2 integrons were detected by standard monoplex PCR...
November 17, 2016: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
https://www.readbyqxmd.com/read/27837497/the-changing-epidemiology-of-invasive-fungal-infections
#10
David A Enoch, Huina Yang, Sani H Aliyu, Christianne Micallef
Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C...
2017: Methods in Molecular Biology
https://www.readbyqxmd.com/read/27835947/successful-treatment-of-severe-pneumocystis-pneumonia-in-an-immunosuppressed-patient-using-caspofungin-combined-with-clindamycin-a-case-report-and-literature-review
#11
Hongjuan Li, Haoming Huang, Hangyong He
BACKGROUND: Pneumocystis jirovecii is responsible for Pneumocystis pneumonia (PCP), which occurs almost exclusively in immunocompromised individuals. Trimethoprim-sulfamethoxazole (TMP-SMZ) is regarded as the first-line treatment and prophylaxis for P. jirovecii infection, but the frequency of adverse reactions and newly emerged antibiotic resistance limit its use. CASE PRESENTATION: Ulcerations and hemorrhages involving the tongue were noted secondary to TMP-SMZ desensitization against PCP in a 46-year-old male who had previously been diagnosed with IgA nephropathy and sustained prolonged corticosteroid therapy...
November 11, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27814896/pneumocystis-jirovecii-pneumonia-in-systemic-autoimmune-rheumatic-disease-a-case-control-study
#12
Susan Tadros, Andrew J Teichtahl, Sabina Ciciriello, Ian P Wicks
INTRODUCTION AND OBJECTIVES: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that affects the immunocompromised. Patients with systemic autoimmune rheumatic disease are increasingly recognised as an at-risk clinical population with a high mortality. This case-control study examined differences in the characteristics and peripheral blood parameters between patients with systemic autoimmune rheumatic disease who developed PJP and gender, age and disease-matched controls...
September 28, 2016: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/27812050/clinical-outcomes-of-pneumocystis-pneumonia-from-a-tertiary-care-centre-in-pakistan
#13
Ali Bin Sarwar Zubairi, Hira Shahzad, Afia Zafar
OBJECTIVE: To assess the predisposing immunocompromised states, administration of pneumocystis jirovecii pneumonia prophylaxis, the disease course and outcomes of patients with pneumocystis jirovecii pneumonia. METHODS: The retrospective study was conducted at the Aga Khan University Hospital in Karachi. The medical records of patients diagnosed with pneumocystis jirovecii pneumonia from January 1995 to October 2015 were retrieved. Baseline characteristics, clinical course, treatment, and mortality rates were noted...
November 2016: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/27789058/evaluation-of-a-new-commercial-real-time-pcr-assay-for-diagnosis-of-pneumocystis-jirovecii-pneumonia-and-identification-of-dihydropteroate-synthase-dhps-mutations
#14
Isabel Montesinos, Marie-Luce Delforge, Farida Ajjaham, Françoise Brancart, Maya Hites, Frederique Jacobs, Olivier Denis
The PneumoGenius® real-time PCR assay is a new commercial multiplex real-time PCR method, which detects the Pneumocystis mitochondrial ribosomal large subunit (mtLSU) and two dihydropteroate synthase (DHPS) point mutations. To evaluate the clinical performance of this new real-time PCR assay we tested 120 extracted DNA samples from bronchoalveolar lavage specimens. These set of extracted DNA samples had already tested positive for Pneumocystis and patients had been classified in probable and unlikely PCP in a previous study...
January 2017: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/27721666/intermittent-courses-of-corticosteroids-also-present-a-risk-for-pneumocystis-pneumonia-in-non-hiv-patients
#15
Maria L Calero-Bernal, Isabel Martin-Garrido, Mikel Donazar-Ezcurra, Andrew H Limper, Eva M Carmona
Introduction. Pneumocystis pneumonia (PCP) is rising in the non-HIV population and associates with higher morbidity and mortality. The aggressive immunosuppressive regimens, as well as the lack of stablished guidelines for chemoprophylaxis, are likely contributors to this increased incidence. Herein, we have explored the underlying conditions, immunosuppressive therapies, and clinical outcomes of PCP in HIV-negative patients. Methods. Retrospective analysis of PCP in HIV-negative patients at Mayo Clinic from 2006-2010...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/27629868/prescription-of-pneumocystis-jiroveci-pneumonia-prophylaxis-in-hiv-infected-patients
#16
Xia Lin, Shikha Garg, Christine L Mattson, Qingwei Luo, Jacek Skarbinski
The US treatment guidelines recommend Pneumocystis jiroveci pneumonia (PCP) prophylaxis for all HIV-infected persons with a CD4 count <200 cells/mm(3) (ie, eligible for PCP prophylaxis). However, some studies suggest PCP prophylaxis may be unnecessary in virally suppressed patients. Using national data of HIV-infected adults receiving medical care in the United States during 2009 to 2012, the authors assessed the weighted percentage of eligible patients who were prescribed PCP prophylaxis and the independent association between PCP prophylaxis prescription and viral suppression...
September 14, 2016: Journal of the International Association of Providers of AIDS Care
https://www.readbyqxmd.com/read/27550993/ecil-guidelines-for-treatment-of-pneumocystis-jirovecii-pneumonia-in-non-hiv-infected-haematology-patients
#17
REVIEW
Georg Maschmeyer, Jannik Helweg-Larsen, Livio Pagano, Christine Robin, Catherine Cordonnier, Peter Schellongowski
The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice...
September 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27550992/ecil-guidelines-for-preventing-pneumocystis-jirovecii-pneumonia-in-patients-with-haematological-malignancies-and-stem-cell-transplant-recipients
#18
REVIEW
Johan Maertens, Simone Cesaro, Georg Maschmeyer, Hermann Einsele, J Peter Donnelly, Alexandre Alanio, Philippe M Hauser, Katrien Lagrou, Willem J G Melchers, Jannik Helweg-Larsen, Olga Matos, Stéphane Bretagne, Catherine Cordonnier
The 5th European Conference on Infections in Leukaemia (ECIL-5) meeting aimed to establish evidence-based recommendations for the prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in non-HIV-infected patients with an underlying haematological condition, including allogeneic HSCT recipients. Recommendations were based on the grading system of the IDSA. Trimethoprim/sulfamethoxazole given 2-3 times weekly is the drug of choice for the primary prophylaxis of PCP in adults ( A-II: ) and children ( A-I: ) and should be given during the entire period at risk...
September 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27550990/pneumocystis-jirovecii-pneumonia-still-a-concern-in-patients-with-haematological-malignancies-and-stem-cell-transplant-recipients
#19
REVIEW
Catherine Cordonnier, Simone Cesaro, Georg Maschmeyer, Hermann Einsele, J Peter Donnelly, Alexandre Alanio, Philippe M Hauser, Katrien Lagrou, Willem J G Melchers, Jannik Helweg-Larsen, Olga Matos, Stéphane Bretagne, Johan Maertens
Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from that associated with HIV infection, with the disease being acute and more often severe, having a lower fungal burden and being more frequently linked to treatment with corticosteroids. Most cases occur in patients not receiving adequate prophylaxis...
September 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27531676/gene-expression-based-discovery-of-atovaquone-as-a-stat3-inhibitor-and-anti-cancer-agent
#20
Michael Xiang, Haesook Kim, Vincent T Ho, Sarah R Walker, Michal Bar-Natan, Melodi Anahtar, Suhu Liu, Patricia A Toniolo, Yasmin Kroll, Nichole Jones, Zachary T Giaccone, Lisa N Heppler, Darwin Q Ye, Jason J Marineau, Daniel Shaw, James E Bradner, Traci Blonquist, Donna Neuberg, Claudio Hetz, Richard M Stone, Robert J Soiffer, David A Frank
The oncogenic transcription factor signal transducer and activator of transcription 3 (STAT3) is frequently activated inappropriately in a wide range of hematological and solid cancers, but clinically-available therapies targeting STAT3 are lacking. Using a computational strategy to identify compounds opposing the gene expression signature of STAT3, we discovered atovaquone (Mepron™), an FDA-approved anti-microbial, to be a potent STAT3 inhibitor. We show that, at drug concentrations routinely achieved clinically in human plasma, atovaquone inhibits STAT3 phosphorylation, the expression of STAT3 target genes, and the viability of STAT3-dependent hematological cancer cells...
August 16, 2016: Blood
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