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

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.

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with <b><i>Pneumocystis jirovecii</i></b> Pneumonia

“…Furthermore, it remains unclear whether adjunctive therapy with glucocorticosteroids in non-HIV-infected patients (e.g., in the intensive care unit setting) leads to any benefit for this subgroup [20, 56, 57]. If patients are already treated with glucocorticosteroids for another reason, there should not be an abrupt discontinuation, though an individual adjustment seems mandatory.…”

Gender-Specific Aspects in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation: A Single-Center Experience

“…These products were irradiated with 30 Gy. Furthermore, patients received antibiotic prophylaxis with nonabsorbable antibiotics, Pneumocystis carinii prophylaxis with co-trimoxazole, and Herpes simplex virus prophylaxis with intravenous acyclovir [17,18] . Recombinant human (rh) G-CSF at a dose of 5 μg/kg/day was administered from day 7 after autologous ASCT until a rise in absolute neutrophil count >0.5 × 10 9 /L for 3 consecutive days.…”

Molecular Demonstration of a Pneumocystis Outbreak in Stem Cell Transplant Patients: Evidence for Transmission in the Daycare Center

“…Person-to-person transmission has been documented during outbreaks, especially in solid organ transplant wards (Yiannakis and Boswell, 2016). To avoid such transmission, recent guidelines for managing PCP in hematology patients published by the European Conference on Infections in Leukemia group (Alanio et al, 2016c; Maertens et al, 2016; Maschmeyer et al, 2016) state that “it seems reasonable that severely immunocompromised patients should avoid contact with patients with documented PCP.” However, because data is lacking in this population, this is a C-III recommendation (e.g., there is poor evidence to support it). Similarly, the 2007 guidelines for isolation precautions from the US Centers for Disease Control and Prevention advises that PCP-infected patients should not be placed in the same room as immunocompromised patients, and other standard precautions should be taken (Siegel et al, 2007).…”