scholarly journals Pneumocystis jirovecii Pneumonia Prophylaxis for Cancer Patients during Chemotherapy

Pathogens ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 237
Author(s):  
Kazuto Takeuchi ◽  
Yoshihiro Yakushijin
Keyword(s):  
Cancer Treatment ◽  
Treatment Outcomes ◽  
Cancer Patients ◽  
Potential Problem ◽  
Corticosteroid Treatment ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Healthy Individuals ◽  
Life Threatening

Pneumocystis jirovecii pneumonia (PJP) is one type of life-threatening pneumonia in immunocompromised patients. PJP development should be considered in not only immunocompromised individuals, but also patients undergoing intensive chemotherapies and immunotherapies, organ transplantation, or corticosteroid treatment. Past studies have described the clinical manifestation of PJP in patients during chemotherapy and reported that PJP affects cancer treatment outcomes. Therefore, PJP could be a potential problem for the management of cancer patients during chemotherapy, and PJP prophylaxis would be important during cancer treatment. This review discusses PJ colonization in outpatients during cancer chemotherapy, as well as in healthy individuals, and provides an update on PJP prophylaxis for cancer patients during chemotherapy.

scholarly journals Pneumocystis jirovecii detection in asymptomatic patients: what does its natural history tell us?

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 739 ◽  
Author(s):  
Alexandre Alanio ◽  
Stéphane Bretagne
Keyword(s):  
Quantitative Polymerase Chain Reaction ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii ◽  
Immunocompromised Patients ◽  
Healthy Individuals ◽  
Real Time Quantitative Pcr ◽  
Asymptomatic Patients ◽  
Fungal Load ◽  
Invasive Infections ◽  
Life Threatening

Pneumocystis jiroveciiis an unusual ascomycetous fungus that can be detected in the lungs of healthy individuals. Transmission from human to human is one of its main characteristics in comparison with other fungi responsible for invasive infections.P. jiroveciiis transmitted through the air between healthy individuals, who are considered to be the natural reservoir, at least transiently. In immunocompromised patients,P. jiroveciimultiplies, leading to subacute infections and acute life-threatening pneumonia, called Pneumocystis pneumonia [PCP]. PCP is caused by genotypically distinct mixtures of organisms in more than 90% of cases, reinforcing the hypothesis that there is constant inhalation ofP. jiroveciifrom different contacts over time, although reactivation of latent organisms from previous exposures may be possible. Detection ofP. jiroveciiDNA without any symptoms or related radiological signs has been called “colonization”. This situation could be considered as the result of recent exposure toP. jiroveciithat could evolve towards PCP, raising the issue of cotrimoxazole prophylaxis for at-risk quantitative polymerase chain reaction (qPCR)-positive immunocompromised patients. The more accurate way to diagnose PCP is the use of real-time quantitative PCR, which prevents amplicon contamination and allows determination of the fungal load that is mandatory to interpret the qPCR results and manage the patient appropriately. The detection ofP. jiroveciiin respiratory samples of immunocompromised patients should be considered for potential risk of developing PCP. Many challenges still need to be addressed, including a better description of transmission, characterization of organisms present at low level, and prevention of environmental exposure during immunodepression.

scholarly journals Point-Counterpoint: Should Serum β-d-Glucan Testing Be Used for the Diagnosis of Pneumocystis jirovecii Pneumonia?

2019 ◽  
Vol 58 (1) ◽  
Author(s):  
Gabriela Corsi-Vasquez ◽  
Luis Ostrosky-Zeichner ◽  
Edward F. Pilkington ◽  
Paul E. Sax
Keyword(s):  
High Risk ◽  
Prophylactic Antibiotics ◽  
Induced Sputum ◽  
Pneumocystis Jirovecii ◽  
Outpatient Clinics ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Content Type ◽  
Aids Epidemic

Despite the widespread use of prophylactic antibiotics in high-risk individuals, Pneumocystis jirovecii remains an important cause of pneumonia in immunocompromised patients. During the peak of the AIDS epidemic, many hospitals and outpatient clinics were very proficient at collecting induced sputum specimens for the diagnosis of Pneumocystis jirovecii pneumonia (PJP).

scholarly journals Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yang Liu ◽  
Ke Zheng ◽  
Yecheng Liu ◽  
Huadong Zhu
Keyword(s):  
Nephrotic Syndrome ◽  
T Lymphocyte ◽  
Lymphocyte Count ◽  
Clinical Manifestations ◽  
Multivariate Logistic Regression Analysis ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Confirmatory Tests ◽  
Life Threatening ◽  
Hiv Negative

Purpose. With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients. This study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. Methods. We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. The diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis. Results. A total of 57 patients were included in this study. The PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. The T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4+ T lymphocyte count (OR, 0.981; 95% CI, 0.967–0.996; p=0.001). The cut-off value of 71 cells/μl for the CD4+ T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used. Conclusions. PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. The CD4+ T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes.

scholarly journals 402. Breakthrough Pneumocystis jirovecii Pneumonia Among Cancer Patients: Opportunity for Antimicrobial Stewardship?

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S154-S155
Author(s):  
Steven Roncaioli ◽  
Andrew Bryan ◽  
Erica Stohs ◽  
Catherine Liu ◽  
Ania Sweet ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Antimicrobial Stewardship ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia

scholarly journals Is It Possible to Differentiate Pneumocystis jirovecii Pneumonia and Colonization in the Immunocompromised Patients with Pneumonia?

2021 ◽  
Vol 7 (12) ◽  
pp. 1036
Author(s):  
Yudy A. Aguilar ◽  
Zulma Vanessa Rueda ◽  
María Angélica Maya ◽  
Cristian Vera ◽  
Jenniffer Rodiño ◽  
...  
Keyword(s):  
Qpcr Assay ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Rrna Gene ◽  
Immunocompromised Patients ◽  
Lung Cancer Patients ◽  
Molecular Tests ◽  
Cancer Group ◽  
Diagnostic Characteristics ◽  
Immunosuppressed Patients

Respiratory sample staining is a standard tool used to diagnose Pneumocystis jirovecii pneumonia (PjP). Although molecular tests are more sensitive, their interpretation can be difficult due to the potential of colonization. We aimed to validate a Pneumocystis jirovecii (Pj) real-time PCR (qPCR) assay in bronchoscopic bronchoalveolar lavage (BAL) and oropharyngeal washes (OW). We included 158 immunosuppressed patients with pneumonia, 35 lung cancer patients who underwent BAL, and 20 healthy individuals. We used a SYBR green qPCR assay to look for a 103 bp fragment of the Pj mtLSU rRNA gene in BAL and OW. We calculated the qPCR cut-off as well as the analytical and diagnostic characteristics. The qPCR was positive in 67.8% of BAL samples from the immunocompromised patients. The established cut-off for discriminating between disease and colonization was Ct 24.53 for BAL samples. In the immunosuppressed group, qPCR detected all 25 microscopy-positive PjP cases, plus three additional cases. Pj colonization in the immunocompromised group was 66.2%, while in the cancer group, colonization rates were 48%. qPCR was ineffective at diagnosing PjP in the OW samples. This new qPCR allowed for reliable diagnosis of PjP, and differentiation between PjP disease and colonization in BAL of immunocompromised patients with pneumonia.

Neuroleptic malignant syndrome in cancer treatment

2005 ◽  
Vol 3 (1) ◽  
pp. 51-53 ◽  
Author(s):  
CHIAKI KAWANISHI ◽  
HIDEKI ONISHI ◽  
DAIJI KATO ◽  
TOMOKI YAMADA ◽  
MASANARI ONOSE ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Neuroleptic Malignant Syndrome ◽  
Risk Group ◽  
High Risk Group ◽  
Careful Monitoring ◽  
Risk Of Death ◽  
Psychiatric Units ◽  
Life Threatening ◽  
Complicating Factors

Objective: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to neuroleptics. Several prospective studies have reported NMS occurrence rates ranging from 0.07% to 2.2% of patients receiving neuroleptics. However, few occurrences of NMS have been reported in cancer patients despite frequent complications of cancer and its treatment by mental disorders managed with neuroleptic drugs. Exhaustion, dehydration, and malnutrition are considered risk factors for NMS, and cancer patients represent a high risk group for NMS.Methods: We describe a patient with metastatic chondrosarcoma who had received frequent neuroleptic injections prior to brain surgery and developed NMS in the intensive care unit immediately after surgery. The patient showed delirium, hyperpyrexia, tachycardia, diaphoresis, and extrapyramidal symptoms. After a diagnosis of NMS was made, supportive care and careful monitoring were carried out, and the patient recovered over an interval of 11 days.Results and significance of the research: Clinical NMS studies have been conducted mainly in psychiatric units, but NMS can occur wherever psychotropic drugs are administered. NMS can be difficult to diagnose due to multiple complicating factors in cancer treatment, but the diagnosis is highly important given the risk of death. Recognition of prodromal NMS symptoms can facilitate actions to decrease morbidity and mortality. It is suggested that special attention to cancer patients undergoing psychopharmacologic treatment is required in clinical oncologic practice.

Dapsone for Pneumocystis jirovecii pneumonia prophylaxis – applying theory to clinical practice with a focus on drug interactions

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Carmela Emma Corallo ◽  
John Coutsouvelis ◽  
Susan Morgan ◽  
Orla Morrissey ◽  
Sharon Avery
Keyword(s):  
Organ Transplant ◽  
Cost Effective ◽  
Chemotherapeutic Agents ◽  
Pneumocystis Jirovecii ◽  
Haematopoietic Stem Cell ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Solid Organ ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
Substantial Risk

AbstractPneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised individuals. The incidence can be as high as 80% in some groups but can be reduced to less than 1% with appropriate prophylaxis. HIV-infected patients with a low CD4 count are at the highest risk of PJP. Others at substantial risk include haematopoietic stem cell and solid organ transplant recipients, those with cancer (particularly haematologic malignancies), and those receiving glucocorticoids, chemotherapeutic agents, and other immunosuppressive medications. Trimethoprim-sulfamethoxazole is an established first-line line agent for prevention and treatment of PJP. However, in some situations, this medication cannot be used and dapsone is considered a suitable cost-effective second line agent. However, information on potential interactions with drugs commonly used in immunosuppressed patients is lacking or contradictory. In this this article we review the metabolic pathway of dapsone with a focus on interactions and clinical significance particularly in patients with haematological malignancies. An understanding of this process should optimise the use of this agent.

scholarly journals Pneumocystis jirovecii pneumonia in AIDS and non-AIDS immunocompromised patients – an update

2018 ◽  
Vol 12 (10) ◽  
pp. 824-834 ◽  
Author(s):  
Yuan-Ti Lee ◽  
Ming-Lung Chuang
Keyword(s):  
Mortality Rate ◽  
Clinical Manifestations ◽  
Lactic Dehydrogenase ◽  
Diagnosis And Treatment ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Aids Patients ◽  
Chain Reactions ◽  
Increased Risk

Introduction: Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients. Methodology: We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017. Results: The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial. Conclusions: Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.

scholarly journals Development of a Droplet Digital Polymerase Chain Reaction for Sensitive Detection of Pneumocystis jirovecii in Respiratory Tract Specimens

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Yi ◽  
Nan Wang ◽  
Jie Wu ◽  
Yueming Tang ◽  
Jingjia Zhang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Digital Pcr ◽  
Absolute Quantification ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii ◽  
Immunocompromised Patients ◽  
Balf Sample ◽  
Bronchoalveolar Fluid ◽  
Life Threatening ◽  
Digital Polymerase Chain Reaction

Background:Pneumocystis jirovecii is a human-specific opportunistic fungus that causes Pneumocystis pneumonia (PCP), a life-threatening opportunistic lung infection that affects immunocompromised patients. P. jirovecii colonization may be linked to the transmission of the infection. The detection of P. jirovecii in immunocompromised patients is thus especially important. The low fungal load and the presence of PCR inhibitors limit the usefulness of quantitative PCR (qPCR) for accurate absolute quantification of P. jirovecii in specimens. Droplet digital PCR (ddPCR), however, presents a methodology that allows higher sensitivity and accuracy. Here, we developed a ddPCR method for detecting P. jirovecii DNA in respiratory specimens, and evaluated its sensitivity against qPCR.Materials and Methods: One bronchoalveolar fluid (BALF) sample each was collected from 82 patients with potential PCP to test the presence of P. jirovecii DNA using both ddPCR and qPCR, and samples with inconsistent results between the two methods were further tested by metagenomic next generation sequencing (mNGS). In addition, 37 sputum samples from 16 patients diagnosed with PCP, as well as continuous respiratory tract specimens from nine patients with PCP and treated with sulfonamides, were also collected for P. jirovecii DNA testing using both ddPCR and qPCR.Results: ddPCR and qPCR gave the same results for 95.12% (78/82) of the BALF samples. The remaining four specimens tested positive using ddPCR but negative using qPCR, and they were found to be positive by mNGS. Detection results of 78.37% (29/37) sputum samples were consistent between ddPCR and qPCR, while the other eight samples tested positive using ddPCR but negative using qPCR. The P. jirovecii load of patients with PCP decreased to undetectable levels after treatment according to qPCR, but P. jirovecii was still detectable using ddPCR.Conclusions: ddPCR was more sensitive than qPCR, especially at detecting low-pathogen-load P. jirovecii. Thus, ddPCR represents a useful, viable, and reliable alternative to qPCR in P. jirovecii testing in patients with immunodeficiency.

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