Comparison of Biopsy-Proven Pneumocystis carinii Pneumonia in Acquired Immune Deficiency Syndrome Patients and Renal Allograft Recipients

Sterling, Rosalyn P.; Bradley, Brian B.; Khalil, Kamal; Kerman, Ronald H.; Conklin, Richard H.

doi:10.1016/s0003-4975(10)64191-4

Cited by 20 publications

(5 citation statements)

References 17 publications

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“…Previous studies were smaller [13][14][15][16] and were performed in the era before the availability of antiretroviral therapy and the introduction of primary PCP prophylaxis for HIVinfected patients [14][15][16]. In our study, the main differences in the presentation of PCP between HIV-positive and HIV-negative patients were as follows: HIV-positive patients were (1) younger than HIV-negative patients, (2) had a longer duration of symptoms, (3) a higher frequency of general symptoms (sweating, weight loss, cachexia), and (4) a higher frequency of thoracic pain.…”

Section: Discussionmentioning

confidence: 99%

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Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus (HIV)—Positive and HIV-Negative Immunocompromised Patients

Nüesch¹,

Bellini²,

Zimmerli³

1999

Clinical Infectious Diseases

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For 89 human immunodeficiency virus (HIV)-positive and 32 HIV-negative immunocompromised patients who had 121 episodes of Pneumocystis carinii pneumonia (PCP), clinical features and changes over time were compared. HIV-infected patients characteristically had a longer duration of symptoms (23 vs. 13 days; P<.005); were younger (39 vs. 48 years; P<.001); had a higher frequency of sweating, weight loss, and thoracic pain; and had fewer admissions to the intensive care unit (16% vs. 31%; P<.05). In addition, they had significantly higher hemoglobin levels, lower thrombocyte counts, lower C-reactive protein values, and a higher proportion of eosinophils and lymphocytes in bronchoalveolar lavage fluid. After 1995, HIV-negative patients' mean length of stay dropped from 34 days to 16 days (P<.005), and their hospital mortality rate dropped from 29% to 7% (P<.001). HIV-positive patients with PCP differed in several aspects from those without HIV infection. Knowledge gained from experience with treatment of opportunistic infections in patients with AIDS has improved the management of PCP in patients with other immunodeficiencies.

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Section: Discussionmentioning

confidence: 99%

“…In 3 published studies, the duration of symptoms in HIVinfected patients was consistently longer than for HIV-negative patients [13][14][15]. Mortality, however, was higher [15], lower [13], or equal at a high level [14].…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus (HIV)—Positive and HIV-Negative Immunocompromised Patients

Nüesch¹,

Bellini²,

Zimmerli³

1999

Clinical Infectious Diseases

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“…Prior to the use of trimethoprim–sulfamethoxazole, mortality from PCP in KTRs was very high (409,410). The treatment of PCP includes both the use of intravenous trimethoprim–sulfamethoxazole as well as corticosteroids for KTRs with significant hypoxemia (406).…”

Section: Rationalementioning

confidence: 99%

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,172

294

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Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2009.02834.x S2 American Journal of Transplantation 2009; 9 (Suppl 3): S2-S2Since the first successful kidney transplantation in 1954 It is our hope that this document will serve several useful purposes. Our primary goal is to improve patient care. We hope to accomplish this in the short term by helping clinicians know and better understand the evidence (or lack of evidence) that determines current practice. By making this guideline broadly applicable, our purpose is to also encourage and enable the establishment and development of transplant programs worldwide. Finally, by providing comprehensive evidence-based recommendations, this guideline will also help define areas where evidence is lacking and research is needed. Helping to define a research agenda is an often neglected, but very important function of clinical practice guideline development.We used the GRADE system to rate the strength of evidence and the strength of recommendations. In all, there were only 4 (2%) recommendations in this guideline for which the overall quality of evidence was graded 'A,' whereas 27 (13.6%) were graded 'B,' 77 (38.9%) were graded 'C,' and 90 (45.5%) ' and 148 (74.7%) graded '2.' There were 3 (1.5%) recommendations graded '1A,' 16 (8.1%) were '1B,' 18 (9.1%) were '1C, ' and 13 (6.6%) were '1D.' There was 1 (0.5%) graded '2A,' 11 (5.6%) were '2B,' 59 (29.8%) were '2C, ' and 77 (38.9%) BackgroundExcept perhaps for transplantation between identical twins, all kidney transplant recipients (KTRs) need immunosuppressive medications to prevent rejection. Induction therapy is treatment with a biologic agent, either a lymphocyte-depleting agent or an interleukin 2 receptor antagonist (IL2-RA), begun before, at the time of, or immediately after transplantation. The purpose of induction therapy is to deplete or modulate T-cell responses at the time of antigen presentation. Induction therapy is intended to improve the efficacy of immunosuppression by reducing acute rejection, or by allowing a reduction of other components of the regimen, such as calcineurin inhibitors (CNIs) or corticosteroids. Available lymphocytedepleting agents include antithymocyte globulin (ATG), antilymphocyte globulin (ALG) and monomurab-CD3. Basiliximab and daclizumab, the two IL2-RAs that are currently available in many parts of the world, bind the CD25 antigen (interleukin-2 [IL2] receptor a-chain) at the surface of activated T-lymphocytes and thereby competitively inhibit IL2-mediated lymphocyte activation, a crucial phase in cellular immune response of allograft rejection. Rationale• There is high-quality evidence that the benefits of IL2-RA vs. no IL2-RA (or placebo) outweigh harm in a broad range of KTRs with variable immunological risk and concomitant immunosuppressive medication regimens.• There is moderate-quality evidence that a lymphocytedepleting agent vs. no lymphocyte-depleting a...

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“…Prior to the use of TMP-SMX, mortality from PCP in kidney transplant recipients was very high (Hennequin et al, 1995;Sterling et al, 1984). The treatment of PCP includes both the use of intravenous TMP-SMX as well as corticosteroids for kidney transplant recipients with significant hypoxemia and reduction of immunosuppressive medications (5).…”

Section: Treatmentmentioning

confidence: 99%

Infectious Complications in Kidney Transplantation

El‐Husseini¹,

Hassan²

2011

After the Kidney Transplant - The Patients and Their Allograft

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Comparison of Biopsy-Proven Pneumocystis carinii Pneumonia in Acquired Immune Deficiency Syndrome Patients and Renal Allograft Recipients

Cited by 20 publications

References 17 publications

Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus (HIV)—Positive and HIV-Negative Immunocompromised Patients

Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus (HIV)—Positive and HIV-Negative Immunocompromised Patients

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Infectious Complications in Kidney Transplantation

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