Pneumocystis carinii and Parasitic Infections in the Immunocompromised Host

Fishman, Jay A.

doi:10.1007/0-306-47527-8_8

Cited by 19 publications

(11 citation statements)

References 314 publications

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“…The incidence of PCP is highest in the first 12 months after transplantation, resulting in the use of trimethoprim-sulphamethoxazole (TMP-SMX) routinely during this period for primary prophylaxis [1]. As a result, the overall frequency of PCP has declined.…”

Section: Introductionmentioning

confidence: 99%

Late-onset and atypical presentation of Pneumocystis carinii pneumonia in a renal transplant recipient

Yong

Grove

et al. 2009

Clin Exp Nephrol

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Pneumocystis jivorecii (formerly known as carinii) pneumonia (PCP) is potentially a life-threatening opportunistic infection after organ transplantation, occurring most frequently in the first 12 months, where the incidence rate is several-fold higher than in later years. PCP typically presents with fever, cough, dyspnoea and hypoxia. In organ transplant recipients, the onset of symptoms is generally more fulminant compared to patients infected with the human immunodeficiency virus. We present a patient who developed PCP five years after a renal transplantation. His presentation was characterised by atypical symptoms and an indolent onset. Previous acute vascular rejection, ongoing maintenance prednisolone usage, cytomegalovirus seropositivity and past tuberculous infection may have predisposed this patient to PCP.

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Section: Introductionmentioning

confidence: 99%

Late-onset and atypical presentation of Pneumocystis carinii pneumonia in a renal transplant recipient

Yong

Grove

et al. 2009

Clin Exp Nephrol

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“…The prevalence of mycobacterial tuberculosis infection in renal transplant recipient varies from 3.5% to 13.3%. [12] In a study in posttransplant infections in South India, the prevalence was 10.6%. [3] Two out of 169 transplant recipients who were studied presented with atypical mycobacterial infection in this study.…”

Section: Discussionmentioning

confidence: 99%

Nontubercular mycobacterial infection in a renal allograft recipient

Anandh

Jayanna

2017

Indian J Nephrol

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A 71-year-old male, a renal allograft recipient, presented to us with a history of fever and right palm swelling. He had a history of fever 7 years back when he was treated with antitubercular treatment (ATT). Three years back, he was diagnosed to have gout and he was started on allopurinol. He developed severe bone marrow toxicity and allopurinol was changed to febuxostat. On admission, routine investigations did not reveal any focus of infection. The fluid aspirate from the palm revealed acid-fast bacilli (AFB). He was started on ATT; however, he did not show significant improvement. Two months later, he developed multiple subcutaneous lesions, and the pus again came positive for AFB. Due to lack of improvement, the aspirate was sent for molecular diagnostic identification. The mycobacteria was identified as Mycobacterium haemophilum. His treatment was changed to rifampicin, clarithromycin, and ciprofloxacin. As he showed slow improvement, his immunosuppression was tapered slowly. At 7 months of therapy, he is clinically better and his lesions are healing. His renal functions stayed stable despite tapering of cyclosporine in a patient who is on rifampicin. This case, the first report of M. haemophilum infection in a kidney transplant recipient in India, illustrates the difficulty in diagnosing nontubercular mycobacterial infection in transplant recipients. It also emphasizes the dilemma in tapering immunosuppressive drugs in disseminated nontubercular mycobacterial infections where there are considerable interactions between ATT and immunosuppressives.

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“…All compromised hosts are not the same in terms of their immune defect or opportunistic infections. 4,6,7 This patient was initially treated for bacterial CAP with cefepime. Subsequently, he was given gatifloxacin for atypical CAP coverage, itraconazole for fungal coverage, and trimethoprim-sulfamethoxazole for possible PCP.…”

Section: Ly Thermidor and Cunhamentioning

confidence: 99%