“…Furthermore, early evaluation did not encompass emerging subgroups of patients with haematological malignancy. The estimated risk of PJP in these groups, such as acute myeloid leukaemia, myelodysplasia, myeloma and lymphoma, are based on case reports and are incompletely defined.…”
Section: Determining Patient Risk and The Need For Pjp Prophylaxismentioning
Pneumocystis jirovecii infection (PJP) is a common cause of pneumonia in patients with cancer-related immunosuppression. There are well-defined patients who are at risk of PJP due to the status of their underlying malignancy, treatment-related immunosuppression and/or concomitant use of corticosteroids. Prophylaxis is highly effective and should be given to all patients at moderate to high risk of PJP. Trimethoprimsulfamethoxazole is the drug of choice for prophylaxis and treatment, although several alternative agents are available.
“…Furthermore, early evaluation did not encompass emerging subgroups of patients with haematological malignancy. The estimated risk of PJP in these groups, such as acute myeloid leukaemia, myelodysplasia, myeloma and lymphoma, are based on case reports and are incompletely defined.…”
Section: Determining Patient Risk and The Need For Pjp Prophylaxismentioning
Pneumocystis jirovecii infection (PJP) is a common cause of pneumonia in patients with cancer-related immunosuppression. There are well-defined patients who are at risk of PJP due to the status of their underlying malignancy, treatment-related immunosuppression and/or concomitant use of corticosteroids. Prophylaxis is highly effective and should be given to all patients at moderate to high risk of PJP. Trimethoprimsulfamethoxazole is the drug of choice for prophylaxis and treatment, although several alternative agents are available.
“…Due to the depletion of T-cells and the subsequent impairment in viral antigen presentation, the use of PIs is associated with a higher risk for reactivation of viral infections, particularly VZV. PIs also impact on the net state of immunosuppression and, therefore, may increase the risk for opportunistic infections when used in combination with other immunosuppressive regimens [118].…”
Section: Proteasome Inhibitors: Bortezomib Carfilzomib and Ixazomibmentioning
Clinicians should be aware of the risk of immune-related adverse effects and PML in patients receiving immune checkpoint and cell adhesion inhibitors respectively.
“…Bortezomib is a reversible inhibitor of the 26S proteasome used for treatment of multiple myeloma, and extrapulmonary (intestinal) pneumocystosis has been associated with its use [48]. The basis for increased infection risk is also not clear.…”
HIV-negative populations at risk for PJP can be identified. Conventional PCR increases diagnostic sensitivity but may detect asymptomatic colonization. Quantitative PCR demonstrates potential for distinguishing colonization from infection, but clinical validation is required. Serum (1→3)-β-D-glucan may be elevated in PJP, although standardized cut-off values for clinical infection have not been determined. Further validation of serum markers and molecular diagnostic methods is necessary for early and accurate diagnosis in non-HIV populations.
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