Clinical and Radiological Features of Pneumocystis Pneumonia in Patients with Rheumatoid Arthritis, in comparison with Methotrexate Pneumonitis and Pneumocystis Pneumonia in Acquired Immunodeficiency Syndrome: A Multicenter Study

Tokuda, Hitoshi; Sakai, Fumikazu; Yamada, Hisakata; Johkoh, Takeshi; Imamura, Akifumi; Dohi, Makoto; Hirakata, Michito; Yamada, Takashi; Kamatani, Naoyuki; Kikuchi, Yoshimi; Suzuki, Shoji; Takeuchi, Tsutomu; Tateda, Kazuhiro; Goto, Hajime

doi:10.2169/internalmedicine.47.0702

Cited by 82 publications

(67 citation statements)

References 25 publications

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“…Yapılan çalışmalarda özellikle düşük doz metotreksat kullanımının PCP gelişimi açısından risk oluşturduğu bildirilmektedir [23][24][25] . Çalışma-mızda dönem dönem metotreksat aldıkları gözlenen RA'li üç hastanın ikisi "olası PCP" olgusu olarak değerlendirilmiştir.…”

Section: Discussionunclassified

Investigation of Pneumocystis jirovecii Pneumonia and Colonization in Iatrogenically Immunosuppressed and Immunocompetent Patients

Özkoç

Delıbaş²

2015

Mikrobiyol Bul

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ÖZPneumocystis pnömonisi (PCP), immün sistem bozukluğu olan hastalarda ölümcül seyredebilen bir akciğer enfeksiyonudur. Bununla birlikte Pneumocystis jirovecii'nin sağlıklı kişilerde ve diğer kronik akciğer hastalarında kolonize olabildiği bilinmektedir. Bu çalışmada, immün sistemi normal ve iyatrojenik olarak baskılanmış hastaların, PCP ve P.jirovecii kolonizasyonu yönünden değerlendirilmesi amaçlanmıştır. Çalışmaya, Ocak 2011-Nisan 2014 tarihleri arasında farklı pulmoner semptomları nedeniyle bronkoskopi yapılan toplam 92 hasta (66 erkek, 26 kadın; yaş aralığı: 18-93 yıl, ortanca: 58.5) dahil edilmiştir. Hastaların 65'i immünosüpresif ilaç (38'i anti-kanser, 15'i anti-rejeksiyon/immünomodülatör ve 12'si kortikosteroid) tedavisi alan, 27'si ise almayan olgulardır. Hastalara ait bronkoalveolar lavaj (BAL) sıvısı örnekleri P.jirovecii ribozomal RNA büyük alt ünitesini kodlayan mitokondriyal geni (mtLSUrRNA) çoğal-tan iki turlu (nested) PCR (nPCR) yöntemi ile değerlendirilmiş; ayrıca tüm örnekler Giemsa ve Gomori'nin metenamin gümüş (GMG) boyama yöntemiyle boyanarak incelenmiştir. Çalışmada, nPCR ile 92 BAL örneğinin 31 (%33.7)'inde P.jirovecii DNA'sı saptanmıştır. Birinci PCR aşamasında, immünosüpresif altı (%6.4) hasta pozitif iken, nPCR ile immünosüpresif 65 hastanın 26 (%40)'sı ve immünokompetan 27 hastanın beşi (%18.5) pozitif bulunmuştur. nPCR ile pozitif saptanan 31 örneğin sadece beşinde (%16.1) Giemsa ve GMG boyaları ile P.jirovecii kist ve trofozoitleri gözlenmiştir. nPCR pozitif olguların immüno-süpresif olma olasılığı, nPCR negatif hastalara göre istatistiksel olarak anlamlı düzeyde yüksek bulunmuş (χ²= 3.940; p= 0.047); bu farkın organ transplant alıcıları ve anti-rejeksiyon/immünomodülatör ilaç tedavisi alan hastalarda daha belirgin olduğu (sırasıyla, χ²= 6.715, p= 0.01; χ²= 5.550, p= 0.018) izlenmiştir. nPCR pozitif saptanan hastalar klinik, laboratuvar ve radyolojik olarak incelendiğinde; immünosüpresif grupta yer alan beş (2 böbrek transplantı, 1 kemik iliği transplantı, 1 akciğer kanseri ve 1 interstisyel Geliş Tarihi

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Section: Discussionunclassified

Investigation of Pneumocystis jirovecii Pneumonia and Colonization in Iatrogenically Immunosuppressed and Immunocompetent Patients

Özkoç

Delıbaş²

2015

Mikrobiyol Bul

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“…The typical clinical features of methotrexate pneumonitis include progressive dyspnea and cough that are often associated with fever [7]. Hypoxemia is always present [7], and chest CT findings frequently show bilateral ground‐glass opacities and consolidations [8]. Our patient had no respiratory symptoms, and her chest X‐ray findings of tiny consolidations in the right lower lobe progressed gradually and had been detected before methotrexate treatment.…”

Section: Discussionmentioning

confidence: 62%

Organizing pneumonia associated with multicentric reticulohistiocytosis

Yoshimura

Sato

Imokawa

et al. 2015

Respirology Case Reports

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Organizing pneumonia (OP) is a clinicopathological entity that occurs idiopathically or in association with several conditions such as connective tissue diseases. Multicentric reticulohistiocytosis (MRH) is a systemic disease characterized by polyarthritis and mucocutaneous lesions, but lung involvement is uncommon. We report a patient with MRH associated with OP. This case may be of interest when considering the pathophysiological mechanisms of both diseases.

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“…It is interesting to note that the clinical features and radiographic patterns for PJP in RA patients receiving infliximab appear to differ from those of patients with human immunodeficiency virus infections. 23 During PMS for etanercept, PJP developed in 0.2% of the patients, and 6 of these 25 patients died, raising concern for PJP in TNF blockade and highlighting the need for prophylaxis against patients at risk with sulphamethoxazole-trimetoprine Q13 (ST) compounds. In this regard, serum beta-d glucan was anticipated to be useful for the diagnosis and monitoring of PJP development, 24 and this was confirmed in RA patients.…”

Section: Safety Of Biological Agents In Japanese Patientsmentioning

confidence: 99%

Revolutionary Change in Rheumatoid Arthritis Managementwith Biological Therapy

Takeuchi

2011

Keio J. Med.

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Biological agents targeting a specific molecule have extraordinarily fine specificity and powerful functional capabilities. By the introduction of biological therapy, management of rheumatoid arthritis has undergone a revolution and a paradigm shift. In this review, I will summarize the role in the pathogenesis of rheumatoid arthritis of the molecules targeted by biological agents. Providing evidence obtained in clinical trials and investigator-initiated clinical studies in Japan, the effectiveness and safety of biological therapy in rheumatoid arthritis are discussed. Finally, studies aiming at a personalized strategy with biological agents are listed and the future perspectives toward tailor-made medicine in the field of rheumatology are discussed.

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Clinical and Radiological Features of Pneumocystis Pneumonia in Patients with Rheumatoid Arthritis, in comparison with Methotrexate Pneumonitis and Pneumocystis Pneumonia in Acquired Immunodeficiency Syndrome: A Multicenter Study

Cited by 82 publications

References 25 publications

Investigation of Pneumocystis jirovecii Pneumonia and Colonization in Iatrogenically Immunosuppressed and Immunocompetent Patients

Investigation of Pneumocystis jirovecii Pneumonia and Colonization in Iatrogenically Immunosuppressed and Immunocompetent Patients

Organizing pneumonia associated with multicentric reticulohistiocytosis

Revolutionary Change in Rheumatoid Arthritis Managementwith Biological Therapy

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