scholarly journals 336. COVID-19 and Pneumocystis jiroveci Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S272-S273
Author(s):  
Christopher Saling ◽  
Sabirah N Kasule ◽  
Holenarasipur R Vikram
Keyword(s):  
Opportunistic Infection ◽  
Patient Characteristics ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Pneumocystis Jiroveci ◽  
Infection Age ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Immunodeficiency Virus ◽  
Low Threshold ◽  
Mean Time

Abstract Background More accounts of opportunistic infection in COVID-19 patients are emerging. At our institution, we identified 2 COVID-19 patients with Pneumocystis jiroveci pneumonia (PJP) opportunistic infection. This prompted a review of the literature to identify trends in patient characteristics, risk factors, and outcomes in this population. Methods A literature review was conducted using PubMed that identified 13 other patients with both COVID-19 and PJP infection. Age, gender, human immunodeficiency virus (HIV) status, other immunocompromised states, time between COVID-19 and PJP diagnosis, and clinical outcomes were captured for analysis. Results Eleven patients were male. The average age was 56 years. All but 2 patients were immunocompromised. At time of PJP diagnosis, seven patients had newly diagnosed HIV and one had known, well-controlled HIV. One patient had rheumatoid arthritis receiving leflunomide, 1 had ulcerative colitis receiving budesonide and sulfasalazine, 2 patients had multiple myeloma whereby both were on lenalidomide, 1 patient was a renal transplant recipient immunosuppressed on tacrolimus, mycophenolate, and methylprednisolone, and 1 patient had chronic lymphocytic leukemia getting fludarabine, cyclophosphamide, and rituximab. Nine patients had positive COVID-19 and PJP tests performed within 7 days of one another. One patient tested positive for PJP 54 days into admission for COVID-19. This patient received high dose steroids and tocilizumab for initial COVID-19 infection. Three patients were re-hospitalized with PJP after a recent admission for COVID-19 pneumonia, with a mean time to readmission of 25 days. One of these 3 patients had no treatment for COVID-19, while 2 received steroids. Five of the total 15 patients (33%) died. Conclusion COVID-19 treatments with high dose steroids and tocilizumab can make patients vulnerable for opportunistic infection with PJP. Furthermore, COVID-19 is known to cause lymphopenia which may further increase this risk. A diagnosis of concomitant PJP can be especially challenging due to nearly identical radiographical findings. Serum beta-D glucan and HIV testing can be especially helpful in this situation, and there should be a low threshold for performing bronchoalveolar lavage. Disclosures All Authors: No reported disclosures

scholarly journals Co-infection by Cryptococcus neoformans fungaemia and Non tuberculous Mycobacterium together with Pneumocystis jiroveci pneumonia in a patient with newly diagnosed HIV infection

2021 ◽  
Author(s):  
Eihab Subahi ◽  
safwan aljafar ◽  
haidar barjas ◽  
Mohamed Abdelrazek ◽  
Fatima Rasoul
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Cryptococcus Neoformans ◽  
Opportunistic Infections ◽  
Newly Diagnosed ◽  
Aids Patients ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Immunodeficiency Virus

Opportunistic infections are common in human immunodeficiency virus (HIV)-infected patients. Co-infections with Cryptococcus neoformans together with Mycobacterium and Pneumocystis jiroveci pneumonia (PCP) are rare, and typically occur in immunocompromised individuals, particularly AIDS patients.

scholarly journals The Evaluation of the Factors Affecting Mortality in Cases of HIV-infected Pneumocystis Jiroveci Pneumonia

2021 ◽  
Vol 34 (2) ◽  
pp. 109-112
Author(s):  
Ayşe İnci ◽  
Ahmet Refik Konyalı ◽  
Nagehan Didem Sarı
Keyword(s):  
Mortality Rate ◽  
Pneumocystis Jiroveci ◽  
Factors Affecting ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Immunodeficiency Virus ◽  
Common Opportunistic Infection ◽  
The Mean ◽  
Cd4 Lymphocyte ◽  
Comorbidity Status

Objective: Pneumocystis jiroveci pneumonia (PJP) is a common opportunistic infection in human immunodeficiency virus (HIV) infection cases. This study aimed to investigate the mortality rate and the factors affecting mortality in HIV-infected PJP cases followed in our clinic. Methods: In this study HIV (+) cases followed up in our clinic between 2012-2019 were included. Age, sex, comorbidity status, LDH, CD4, lymphocyte, albumin, values, and blood gas results of these patients were recorded at the time of diagnosis. Results: Twenty-eight patients with the diagnosis of HIV-infected PJP were included in the study. The mean age of the patients was 45.7 years, and the male ratio was 78.6% (18/28). The overall hospital mortality rate was 35.7% (10/28) among the cases. Conclusions: As a result, performing studies involving many patients may be beneficial in these patients for diagnosis, follow-up and early treatment.

scholarly journals 1130. Low Risk of Pneumocystis jiroveci Pneumonia in Patients With Waldenstrom’s Macroglobulinemia on Ibrutinib

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S338-S339
Author(s):  
Amanda E Kusztos ◽  
Matthew P Cheng ◽  
Joshua N Gustine ◽  
Toni E Dubeau ◽  
Ann E Woolley ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Lymphocytic Leukemia ◽  
Waldenström’S Macroglobulinemia ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Increased Risk ◽  
Waldenstrom's Macroglobulinemia ◽  
Waldenstrom’S Macroglobulinemia ◽  
Waldenström's Macroglobulinemia ◽  
Research Grant

Abstract Background Ibrutinib is a Bruton’s tyrosine kinase inhibitor that is FDA approved for the treatment of chronic lymphocytic leukemia (CLL), mantle cell lymphoma, marginal zone lymphoma, and Waldenstrom’s macroglobulinemia (WM). Fungal infections including Pneumocystis jiroveci pneumonia (PCP) are increasingly reported in patients with CLL and lymphoma on ibrutinib possibly due to the off-target effect of ibrutinib on the adaptive immune system. Whether this increased risk is due to the effect of ibrutinib alone or in combination with immune dysregulation due to underlying malignancy is unknown. The purpose of this study was to assess the incidence of PCP in patients with WM on ibrutinib therapy. Methods A retrospective cohort study was performed of all patients with WM who initiated ibrutinib monotherapy at Dana-Farber Cancer Institute between July 1, 2015 and January 30, 2018. Baseline characteristics, laboratory parameters, previous and concomitant malignancy treatment regimens, and antimicrobial medications were collected by chart review. Patients were followed until April 1, 2018 for the development of PCP. Results There were a total of 106 patients with WM on ibrutinib during the study period. Sixty-one (58%) were male, and the median age at initiation of ibrutinib was 69 years (range 43 – 89). Forty-six patients (43%) received prior therapy for WM, with a median of two previous treatment courses (range 1–6). Fourteen patients (13%) were on PCP prophylaxis for a combined duration of 8 person-years. No cohort patient developed PCP during the study period, which included 146 person-years of ibrutinib exposure. Three patients (3%) died due to disease progression (n = 2) and E. coli sepsis (n = 1). Conclusion Patients with WM on ibrutinib monotherapy appear to have a different infectious risk profile than patients with CLL or lymphoma and do not have a high risk of developing PCP. These data suggest that PCP prophylaxis is likely not beneficial for patients with WM on ibrutinib. Disclosures M. P. Cheng, Royal College of Physicians and Surgeons of Canada: Member, Salary. S. P. Hammond, Merck: Investigator, Research support. J. J. Castillo, Pharmacyclics: Consultant and Grant Investigator, Consulting fee and Research grant. N. C. Issa, GSK: Investigator, Research grant. Merck: Investigator, Research grant. Akros Pharma: Consultant, Consulting fee.

Pneumocystis jiroveci pneumonia during first and second-line chemotherapy for solid tumours.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18330-e18330
Author(s):  
Emma Shaughnessy ◽  
Kevin Armstrong ◽  
Madeline Rogers-Seeley ◽  
Adarsh Das ◽  
Domenic Higgs ◽  
...  
Keyword(s):  
Reference Range ◽  
Cd4 Count ◽  
Solid Tumours ◽  
High Dose ◽  
Second Line ◽  
First Line ◽  
Pneumocystis Jiroveci ◽  
Second Line Chemotherapy ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Line Chemotherapy

e18330 Background: Pneumocystis jiroveci pneumonia (PJP) is an opportunistic fungal infection, historically associated with individuals with advanced immunodeficiency, sustained temozolamide chemotherapy and in those who have undergone multiple lines of chemotherapy. PJP is now increasingly being recognised in patients undergoing first-line chemotherapy. This is a retrospective study of ten cases of PJP at our institution amongst patients undergoing first or second-line chemotherapy for solid tumours. Methods: An electronic database search was conducted, looking at cases of PJP diagnosed in our institution over a five year period. Ten patients with a history of PJP were identified. These patients’ pharmacy records, pathology, imaging and laboratory results were examined. Results: All identified patients developed PJP whilst undergoing first-line (70%) or second-line (30%) chemotherapy for solid tumours. These included metastatic cancers such as: pancreatic adenocarcinoma (50%), lung cancer (20%), prostate adenocarcinoma (10%), gastric adenocarcinoma (10%); and colon adenocarcinoma (10%). Eight of ten patients were lymphopenic, with lymphocytes counts of 0.1 - 0.5 (reference range 1.0 - 4.0 x 109/L). One patient had a recorded CD4 count of 114 (reference range 500-1500). On the basis of clinical context, ground-glass changes on CT and/or a positive sputum PCR for PJP, each patient was treated with intravenous high-dose trimethoprim/sulfamethoxazole until they were clinically stable. Patients were then switched on to a life-long prophylactic dose. Four patients required intensive care for management of respiratory failure. Nine out of ten patients recovered well without any long-term sequelae and one patient died. Conclusions: PJP is being diagnosed more frequently than previously thought in those receiving first and second-line chemotherapy. Limited research has been conducted into the potential benefit of prescribing trimethoprim/sulfamethoxazole prophylaxis to patients commencing chemotherapy. Monitoring of CD4 count prior to each chemotherapy cycle could provide guidance to oncologists regarding when to commence prophylactic treatment as a means to reducing patients diagnosed with PJP.

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