MiscellaneousPrimary Prophylaxis for Pneumocystis jirovecii Pneumonia in Patients with Connective Tissue Diseases
Section snippets
Patients and Methods
This study was approved by the Institutional Ethics Committee of Ramathibodi Hospital, Mahidol University, Thailand. We retrospectively selected the medical records through a search of the patient database for the corresponding ICD-10 codes for CTD, for both inpatients and outpatients, who had been followed up between October 2006 and September 2007. The inclusion criteria were the following: adult patients (age ≥15 years) who were diagnosed with CTD and had taken prednisolone ≥20 mg/d or
Patient Characteristics
A total of 138 risk episodes of Pneumocystis infection from 132 patients with CTD fulfilled the criteria for analysis. Of the 132 patients, 126 were female. One hundred nineteen patients had SLE, 4 had Behcet's disease, 4 had dermatomyositis, 2 had Takayasu's arteritis, 2 had microscopic polyangiitis (MPA), and 1 had Churg-Strauss syndrome. Six patients had 2 episodes of risk; 1 was a patient with a diagnosis of Behcet's disease and the others were SLE patients.
The demographic data of CTD
Discussion
P jirovecii pneumonia is an uncommon but often fatal occurrence in patients with connective tissue diseases. However, standard guidelines for the administration of PCP prophylaxis to patients with CTDs, especially those with SLE who are receiving immunosuppressive agents, have not been established. This reluctance may be due to overriding concerns about risk of developing ADR from SMZ/TM, the most effective regimen for PCP prophylaxis, and consequently overcomes its potential benefits. Some
Acknowledgment
The authors would like to acknowledge U Udomsubpayakul, MSC, Department of Clinical Epidemiology and Biostatistics, Ramathibodi Medical School, Mahidol University for statistical analysis.
References (30)
- et al.
Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy
Mayo Clin Proc
(1996) - et al.
Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states
Chest
(2000) - et al.
Aerosolized pentamidine as pneumocystis prophylaxis after bone marrow transplantation is inferior to other regimens and is associated with decreased survival and an increased risk of other infections
Biol Blood Marrow Transplant
(2000) - et al.
Safety of dapsone as Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus-infected patients with allergy to trimethoprim/sulfamethoxazole
Am J Med
(1996) - et al.
Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients
Clin Microbiol Rev
(2004) - et al.
An Official ATS Workshop Summary: Recent advances and future directions in pneumocystis pneumonia (PCP)
Proc Am Thorac Soc
(2006) - et al.
Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients
Eur J Clin Microbiol Infect Dis
(2002) - et al.
Pneumocystis carinii pneumonia in patients without HIV infection
J Med Assoc Thai
(2003) - et al.
Pneumocystis pneumonia
N Engl J Med
(2004) - et al.
Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality
Arthritis Rheum
(1999)
Risk factors of Pneumocystis jeroveci pneumonia in patients with systemic lupus erythematosus
Rheumatol Int
Pneumocystis carinii pneumonia in patients without AIDS, 1980 through 1993An analysis of 78 cases
Arch Intern Med
Prevention of infectious complications in rheumatic disease patients: immunizationPneumocystis carinii prophylaxis, and screening for latent infections
Curr Opin Rheumatol
Opportunistic infections in patients with and patients without Acquired Immunodeficiency Syndrome
Clin Infect Dis
A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infectionThe Dutch AIDS Treatment Group
N Engl J Med
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2022, Respiratory InvestigationCitation Excerpt :In contrast, there are no published guidelines for PCP prophylaxis among patients with rheumatologic diseases receiving immunosuppressive drugs. Chemoprophylaxis has been recommended in patients with rheumatologic diseases such as systemic lupus erythematosus, dermatomyositis/polymyositis and Wegener's granulomatosis who are treated with significant doses of glucocorticoids (≥20 mg of prednisolone daily for one month or longer) in combination with a second immunosuppressive drug, particularly a cytotoxic agent due to a high incidence of PCP [49–51]. TMP-SMX is first-choice for prophylaxis in case of non-HIV PCP as well as HIV PCP and is the only agent demonstrated to be more effective than placebo in prospective randomized trials (grade A recommendation) [52,53].
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The authors have no conflicts of interest to disclose.