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https://www.readbyqxmd.com/read/28549105/outbreak-of-pneumocystis-jirovecii-infection-among-heart-transplant-recipients-molecular-investigation-and-management-of-an-inter-human-transmission
#1
William Vindrios, Nicolas Argy, Solène Le Gal, François-Xavier Lescure, Laurent Massias, Minh Patrick Le, Michel Wolff, Yazdan Yazdanpanah, Gilles Nevez, Sandrine Houze, Richard Dorent, Jean-Christophe Lucet
Background: An outbreak of Pneumocystis jirovecii pneumonia (PCP) occurred among heart transplant recipients (HTR) at the outpatient clinic of a university hospital, from March to September 2015. Clinical, therapeutic, biological and molecular data were analyzed to determine its origin and control the outbreak. Methods: Clinical and biological data regarding all HTR followed in the outpatient clinic were collected. PCP diagnosis was based on microscopy and real-time PCR...
May 26, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28506688/human-immunodeficiency-virus-and-fungal-infections
#2
REVIEW
Jeannette Guarner
The discovery of HIV was largely due to the presence of Pneumocystis pneumonia (PCP) in young patients that did not have the usual known causes of immune deficiencies in the early 1980s. Currently, treatment with highly active anti-retroviral therapy (HAART) and the use of prophylaxis for PCP have lowered the frequency of fungal infections; however, these infections continue to cause morbidity and mortality in those patients that fall out or are not in care. The frequency of specific fungal diseases in HIV patients will depend on the prevalence of fungi in the particular geographic location...
April 8, 2017: Seminars in Diagnostic Pathology
https://www.readbyqxmd.com/read/28491877/nodular-regenerative-hyperplasia-a-case-of-rare-prognosis
#3
Mindy Lee, Manhal Izzy, Ashwin Akki, Kathryn Tanaka, Harmit Kalia
Introduction: Nodular regenerative hyperplasia (NRH) is a known etiology of noncirrhotic portal hypertension. Cases of biopsy-proven NRH in human immunodeficiency virus (HIV)-positive patients have been described. While these patients often have normal synthetic liver function, several reports described disease progression to liver failure. Case: We here present a 26-year-old woman with history of congenital HIV on antiretroviral therapy complicated by Pneumocystis carinii pneumonia at age 14. CD4 counts have been >300 with undetectable viral load...
January 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28488228/pneumocystis-pneumonia-and-the-rheumatologist-which-patients-are-at-risk-and-how-can-pcp-be-prevented
#4
REVIEW
Rachel M Wolfe, James E Peacock
PURPOSE OF REVIEW: Immunosuppressive therapy for connective tissue diseases (CTDs) is steadily becoming more intense. The resultant impairment in cell-mediated immunity has been accompanied by an increasing risk for opportunistic infection (OI). Pneumocystis pneumonia (PCP) has been recognized as an OI in patients with CTDs, but specific risk factors and precise indications for PCP prophylaxis remain poorly defined. This review was undertaken to update information on the risk of PCP in patients with CTDs and to examine current guidelines for PCP prophylaxis in this population...
June 2017: Current Rheumatology Reports
https://www.readbyqxmd.com/read/28399687/low-prevalence-of-pneumocystis-pneumonia-in-hospitalized-patients-with-systemic-lupus-erythematosus-review-of-a-clinical-data-warehouse
#5
T M Kapoor, P Mahadeshwar, S Nguyen, J Li, S Kapoor, J Bathon, J Giles, A Askanase
Objective In the era of powerful immunosuppression, opportunistic infections are an increasing concern in systemic lupus erythematosus. One of the best-studied opportunistic infections is Pneumocystis pneumonia; however, the prevalence of Pneumocystis pneumonia in systemic lupus erythematosus is not clearly defined. This study evaluates the prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, with a focus on validating the Pneumocystis pneumonia and systemic lupus erythematosus diagnoses with clinical information...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28303545/low-prevalence-of-dhfr-and-dhps-mutations-in-pneumocystis-jirovecii-strains-obtained-from-a-german-cohort
#6
Isabelle Suárez, Lisa Roderus, Edeltraud van Gumpel, Norma Jung, Clara Lehmann, Gerd Fätkenheuer, Pia Hartmann, Georg Plum, Jan Rybniker
BACKGROUND: Pneumocystis pneumonia (PCP) is an opportunistic and potentially life-threatening infection of immunocompromised individuals. A combination of trimethoprim-sulfamethoxazole is widely used for prophylaxis and treatment of PCP. Polymorphisms in the drug targets, the dihydropteroate synthase (DHPS) or the dihydrofolate reductase (DHFR) are presumably a reason for treatment failure. METHODS: We retrospectively examined the prevalence of DHPS and DHFR mutations in Pneumocystis jirovecii isolates obtained from HIV-infected and non-HIV-infected PCP patients...
March 16, 2017: Infection
https://www.readbyqxmd.com/read/28302661/severe-co-trimoxazole-induced-hypoglycaemia-in-a-patient-with-microscopic-polyangiitis
#7
Thomas Edward Conley, Atif Mohiuddin, Noshaba Naz
A 69-year-old man presented to the emergency department with lower respiratory tract infection and febrile neutropaenia. He was recently discharged following a 50-day hospital stay with newly diagnosed microscopic polyangiitis, complicated by pulmonary haemorrhage and severe renal dysfunction requiring renal replacement therapy, plasma exchange and immunosuppression (cyclophosphamide and methylprednisolone). High risk of pneumocystis pneumonia (PCP) led to an escalation in treatment from prophylactic to therapeutic oral co-trimoxazole, alongside broad-spectrum antibiotics...
March 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28280256/late-onset-cerebral-toxoplasmosis-after-allogeneic-hematopoietic-stem-cell-transplantation
#8
Ahmed M Khalaf, Mahmoud A Hashim, Mohammed Alsharabati, Kenneth Fallon, Joel K Cure, Peter Pappas, Shin Mineishi, Ayman Saad
BACKGROUND Toxoplasmosis is an uncommon but potentially fatal complication following allogeneic hematopoietic stem cell transplantation (HCT). Post-transplant toxoplasmosis is often a reactivation of prior infection and typically occurs within the first 6 months of transplant. Herein, we report that cerebral toxoplasmosis may occur 22 months after allogeneic hematopoietic stem cell transplantation. CASE REPORT We describe a case of cerebral toxoplasmosis that occurred 22 months after an allogeneic HCT while the patient was on aerosolized pentamidine for Pneumocystis jiroveci pneumonia (PCP) prophylaxis...
March 10, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28267082/guidelines-for-the-prophylaxis-of-pneumocystis-jirovecii-pneumonia-pjp-in-children-with-solid-tumors
#9
Rebecca Proudfoot, Bob Phillips, Sophie Wilne
Although it is well-established that children undergoing allogeneic stem cell transplants and treatment for leukemia should be offered prophylaxis against Pneumocystis jirovecii pneumonia, the risk for children with solid malignancies is less certain. This guideline has been developed with the aim of standardizing practice and optimizing the benefit versus risk of prophylactic medication in this group of patients. P. jirovecii pneumonia has a high mortality rate even with prompt antimicrobial treatment. Since prophylaxis with co-trimoxazole is safe, effective, and inexpensive, we suggest that all children with malignancies undergoing immunosuppressive therapy are offered prophylaxis unless there are clear contraindications...
April 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28250304/pneumocystis-pneumonia-concomitant-with-ectopic-acth-syndrome-caused-by-a-large-cell-neuroendocrine-carcinoma-of-the-thymus
#10
Naohiro Oda, Nobuaki Miyahara, Masahiro Tabata, Daisuke Minami, Kiichiro Ninomiya, Arihiko Kanehiro, Motoshi Komatsubara, Kenichi Inagaki, Mitsune Tanimoto, Katsuyuki Kiura
We herein report the case of a 44-year-old man who was diagnosed with pneumocystis pneumonia (PCP) concomitant with ectopic adrenocorticotropic hormone (ACTH) syndrome, which had been caused by a large cell neuroendocrine carcinoma of the thymus. Chest computed tomography revealed ground-glass opacities in the lungs. PCP was diagnosed by a polymerase chain reaction with bronchoalveolar lavage. The levels of cortisol were slowly corrected with an adrenal enzyme inhibitor, and the exacerbation of PCP was successfully avoided...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28223177/pneumocystis-pneumonia-in-patients-with-inflammatory-or-autoimmune-diseases-usefulness-of-lymphocyte-subtyping
#11
Yi Li, Marc Ghannoum, Chuntao Deng, Yanxia Gao, Huadong Zhu, Xuezhong Yu, Valery Lavergne
OBJECTIVES: No consensus currently exists on the indications for Pneumocystis jirovecii prophylaxis in patients with inflammatory or autoimmune diseases. The main objective was to identify biomarkers associated with P. jirovecii pneumonia (PCP) in this population. METHODS: A retrospective study was carried out at Beijing Union Medical College Hospital (2003-2014). All patients with an inflammatory or autoimmune disease presenting with acute onset of fever and respiratory symptoms were included...
February 20, 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/28214184/-systemic-lupus-erythematosus-and-lymphopenia-clinical-and-pathophysiological-features
#12
M Martin, A Guffroy, X Argemi, T Martin
Lymphopenia is frequent in systemic lupus erythematosus (SLE) and profound (<500/mm(3)) in 10% of cases. T lymphocytes, especially CD4+, are more affected than B cells. The pathophysiological mechanisms are complex, involving lymphocytotoxic antibodies, excess of apoptosis, increased susceptibility of T cells to complement mediated cytolysis, as well as lymphopoiesis impairment and lymphocyte sequestration. Lymphopenia in SLE is independent from other cytopenia and immunosuppressive drug regiments, and associated with disease activity, risk of flare and damage scores...
February 14, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/28169011/investigation-of-outbreaks-of-pneumocystis-jirovecii-pneumonia-in-two-scottish-renal-units
#13
T Inkster, S Dodd, R Gunson, L Imrie, E Spalding, S Packer, C Deighan, C Daly, J Coia, T Imtiaz, C McGuffie, R Wilson, A M Bal
Pneumocystis jirovecii is recognized as an opportunistic pathogen. In recent years, human-to-human transmission of P. jirovecii has been demonstrated. However, outbreaks of P. jirovecii infections are not well defined because the epidemiological setting that facilitates transmission is not fully understood. This article describes two outbreaks of P. jirovecii pneumonia (PCP) in renal transplant patients in the West of Scotland. In total, 25 patients in two geographically contiguous locations were affected...
November 18, 2016: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28134084/pneumocystis-jiroveci-pneumonia-in-rheumatic-disease-a-20-year-single-centre-experience
#14
Christopher A Mecoli, Deanna Saylor, Allan C Gelber, Lisa Christopher-Stine
OBJECTIVES: Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection with high mortality among patients with underlying rheumatologic conditions. Given the paucity of prospective data to guide treatment, clinical guidelines to initiate PJP prophylaxis are based on expert opinion and identify patients on ≥20 mg daily prednisone for ≥4 weeks duration for treatment. Herein we describe the PJP experience in rheumatic disease over a 20-year period at a single academic medical centre to investigate this 20 mg threshold and risk associated with lymphocyte counts, co-existing lung disease and immunosuppressive medications...
January 27, 2017: Clinical and Experimental Rheumatology
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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...
June 2017: Clinical Gastroenterology and Hepatology
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