scholarly journals ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients

2016 ◽  
Vol 71 (9) ◽  
pp. 2405-2413 ◽  
Author(s):  
Georg Maschmeyer ◽  
Jannik Helweg-Larsen ◽  
Livio Pagano ◽  
Christine Robin ◽  
Catherine Cordonnier ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Treatment Success ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Antimicrobial Treatment ◽  
Pneumocystis Jirovecii ◽  
High Dose ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Laboratory Findings ◽  
Patients At Risk

Abstract 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. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.

Short Oral Antibiotic Treatment of Osteomyelitis Questioned

1980 ◽  
Vol 2 (1) ◽  
pp. 18-18
Keyword(s):  
Antimicrobial Therapy ◽  
Oral Therapy ◽  
Initial Period ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Oral Route ◽  
Antimicrobial Treatment ◽  
Blood Levels ◽  
Oral Antibiotic ◽  
Cortical Destruction

Dr. Rothman of Haverhill, MA questioned the short duration of antimicrobial treatment and use of oral route for the patient with osteomyelitis presented by Bennett in PIR 1:153, November 1979. He noted that the traditional regimen for osteomyelitis calls for six weeks of intravenous antimicrobial therapy. Dr. Bennett quotes from Telzlaff et al (J Pediatr 92:485, 1978). In this report good results were found when antimicrobial regimens for patients with osteomyelitis and suppurative arthritis consisted of a brief initial period of parenteral therapy of only one to seven days followed by oral antimicrobial therapy begun when there was a definitive decrease in clinical signs of inflammation and continued for three weeks or longer. It is important to note that surgical drainage of pus was carried out, that antimicrobial blood levels were obtained after initiation of oral therapy to ensure adequate levels, that therapy was continued until all signs and symptoms had subsided, that there was no evidence of cortical destruction or sequestrum formation on roentgenogram, and the erythrocyte sedimentation rate was less than 20 mg/hr. When these conditions are met it is clear that oral therapy can be an adequate substitute for prolonged intravenous therapy for osteomyelitis in children.

scholarly journals Diagnostic Performance of Bronchoalveolar Lavage (1,3)-β-d-Glucan Assay for Pneumocystis jirovecii Pneumonia

2020 ◽  
Vol 6 (4) ◽  
pp. 200
Author(s):  
Shiwei Zhou ◽  
Kathleen A. Linder ◽  
Carol A. Kauffman ◽  
Blair J. Richards ◽  
Steve Kleiboeker ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Test Performance ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Lavage Fluid ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Characteristic Area

We evaluated the performance of the (1,3)-β-d-glucan (BDG) assay on bronchoalveolar lavage fluid (BALF) as a possible aid to the diagnosis of Pneumocystis jirovecii pneumonia. BALF samples from 18 patients with well-characterized proven, probable, and possible Pneumocystis pneumonia and 18 well-matched controls were tested. We found that the best test performance was observed with a cut-off value of 128 pg/mL; receiver operating characteristic/area under the curve (ROC/AUC) was 0.70 (95% CI 0.52–0.87). Sensitivity and specificity were 78% and 56%, respectively; positive predictive value was 64%, and negative predictive value was 71%. The low specificity that we noted limits the utility of BALF BDG as a diagnostic tool for Pneumocystis pneumonia.

Pneumocystis jirovecii Pneumonia and Human Immunodeficiency Virus Co-Infection in Western Iran

2020 ◽  
Author(s):  
Arezoo BOZORGOMID ◽  
Yazdan HAMZAVI ◽  
Sahar HEIDARI KHAYAT ◽  
Behzad MAHDAVIAN ◽  
Homayoon BASHIRI
Keyword(s):  
Human Immunodeficiency Virus ◽  
Signs And Symptoms ◽  
Rapid Identification ◽  
Diagnostic Methods ◽  
Pneumocystis Jirovecii ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cell Counts ◽  
Stage 4 ◽  
Immunodeficiency Virus

Background: The human immunodeficiency virus (HIV) is one of the greatest health challenges facing worldwide. The virus suppresses the immune system of the patient. The purpose of this study was to describe the epidemiology of Pneumocystis jirovecii colonization, rarely found in normal people, in patients with stage 4 HIV infection in Kermanshah, Iran, from Mar 1995 to Feb 2016. Methods: In this retrospective study, we surveyed medical records of stage 4 HIV-positive patients with Pneumocystis admitted to Behavioral Counseling Center of Kermanshah. Several parameters were analyzed including demographic characteristics, body mass index (BMI), treatment regimen, diagnostic methods, presenting signs and symptoms, presence of co-pathogens (bacteria, viruses, or fungi), and nadir of CD4 T-cell count before and after treatment. Results: During the study period, 114 HIV-positive patients were analyzed, of whom 93 were male and 21 were female, respectively. Of 114 cases, 26 (22.8%) patients had Pneumocystis. All 26 colonized patients had CD4 cell counts below 200 cells/mm3 (range 9–186). The median CD4 count increased from 91 cells/mm3 pretrimethoprim/sulfamethoxazole (TMP/SMX) to an estimated 263 cells/mm3 after starting (TMP/SMX). BMI was normal in the majority of the patients (85%) and coughs, sputum, and chest pain (19; 73%) followed by dyspnea, weakness, and lethargy (7; 27%) were the most common presentations of fungal pneumonia. Conclusion: HIV/AIDS-infected patients are an environmental reservoir of P. jirovecii infection that might transmit the infection from one person to another via the airborne route. In addition, rapid identification of such individuals may reduce the morbidity and mortality rate of this disease.

scholarly journals P.103 When a neurosurgeon should care about pneumonia: the case for Pneumocystis jirovecii pneumonia prophylaxis in neurosurgical patients

2019 ◽  
Vol 46 (s1) ◽  
pp. S41
Author(s):  
M de Lotbiniere-Bassett ◽  
M Dhillon ◽  
PJ Boiteau ◽  
P Couillard
Keyword(s):  
Care Pathway ◽  
Pneumocystis Jirovecii ◽  
High Dose ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Increased Risk ◽  
Neurosurgical Patients ◽  
Preventable Harm ◽  
Dose Corticosteroid ◽  
High Index Of Suspicion ◽  
Hiv Negative

Background: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic interstitial fungal pneumonia. The incidence of PJP in HIV-positive populations is decreasing, while it is increasing in HIV-negative immunocompromised populations, such as neurosurgical patients treated with high-dose corticosteroids. Morbidity and mortality can be severe owing to acute respiratory failure. Methods: Two cases are described and a literature review performed to determine the incidence of PJP in the neurosurgery population. A standardized care pathway is proposed to reduce preventable harm. Results: Long-term, high-dose corticosteroid regimens (≥4 mg dexamethasone daily for ≥4 weeks) with taper are associated with increased risk of PJP infection. Additional risk factors for infection in HIV-negative patients include CNS malignancy and concurrent radiation therapy. TMP-SMX is the first-line agent for PJP prophylaxis. Conclusions: Clinicians should maintain a high index of suspicion of PJP and adopt a standardized protocol for prophylaxis in neurosurgical patients treated with high-dose corticosteroids.

scholarly journals Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study

2021 ◽  
pp. archdischild-2021-322290
Author(s):  
Jordan E Roberts ◽  
Jeffrey I Campbell ◽  
Kimberlee Gauvreau ◽  
Gabriella S Lamb ◽  
Jane Newburger ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Oral Mucosa ◽  
Multivariable Analysis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Laboratory Findings ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Clinical Signs And Symptoms ◽  
Inflammatory Syndrome

ObjectiveFeatures of multisystem inflammatory syndrome in children (MIS-C) overlap with other febrile illnesses, hindering prompt and accurate diagnosis. The objectives of this study were to identify clinical and laboratory findings that distinguished MIS-C from febrile illnesses in which MIS-C was considered but ultimately excluded, and to examine the diseases that most often mimicked MIS-C in a tertiary medical centre.Study designWe identified all children hospitalised with fever who were evaluated for MIS-C at our centre and compared clinical signs and symptoms, SARS-CoV-2 status and laboratory studies between those with and without MIS-C. Multivariable logistic LASSO (least absolute shrinkage and selection operator) regression was used to identify the most discriminative presenting features of MIS-C.ResultsWe identified 50 confirmed MIS-C cases (MIS-C+) and 68 children evaluated for, but ultimately not diagnosed with, MIS-C (MIS-C-). In univariable analysis, conjunctivitis, abdominal pain, fatigue, hypoxaemia, tachypnoea and hypotension at presentation were significantly more common among MIS-C+ patients. MIS-C+ and MIS-C- patients had similar elevations in C-reactive protein (CRP), but were differentiated by thrombocytopenia, lymphopenia, and elevated ferritin, neutrophil/lymphocyte ratio, BNP and troponin. In multivariable analysis, predictors of MIS-C included age, neutrophil/lymphocyte ratio, platelets, conjunctivitis, oral mucosa changes, abdominal pain and hypotension.ConclusionsAmong hospitalised children undergoing evaluation for MIS-C, children with MIS-C were older, more likely to present with conjunctivitis, oral mucosa changes, abdominal pain and hypotension, and had higher neutrophil/lymphocyte ratios and lower platelet counts. These data may be helpful for discrimination of MIS-C from other febrile illnesses, including bacterial lymphadenitis and acute viral infection, with overlapping features.

scholarly journals Epidemiological Outbreaks of Pneumocystis jirovecii Pneumonia Are Not Limited to Kidney Transplant Recipients: Genotyping Confirms Common Source of Transmission in a Liver Transplantation Unit

2016 ◽  
Vol 54 (5) ◽  
pp. 1314-1320 ◽  
Author(s):  
Guillaume Desoubeaux ◽  
Manon Dominique ◽  
Florent Morio ◽  
Rose-Anne Thepault ◽  
Claire Franck-Martel ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Clinical Signs ◽  
Pneumocystis Jirovecii ◽  
Clinical Samples ◽  
Common Source ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Content Type ◽  
Molecular Genotyping

Over a 5-month period, four liver transplant patients at a single hospital were diagnosed withPneumocystis jiroveciipneumonia (PCP). This unusually high incidence was investigated using molecular genotyping. Bronchoalveolar lavage fluids (BALF) obtained from the four liver recipients diagnosed with PCP were processed for multilocus sequence typing (MLST) at three loci (SOD, mt26s, andCYB). Twenty-four other BALF samples, which were positive forP. jiroveciiand collected from 24 epidemiologically unrelated patients with clinical signs of PCP, were studied in parallel by use of the same method.Pneumocystis jiroveciiisolates from the four liver recipients all had the same genotype, which was different from those of the isolates from all the epidemiologically unrelated individuals studied. These findings supported the hypothesis of a common source of contamination or even cross-transmission of a singleP. jiroveciiclone between the four liver recipients. Hospitalization mapping showed several possible encounters between these four patients, including outpatient consultations on one particular date when they all possibly met. This study demonstrates the value of molecular genotyping ofP. jiroveciiisolated from clinical samples for epidemiological investigation of PCP outbreaks. It is also the first description of a common source of exposure to a singleP. jiroveciiclone between liver transplant recipients and highlights the importance of prophylaxis in such a population.

scholarly journals Pneumocystis Jirovecii Pneumonia as a Sequela of COVID-19

2021 ◽  
pp. 425-428
Author(s):  
Zubair SM ◽  
Muhammad Zaid HH ◽  
Talha S
Keyword(s):  
Bronchoalveolar Lavage ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Shortness Of Breath ◽  
Remarkable Improvement

A 71 years old male came to the hospital with the complaint of cough and fever since 7 days. He was diagnosed with severe COVID pneumonia and was managed with steroids and tocilizumab. He was discharged on steroids and came after 20 days with complaints of worsening shortness of breath and hypoxia. Bronchoscopy and bronchoalveolar lavage was done which showed positive PCR for Pneumocystis Jirovecii Pneumonia (PCP). Patient was started on co-trimoxazole and steroids after which he showed remarkable improvement. This is one of the rare cases in which patient developed PCP as a sequelae of COVID-19.

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